Orthotic treatment in patients with adult onset spinal deformity (AS): a systematic review

Introduction: Studies from the USA have estimated the incidence of spinal deformityin the adult population (mean age 70.5 years) at up to 68% (Schwabet al., 2005). Patients with AS are increasing being referred to orthotistsand other medical and allied health professionals for problems relatingto increasing spinal deformity. Patients generally present with spinalpain, reduced mobility, decreased function and low self-esteem. Given the non-invasive nature and relatively low cost of orthotic treatmenttogether with the increasing demographic of older people in the UK aswell as worldwide, it is highly likely that orthotic referrals will increasesignificantly in the near future.

Objectives: To evaluate the efficacy of orthotic treatment in patients with adultonset spinal deformity (scoliosis or kyphosis).MethodsSearch Strategy: The following databases were searched with EnglishLanguage limitations: NTIS, OpenGrey.org On-going research via onlineprofessional forums and other expert opinion, BAPO, ISPO AAOP - JPOAAOP CPO, CAPO, CENTRAL - Cochrane Library, EBSCO including, Cinahl-full text, MEDLINE AMED. Limiters to "all adult". English language only.Selection criteria: Randomised controlled trials, prospective cohort studies,quasi experimental designs, comparing orthotic treatments with notreatment, and other non-surgical interventions and co- interventions.

Results and discussion: Only four studies that matched the inclusion criteria were found. These included a randomised cross-over trial (Pfeifer, Begerow and Minne,2004), a single blinded trial (Azadinia et al., 2013), Sinaki et al's study(2005) which had a quasi-experimental design and the final studywhich was a randomised, placebo control trial (Vogt et al., 2008). Thissystematic review looked for high quality evidence regarding the orthotictreatment of adult onset spinal deformities. The four papers thatwere found and reviewed, related to orthotic treatment of kyphosis insubjects of over 60 years of age all of which reported improved balancescores, reduction of deformity, muscle strength and pain after orthotictreatment. All four studies had a number of inherent weaknesses instudy design, and to various extents internal and external validity. Given this and the small number of reports discovered the resultsshould be viewed with caution.

Conclusion and significance: Given the predicted change in the age demographic worldwide, to amore elderly population, the authors recommend further researchinto the orthotic treatment of AS with particular emphasis placed onthe full reporting (ie: comprehensive description of the orthoticdesign, material/construction) of the orthoses used, using valid andappropriate patient-oriented outcome measures. Finally, research isneeded to establish the specific elements of orthotic design/materials that are important in producing positive outcomes. Establishing the precise relationship spinal orthosis design and construction and positiveoutcomes could lead to lighter and more effective devices with increasedpatient compliance in patients with AS.