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Table 1 Summary of the Eligible Studies

From: A systematic literature review of spinal brace/orthosis treatment for adults with scoliosis between 1967 and 2018: clinical outcomes and harms data

Author (Year)MethodsParticipantsMeasurementFindings
Weiss et al (2006) [6]Design: Case report
Brace Type: Lordosing spinal orthosis
Trade name: Physiologic
Material: Polyethylene
Proposed MOA: Sagittal re-alignment brace that has a lordosing action in the lumbar spine
Additional treatment: NA
Region: Germany
Sample size: 1
Age: 47
Sex: 1 Female
Diagnosis: Degenerative
Scoliosis Parameters: 55° Lumbar scoliosis
Co-morbid Illness: Grade II spinal claudication
Prescribed Brace Wear: NA
Primary outcome: VPRS
Secondary outcome: Walking distance
Number of F/U points: 3
Length of F/U:
T1 = 2 days
T2 = 10 days
T3 = 8 weeks
Main finding: Reduction of 1 point on the VPRS after 10 days that remained stable at 8 weeks
Additional findings: Increase in walking distance from 800 to 8000 at T1, then 8000 to 12,000 at T2. Improvements maintained at T3.
Statistical significance: NA
Brace compliance: NA
Harms associated with bracing: NA
Weiss et al (2006) [29]Design: Prospective cohort study
Brace type: Lordosing spinal orthosis
Trade name: Physiologic
Material: Polyethylene
Proposed MOA: Sagittal re-alignment brace that has a lordosing action in the lumbar spine
Additional treatment: NA
Region: Germany
Sample size: 29
Age: 41 years (SD = 21)
Sex: 29 Females
Diagnosis: Scoliosis
Scoliosis Parameters: 37° (SD = 22)
Co-morbid Illness: NA
Prescribed Brace Wear: Minimum prescription of 8 h per day for 7.5 months (SD = 5.6)
Primary outcome: Roland Morris verbal rating scale (0–5 point scale)
Secondary outcome: NA
Number of F/U: 2
Length of F/U:
T1 = ≤1 week
T2 = > 6 months (Avg = 7.5 months)
Main finding: A significant reduction in Roland Morris VRS between T0 and T1. Smaller but non-significant reduction in scores between T0 and T2
Additional findings: NA
Statistical significance: Wilcoxon Test (p < 0.001)
Brace compliance: Poor. Compliance lost in the majority of patients at the time of the follow-up period. Only 7 patients reported wearing the brace for > 4 h at the T2
Harms associated with bracing: NA
Weiss et al (2009) [30]Design: Prospective cohort study
Brace type: Lordosing spinal orthosis
Trade name: Physiologic
Material: Polyethylene
Proposed MOA: Sagittal re-alignment brace that has a lordosing action in the lumbar spine
Additional treatment: NA
Region: Germany
Sample size: 56
Age: NA
Sex: Males and females
Diagnosis: Idiopathic = 48, congenital = 2, de novo degenerative = 3, other = 3 with chronic lower back pain
Scoliosis Parameters: 41° (Range = 10–91)
Co-morbid Illness: NA
Prescribed Brace Wear: 20 h per day for 6 months then on a case-by-case basis after that point
Primary outcome: Roland Morris verbal rating scale (0–5 point scale)
Secondary outcome: progression to surgery for chronic lower back pain
Number of F/U: 2
Length of F/U:
T1 = ≤1 week
T2 = average of 18 months
Main finding: Reduction of Roland Morris scores of 3.3 to 2.7 at T1, then 2.7 to 2.0 at T2
Additional findings: 21 patients were able to completely remove the brace after 6 months due to the alleviation of pain
Statistical significance: Wilcoxon Test (p < 0.05)
Brace compliance: NA
Harms associated with bracing: NA
De Mauroy et al (2011) [19]Design: Retrospective cohort study
Brace type: Rigid polyethylene bi-valve overlapped lumbar brace
Trade name: Lyon brace
Material: High density polyethylene
Proposed MOA: Rebalancing of the spine in the frontal and sagittal plane
Additional treatment: plaster cast (3 weeks), physiotherapy (3 weeks)
Region: France
Sample size: 33
Age: 59.9 (SD = 10.8) [Range 33–77]
Sex: 30 females, 3 males
Diagnosis: Adult scoliosis (lumbar or thoracolumbar)
Scoliosis Parameters: 37° SD = 18 (Range 10–75)
Co-morbid Illness: NA
Prescribed Brace Wear: Recommended > 4 h per day
Primary outcome: Coronal Cobb angle
Secondary outcome: coronal and sagittal balance, rib hump (millimetres)
Number of F/U: 3
Length of F/U:
T1 = 6 months
T2 = 2 years
T3 = ≥5 years
Main finding: Cobb angle increased by > 5° in 5 patients, remained stable in 15 patients and decreased in 12 patients
Additional findings: Secondary outcomes remained stable in 17 patients, improved in 12 patients and worsened in 2 patients
Some patients were able to cease wearing the brace due to a complete abolishment of their symptoms.
Statistical significance: Summary statistics only
Brace compliance: 60% of patients were still wearing the brace for an average of 5 h per day at T3. Brace wear ranged from 2 to 23 h per day.
Harms associated with bracing: NA
Gallo (2014) [27]Design: Case reports
Brace type: Rigid TLSO
Trade name: SBrace L
Material: NA
Proposed MOA: Restoring coronal or sagittal alignment according to the presenting features, tailored brace
Additional treatment: Physiotherapy
Region: NA
Sample size: 2
Age: Case 1 = 65, Case 2 = NA
Sex: 2 Females
Diagnosis: Degenerative scoliosis
Scoliosis Parameters: NA
Co-morbid Illness: NA
Prescribed Brace Wear: Determined by the patient
Primary outcome: VAS and NPRS
Secondary outcome: QOL and activity restriction
Number of F/U: NA
Length of F/U: NA
Main finding:
Case 1: Reduction of 8/10 to 3/10 pain, 3/10 function up to 8/10 function
Case 2: Reduction of 6 points in the VAS scale
Additional findings:
Case 2: Increased mobility noted
Statistical significance: NA
Brace compliance: NA
Harms associated with bracing: NA
Weiss et al (2016) [26]Design: Case report
Brace type: Rigid TLSO
Trade Name: Gensingen
Material: NA
Proposed MOA: Restoring coronal or sagittal alignment according to the presenting features, tailored brace
Additional treatment: Scoliosis specific exercise (Schroth 20–60 min per day) [Tailored], off the shelf TLSO on occasion
Region: Germany
Sample size: 1
Age: 37
Sex: Female
Diagnosis: Late Onset idiopathic scoliosis
Scoliosis Parameters: 56° thoracic curve and a 50° lumbar curve
Co-morbid Illness: NA
Prescribed Brace Wear: 3–4 h per day for three days per week
Primary outcome: VAS
Secondary outcome: Self-perceived QOL and Cobb angle
Number of F/U: 2
Length of F/U:
T1 = 12 months
T2 = 16 months
Main finding: Lower back pain relieved. Only felt during heavy lifting
Additional findings: Lumbar Cobb angle reduced from 50° to 32°
Statistical significance: NA
Brace compliance: NA
Harms associated with bracing: NA
De Mauroy et al (2016) [20]Design: Prospective cohort study
Brace type: Rigid TLSO (rigid lordosing bivalve polyethylene overlapping brace
Trade name: Lyon Brace
Material: Polyethylene
Proposed MOA: Disk protection and a three-dimensional re-equilibration of the spine
Additional treatment: Specific physiotherapy
Region: France
Sample size: 158
Age: 56.08 (SD = 17.35)
Sex: 144 females, 14 males
Diagnosis: Adult scoliosis (lumbar or thoracolumbar)
Scoliosis Parameters: 39.6 (SD = 16.76)
Co-morbid Illness: NA
Prescribed Brace Wear: 3 weeks of plaster cast, followed by 4 h of bracing each day for 6 months
Primary outcome: Coronal Cobb angle, coronal and sagittal balance, rib hump (millimetres)
Secondary outcome: NA
Number of F/U: 1
Length of F/U:
T1 = 8.41 years (SD = 3.26) [Range 5–17 years]
Main finding: No significant change to coronal Cobb angle. 56% remained stable, 24% improved by > 5°, 20% worsened by > 5°
Additional findings: No significant change to rib hump. Sagittal balance worsened on average
Statistical significance: T-test (p = 0.008)
Brace compliance: 23% were non-compliant with the prescribed brace wear hours
Harms associated with bracing: No adverse events associated with bracing.
Polastri et al (2017) [27]Design: Case report
Brace Type: Modified off the shelf brace
Trade Name: NA
Material: Elastic
Proposed MOA: Create coronal shifting force towards concavity of the curve
Additional Treatment: NA
Region: Italy
Sample size: 1
Age: 40
Sex: Female
Diagnosis: Progressive AIS in an adult
Scoliosis Parameters: 22° lumbar curve
Co-morbid Illness: NA
Prescribed Brace Wear: NA
Primary outcome: NPRS and QPDS
Secondary outcome: NA
Number of F/U: 6
Length of F/U:
T1 = 1 month
T2 = 5 months
T3 = 7 months
T4 = 9 months
T5 = 12 months
T6 = 24 months
Main finding: The NPRS reduced from 8.5 at T0 to 2.0 at T6. The QPDS reduced from 43 at T0 down to 15 at T6.
Additional findings: NA
Statistical significance: NA
Brace compliance: Patient adhered to the prescribed treatment and it was well tolerated, and the patient was comfortable with the use of the orthosis.
Harms associated with bracing: No adverse events reported.
Palazzo et al (2017) [28]Design: Retrospective cohort study
Brace Type: Rigid TLSO
Trade Name: Vesinet
Material: Plastic
Proposed MOA: NA
Additional Treatment: NA
Region: France
Sample size: 38
Age: 61.3 (SD = 8.2)
Sex: Female
Diagnosis: 9 progressive idiopathic scoliosis, 29 degenerative scoliosis
Scoliosis Parameters: 49.6° (SD = 17.7)
Co-morbid Illness: NA
Prescribed Brace Wear: Recommended > 6 h per day
Primary outcome: Coronal Cobb angle
Secondary outcome: NA
Number of F/U: 1
Length of F/U:
T1 = ≥5 years
Main finding: The rate of curve progression reduced from 1.28° (SD = 0.79) at T0 to 0.21° (SD = 0.43) at T1
Additional findings: NA
Statistical significance: Linear mixed-effects regression (p < 0.001)
Brace compliance: 4/38 patients did not wear the brace for the prescribed hours each day
Harms associated with bracing: NA
Zaina et al (2018) [21]Design: Pilot Prospective Cohort Study
Brace Type: Soft TLSO
Trade Name: Peak Scoliosis Brace
Material: Fabric, elastic, plastic
Proposed MOA: designed to alleviate chronic pain secondary to scoliosis in adults
Additional Treatment: NA
Region: Italy
Sample size: 20
Age: 67.8 (SD = 10.5)
Sex: Female
Diagnosis: Idiopathic or degenerative scoliosis < 30°
Scoliosis Parameters: 61.9° (SD = 12.6)
Co-morbid Illness: 3 patients had osteoporosis
Prescribed Brace Wear: 2–4 h per day
Primary outcome: Graphical rating scale
Secondary outcome: Roland Morris questionnaire, Core outcome measurement index, Oswestry disability index.
Number of F/U: 1
Length of F/U:
T1 = 4 weeks
Main finding: Worst pain, back pain, and leg pain significantly improved from 7.15 to 5.85, from 6.55 to 5.25, and from 5.65 to 3.55, respectively at T1
Additional findings: All other measures showed statistically significant improvement at T1 except the Oswestry disability index scores which remained stable at T1
Statistical significance: Paired t-test (p < 0.05) for the primary outcome
Brace compliance: All patients were compliant with the prescribed hours of brace wear
Harms associated with bracing: All but one patient reported satisfaction with the brace saying they felt more supported
  1. Avg Average, F/U Follow-up, MOA Mechanism of Action, NPRS Numerical pain rating scale, QOL Quality of life, Quebec Pain and Disability Scale, SD Standard Deviation, T0 Baseline, T[X] = Follow-up point [X] e.g. T3 Follow-up point 3, TLSO Thoracolumbosacral orthosis, VAS Visual analogue scale, VPRS Verbal pain rating scale, ° = Degrees (Cobb angle)