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Trial record 14 of 1047 for:    Recruiting, Not yet recruiting, Available Studies | "Adolescent"

Efficacy of Scoliosis Specific Exercise in Patients With Adolescent Idiopathic Scoliosis During Bracing

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ClinicalTrials.gov Identifier: NCT03305185
Recruitment Status : Recruiting
First Posted : October 9, 2017
Last Update Posted : November 6, 2017
Sponsor:
Collaborator:
The Hong Kong Polytechnic University
Information provided by (Responsible Party):
Dr. Kenny Kwan, The University of Hong Kong

Brief Summary:
The purpose of this study is to examine the effectiveness of Schroth scoliosis-specific exercises (SSE) on patients with adolescent idiopathic scoliosis (AIS) during bracing. The goal is to determine if Schroth SSE combined with bracing can is superior in controlling curve progression when compared with bracing alone. Curve progression is defined as worsening of coronal Cobb angle of 6 degrees or more.

Condition or disease Intervention/treatment Phase
Adolescent Idiopathic Scoliosis Combination Product: Schroth SSE with Bracing Device: Bracing alone Not Applicable

Detailed Description:

Adolescent Idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine, characterised by a lateral curvature and vertebral rotation. Its prevalence is estimated to be 2.5% in children between aged 10 and 16 in Hong Kong. Curve progression occurs during pubertal growth spurt. If the primary curve does not exceed 40o at skeletal maturity, it is unlikely to continue to progress, and there are little or no long-term clinical consequences. However, if the curve progresses beyond 50o during adolescence, it may cause functional limitation, accelerated disc degeneration with potential neurologic deficit, cosmetic concerns, decreased quality of life, and possible progression in adulthood. Thus, surgical correction of the deformity with instrumented spinal fusion is usually recommended if the curve reaches 50o during adolescence.

Currently, spinal bracing is the only the only non-operative treatment supported with high-quality evidence that can prevent curve progression. In a randomised controlled trial, Weinstein et al. recently reported in the New England Journal of Medicine that bracing was effective in preventing curve progression to threshold for surgery in 72% of cases. The trial was terminated early due to the treatment benefit in favour of bracing. Nonetheless, the authors reported a treatment failure rate of 25% in the randomised cohort, which was similar to previous published studies. Hence, despite the best available non-operative treatment, the number of adolescents ultimately requiring surgery remains substantial. Surgery is associated with medical morbidities, can cause psychosocial stress to the children and their families, and has significant financial impact on healthcare, with the total costs of spinal surgery to correct AIS ranked second only to appendicitis among children 10 to 17 years of age. Consequently, further effective strategies to prevent scoliosis progression in children are needed.

Scoliosis-specific exercise (SSE) has been proposed as an additional non-operative intervention that may reduce curve progression during the adolescent growth spurt. However, the standard of care for non-operative treatment of AIS varies widely between North America and Europe, and the use of SSE is not universally accepted. SSE is a potentially low-cost intervention that will be of substantial benefit even if a relative risk reduction in curve progression or reaching the threshold for surgery is reduced in a modest proportion of those participating.

SSE, as opposed to generalized physiotherapy, consists of individually-adapted exercises that aim to promote spinal realignment through self-correction and stabilisation, as well as modulating patterns of trunk muscles recruitment. Electromyography (EMG) of paraspinal and abdominal muscles in AIS patients revealed disrupted patterns of muscles recruitment, which are associated with a disparity in trunk isometric rotation strength between sides. AIS patients demonstrate proprioceptive and balance control problems, along with a distorted body schema, resulting in a mismatch between the actual spinal alignment and the patients' internal representation of the body. SSE aims to reverse the anomalous patterns of muscle recruitment through training, and modify the body schema with visual and somatosensory feedback. This forms the theoretical neurophysiological basis for using this treatment strategy for AIS.

Schroth SSE is one of the most studied and widely-used schools of SSE. It is a technique tailored to the type of scoliosis and the curve magnitude of each patient. It is based on vertebrae deflections and sagittal corrections that result in horizontal vertebrae de-rotation. It uses rotational breathing and postural auto-correction to reverse the underlying impairments in spinal muscle function, postural control and proprioception which contribute to the development of curvature in AIS. Patients will also be given cognitive behavioural strategies to empower them to self-manage their conditions.


Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 136 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description:

Patients diagnosed with AIS referred for bracing through the hospital's specialist outpatient clinic are eligible to enrol the study. The Investigator will document whether each patient meets the selection criteria before enrolment into the study. The Investigator or designee will also obtain an IRB/EC approved Informed consent from each patient and/or guardian.

Recruited patients will be randomly assigned to either SSE group or control group in a ratio of 1:1. The radiographic evaluation, physical examination and PROM questionnaires will be assessed at baseline, 3 months, 6 months and 12 months post treatment.

Masking: Double (Investigator, Outcomes Assessor)
Masking Description: Assessor, statistician and investigator blinded
Primary Purpose: Treatment
Official Title: Efficacy of Scoliosis Specific Exercise (SSE) in Patients With Adolescent Idiopathic Scoliosis (AIS) During Bracing: A Randomized Controlled Clinical Trial
Actual Study Start Date : October 9, 2017
Estimated Primary Completion Date : September 30, 2019
Estimated Study Completion Date : September 30, 2019

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Schroth SSE with Bracing
Patients in this group will be prescribed an outpatient-based Schroth exercise program, as per our preliminary study. It consists of an individualised eight-week outpatient program that includes four initial private training sessions, once every two weeks, where exercises will be taught to the patient and their caregivers. A home exercise program will be instituted thereafter and patients will be required to return for supervised sessions once every two months.
Combination Product: Schroth SSE with Bracing
Patients in this group will be prescribed an outpatient-based Schroth exercise program, as per our preliminary study. It consists of an individualised eight-week outpatient program that includes four initial private training sessions, once every two weeks, where exercises will be taught to the patient and their caregivers. A home exercise program will be instituted thereafter and patients will be required to return for supervised sessions once every two months.

Active Comparator: Bracing alone
Patients in the control group will receive standard level of care for bracing, which consists of education on general exercises for spinal movement, strengthening, and balancing. These patients will only attend study assessments with no extra physiotherapy sessions.
Device: Bracing alone
Patients in the control group will receive standard level of care for bracing, which consists of education on general exercises for spinal movement, strengthening, and balancing. These patients will only attend study assessments with no extra physiotherapy sessions.




Primary Outcome Measures :
  1. Effect of Schroth SSE during bracing versus bracing alone in AIS patients as determined by the difference in coronal Cobb angle pre- and one year post-treatment [ Time Frame: baseline, 3 months, 6 months, 12 months ]
    1. To evaluate the effect of Schroth SSE during bracing versus bracing alone in AIS patients as determined by the difference in coronal Cobb angle pre- and one year post-treatment


Secondary Outcome Measures :
  1. Compare changes in sagittal plane radiological parameter between Schroth SSE with bracing and bracing alone by EOS Imaging System [ Time Frame: baseline, 3 months, 6 months, 12 months ]
    To evaluate the effect of Schroth SSE during bracing compared with bracing alone on sagittal plane radiological parameter using EOS Imaging System

  2. Compare changes in transverse plane radiological parameter between Schroth SSE with bracing and bracing alone by EOS Imaging System [ Time Frame: baseline, 3 months, 6 months, 12 months ]
    To evaluate the effect of Schroth SSE during bracing compared with bracing alone on transverse plane radiological parameter using EOS Imaging System

  3. Compare changes in surface topography between Schroth SSE with bracing and bracing alone [ Time Frame: baseline, 3 months, 6 months, 12 months ]
    To evaluate the effect of Schroth SSE during bracing compared with bracing alone on surface topography

  4. Compare the effect of Schroth SSE with bracing and bracing alone on surface electromyography [ Time Frame: baseline, 3 months, 6 months, 12 months ]
    To evaluate the effect of Schroth SSE during bracing compared with bracing alone on surface electromyography (sEMG)

  5. Measure quality of life between Schroth SSE with underarm brace and underarm brace alone by SRS-7 questionaire [ Time Frame: baseline, 3 months, 6 months, 12 months ]
    To measure quality of life between Schroth SSE with underarm brace and underarm brace alone by SRS-7 questionaire

  6. Measure health outcomes between Schroth SSE with underarm brace and underarm brace alone by EQ-5D-5L [ Time Frame: baseline, 3 months, 6 months, 12 months ]
    To measure health outcomes between Schroth SSE with underarm brace and underarm brace alone by EQ-5D-5L

  7. Measure patients' perception of their appearance between Schroth SSE with underarm brace and underarm brace alone by Trunk Appearance Perception Scale (TAPS) [ Time Frame: baseline, 3 months, 6 months, 12 months ]
    To measure patients' perception of their appearance between Schroth SSE with underarm brace and underarm brace alone by Trunk Appearance Perception Scale (TAPS)

  8. Measure levels of pain between Schroth SSE with underarm brace and underarm brace alone by Numeric Pain Ratings [ Time Frame: baseline, 3 months, 6 months, 12 months ]
    To measure levels of pain between Schroth SSE with underarm brace and underarm brace alone by Numeric Pain Ratings



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Ages Eligible for Study:   10 Years to 15 Years   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Diagnosis of AIS
  • Male or female from 10 to 15 year-old, inclusive, at the time of consent provided
  • Skeletal immaturity, defined as a Risser grade (amount of ossification and eventual fusion of the iliac apophysis) of 0, 1, or 2
  • Cobb angle of 25-40
  • No prior conservative or surgical treatment for AIS

Exclusion Criteria:

  • An underlying cause or association that may cause scoliosis
  • Leg length discrepancies or lower limb deformities that may interfere with spinal posture
  • Previous spinal surgery
  • Cognitive impairment
  • Those receiving any other forms of treatment including alternative medicine for the treatment of their scoliosis
  • Those who are unable to return for follow-up to complete the trial.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03305185


Contacts
Contact: Dr Kenny Kwan, BMBCh (Oxon) +85222554654 kyhkwan@hku.hk
Contact: Tsz Ching Chan, BSc +85267030807 tcc0525@hku.hk

Locations
Hong Kong
Duchess of Kent Children's Hospital Recruiting
Hong Kong, Hong Kong
Contact: Dr Kenny Kwan, BMBCh (Oxon)    +852 22554654    kyhkwan@hku.hk   
Contact: Tsz Ching Chan, BSc    +852 67030807    tcc0525@hku.hk   
Principal Investigator: Dr Kenny Kwan, BMBCh (Oxon)         
Sub-Investigator: Professor Kenneth Cheung, MD(HK)         
Sub-Investigator: Dr Dino Samartzis, PhD         
Sub-Investigator: Dr Yong Hu, PhD         
Sub-Investigator: Mr Aldous Cheng, MSc         
Sub-Investigator: Dr Joanne Yip, PhD         
Sponsors and Collaborators
The University of Hong Kong
The Hong Kong Polytechnic University
Investigators
Principal Investigator: Dr Kenny Kwan, BMBCh(Oxon) The University of Hong Kong

Responsible Party: Dr. Kenny Kwan, Clinical Assistant Professor, The University of Hong Kong
ClinicalTrials.gov Identifier: NCT03305185     History of Changes
Other Study ID Numbers: UW 16-206
First Posted: October 9, 2017    Key Record Dates
Last Update Posted: November 6, 2017
Last Verified: November 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Dr. Kenny Kwan, The University of Hong Kong:
AIS

Additional relevant MeSH terms:
Scoliosis
Spinal Curvatures
Spinal Diseases
Bone Diseases
Musculoskeletal Diseases