|Title:||Scoping review and clinical research on conservative interventions to adolescent idiopathic scoliosis|
|Advisors:||Wong, Man-sang (BME)|
|Subject:||Scoliosis -- Treatment|
Spine -- Abnormalities -- Alternative treatment
Hong Kong Polytechnic University -- Dissertations
|Department:||Department of Biomedical Engineering|
|Pages:||xvi, 152 pages : color illustrations|
|Abstract:||Adolescent idiopathic scoliosis (AIS) is a complex three-dimensional deformity of spinal and trunk. Untreated idiopathic scoliosis tends to progress during the growth period. Due to limited knowledge about its etiology and pathogenesis, there is no specific and effective treatment to prevent or reduce spinal deformity. The choice of conservative treatment is usually based on the habits of clinicians or patients' preferences rather than reasonable basis. In order to provide scientific evidence for conservative managements of AIS, this research conducted a scoping review of the effects of various conservative interventions based on evidence-based methods firstly. The results showed that exercise combined with orthosis as well as traditional Chinese medicine had good application prospects in the treatment of AIS. However, there is lack of evidence from high quality research to support their application. Therefore, we further conducted clinical controlled studies to identify the feasibility and validity of these two approaches. The thesis includes the following three parts:|
Part I: Conservative interventions in the management of adolescent idiopathic scoliosis: a scoping review
Objective: To provide scientific evidence for clinical application of conservative treatments in the management of AIS, through systematically reviewing the related literatures based on evidence-based methods. Method: The studies were searched in the MEDLINE, EMBASE, CENTRAL, CINAHL, PEDro and CNKI databases by two independent reviewers. Results: Fifteen studies met the final inclusion criteria, because of the high heterogeneity among included studies, the statistical pooling was refrained. The results were analyzed based on the quality and the outcome of the studies, which showed that: 1) Orthosis was more effective than other conservative treatments in reducing spinal deformity; 2) Scoliosis specific exercises showed benefits in patients with mild scoliosis, the effectiveness of the combination of scoliosis specific exercise with orthosis was lack of scientific evidence from randomized controlled studies. 3) Traditional Chinese medicine could correct spinal deformities and balance the muscles on both sides of the spinal curvature, which provided a new strategy for conservative management of patients with AIS; 4) In addition to spinal deformity, more attention should be paid to the impacts of conservative treatments on patients' appearance, mental health, cardiopulmonary function as well as the quality of life. Conclusion: Low methodological weaknesses existed in the current research related to conservative treatments for AIS. High quality studies with well-designed and long follow-up were needed to evaluate the effectiveness of different conservative treatments for AIS.
Part II: The effectiveness of scoliosis specific exercise combined with orthosis on patients with adolescent idiopathic scoliosis: a randomized controlled trial study
Objective: To investigate the effectiveness of the integration of orthotic intervention (OI) and scoliosis specific exercise (SSE) in the treatment of adolescent idiopathic scoliosis. Method: It was a prospective randomized controlled study. Patients who fulfilled the selection criteria were randomly assigned to the OE group or the OI group. All the subjects were prescribed with a rigid thoracolumbosacral orthosis (TLSO). An additional SSE program was provided to the subjects in the OE group. Cobb angle, back muscle endurance, cardiopulmonary function and quality of life of the subjects were measured at baseline, 6-month and 12-month follow-up visits. Results: After 12-month intervention, the patients in OE group showed better spinal deformity reduction than those in the OI group. The back muscle endurance, pulmonary function as well as quality of life decreased in the patients wearing orthosis only, whereas some reductions happened in the patients receiving orthosis combined with exercise. Between-group statistical significances were detected at both 6-month and 12-month follow-ups among Cobb angle, back muscle endurance time, mental health and total score of quality of life as well as all parameters of cardiopulmonary function except for FEV1/FVC and O2/pulse, while between-group differences among ATR and pain score of quality of life were found at 12-month follow-up only. Conclusion: Orthotic intervention combined with SSE could further increase the Cobb angle correction compared with orthotic intervention only. Additional SSE could improve the deteriorated respiratory parameters and back muscle endurance of patients treated with orthosis. Compared with orthosis only, patients showed better quality of life when applying SSE during orthotic intervention, especially in terms of pain and mental health.
Part III: The effectiveness of acupuncture combined with tuina on patients with adolescent idiopathic scoliosis: a quasi-experimental study
Objective: To investigate the effectiveness of acupuncture combined with tuina in the treatment of patients with adolescent idiopathic scoliosis. Method: It was a quasi-experimental study. Patients who fulfilled the selection criteria were included and divided into the experimental group (the TCM group) and the control group. Patients in the experimental group received traditional Chinese medicine intervention (acupuncture combined with tuina), those in the control group received meaningful observation without further intervention. Cobb angle, back muscle endurance, spinal flexibility and quality of life of subjects were measured at baseline and 6-month follow-up visit. Results: Forty-five patients completed the treatment schedule with data available for evaluation. No serious adverse events occurred during the study. After 6month intervention, patients in the TCM group showed significant reduction in Cobb angle correction, while those in the control group presented significant deterioration. The results of back muscle endurance and spinal flexibility in the TCM group were found to be significantly better than that in the control group. In terms of quality of life, the pain score and self-image score of the patients in the TCM group were significantly better than that in the control group at the 6-month assessment. Conclusion: TCM intervention could not only reduce the spinal deformity but also enhance the back muscles strength and the spinal flexibility of AIS patients with mild curvature. In terms of raising the quality of life, TCM relieved patients' pain and increased their self-image. As an effective and safe intervention in the treatment of adolescent idiopathic scoliosis, acupuncture combined with tuina is worth popularizing and applying in Chinese clinical practice.
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