European Vertebral  Deviation Center - Clinique du Parc - Lyon (France)    Quality of Life

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Quality of Life

Course on the LYON METHOD for Scoliosis - Bangalore India 2017

 


 

SOSORT 2017

Quality of life of 98 non-adult patients with scoliosis treated with the new Lyon ARTbrace and evaluated by the Brace Questionnaire

Abstract

Background: Since the validation of the BrQ in French, we have used it to evaluate the new Lyon ARTbrace. The improvement compared to the plaster cast seems obvious, but maintaining an asymmetric with a very high rigid brace during the whole treatment could have a greater impact on quality of life.

Material and Methods: This is a case series study. The BrQ was sent by email to the first 500 patients of our prospective database, less than 1 year after the first ARTbrace was set up (first overall score). The 98 responses received, (response rate of 20%), were analyzed with the statistical package SPSS v20.

Results: The 98 patients had a mean Global score of (M=76.4236, SD = 10.86).

A one way ANOVA showed that the differences in BrQ scores between ART score and global score (n = 98, M = 76.4236, SD = 10.86), is significant only for item 11 (You felt worried because of the brace) F(1,96) = 9.841, p = .002.

A factorial ANOVA was conducted to compare the global BrQ score and the interaction effect between the global BrQ score on the partial 8 domains scores.

4 interaction effects are significant:

1. School activity differed significantly from the global BrQ score, F(63,34) = 3.212, p <.000.

2. Physical Functioning differed significantly from the global BrQ score, F(63,34) = 3.227, p <.000.

3. Social Functioning differed significantly from the global BrQ score, F(63,34) = 4.353, p <.000.

Patients are most satisfied with: 1. School activity (M = 4.27) compared to the global score (M=3.82), 2. Physical functioning (M = 3.92) compared to the global score (M=3.82), 3. Social functioning (M = 3.91) compared to the global score (M=3.82),

4. Emotional Functioning differed significantly from the global BrQ score, F(63,34) = 3.020, p <.000.

Patients are less satisfied with Emotional functioning (M = 3.43) compared to the global score (M=3.82)

Conclusion: Asymmetry and very high rigidity of scoliosis bracing do not modify the first overall mean score of the BrQ compared with other braces. The major impact is more emotional than physical.

Background

The quality of life of children in braces analyzed using non-specific questionnaires is a controversial subject. The brace is a stress for the child, but also a protection that can help them to structure their personality in adolescence. The BrQ is a disease specific quality of life questionnaire specially adapted for children wearing braces. BrQ was designed to investigate eight specific domains: general health perception, physical functioning, emotional functioning, self-esteem and aesthetics, vitality, school activity, bodily pain and social functioning. [1] Since the validation of the BrQ in French, we have used it to evaluate the new Lyon ARTbrace. [2]  With ARTbrace, the improvement compared to the plaster cast seems obvious, but maintaining an asymmetric very high rigid brace during the whole treatment could have a greater impact on quality of life.

Methods

Since 1998 all scoliotic patients are included in a monocentric prospective database for analytic observational study. This is a case series study. The BrQ was sent by email to the first 500 pediatric patients treated with ARTbrace, less than 1 year after the first ARTbrace was set up (first overall score). Written consent was obtained from the relative for publication of this study.

All 98 responses received, (response rate of 20%), were analyzed independently for the 34 items. A one-way ANOVA was used to assess the variation of each item in relation to the overall average of the 34 items for each patient. Another oneway ANOVA was used to assess the variation of each eight domains in relation with the global BrQ score for each patient. SPSS v20 package was used at 95% confidence interval.

Results

The 98 patients had a mean Global score of (M=76.4236, SD = 10.86).

A one way ANOVA showed that the differences in BrQ scores between ART score and global score (n = 98, M = 76.4236, SD = 10.86), is significant only for item 11 (You felt worried because of the brace) F(1,96) = 9.841, p = .002.

A factorial ANOVA was conducted to compare the global BrQ score and the interaction effect between the global BrQ score on the partial 8 domains scores.

4 interaction effects are significant:

1. School activity differed significantly from the global BrQ score, F(63,34) = 3.212, p <.000. Patients are most satisfied with School activity (M = 4.27) compared to the global score (M=3.82)

2. Physical Functioning differed significantly from the global BrQ score, F(63,34) = 3.227, p <.000. Patients are most satisfied with Physical functioning (M = 3.92) compared to the global score (M=3.82)

3. Social Functioning differed significantly from the global BrQ score, F(63,34) = 4.353, p <.000. Patients are most satisfied with Social functioning (M = 3.91) compared to the global score (M=3.82)

4. Emotional Functioning differed significantly from the global BrQ score, F(63,34) = 3.020, p <.000. Patients are less satisfied with Emotional functioning (M = 3.43) compared to the global score (M=3.82)

The four other domains: General Health perception, Self-esteem and aesthetics, Vitality, Bodily Pain, do not differ significantly from the general score.

Discussion

The overall score of 76.42 is very close to those published in the literature: 75,5 for Vasiliadis [1], 76.86 for Chan [3], 78.7 for Aulisa [4], 78.1 for Kinel [5]. Very high rigidity and controlled asymmetry do not affect the quality of life compared to the other braces.

Although the ARTbrace is an asymmetric brace, we find that domain 4 (Self-esteem and Aesthetics) does not differ significantly from the overall score. Although the ARTbrace is a polycarbonate brace with very high rigidity, the domain 7 (Bodily pain) does not differ significantly from the overall score and the 3 domains (School activity, Physical Functioning, Social Functioning) are significantly better than the overall score, which reflects a good acceptance of the ARTbrace.

The emotional functioning is significantly worse than the general score, so it is the psychological impact of wearing a brace more than the characteristics of the brace itself that will affect the quality of life. This evidence suggests that the concept of the step by step should be reevaluated with the concept of Best in-brace correction from the outset. Indeed, a very corrective brace will have no more impact on quality of life than another brace less corrective and apparently less constraining. With equal final result, a more corrective brace can be worn less time in the day, which can improve compliance.

The four other domains: General Health perception, Self-esteem and aesthetics, Vitality, Bodily Pain, do not differ significantly from the general score.

The general mean of the BrQ score is higher than the first overall score mean = 61.89 (Vasiliadis 2006) of the first publication and comparable to the results published later in the literature: (Chan 2014) = 76.86.

Conclusion

Asymmetry and very high rigidity of scoliosis bracing do not modify the first overall mean score of the BrQ compared with other underarm polyethylene symmetrical and asymmetrical braces. Bodily pain and school activity are not significantly changed, and the major impact is more emotional than physical.

References

1.       Vasiliadis E, Grivas T, Gkoltsiou K. Development and preliminary validation of Brace Questionnaire (BrQ): a new instrument for measuring quality of life of brace treated scoliotics. Scoliosis. 2006;1(7)

2.       Deceuninck J, Tirat-Herbert A, Rodriguez Martinez N, Bernard JC. French validation of the Brace Questionnaire (BrQ) Scoliosis Spinal Disord. 2017; 12: 18.

3.       Chan SL, Cheung KM, Luk KD, Wong KW, Wong MS. A correlation study between in-brace correction, compliance to spinal orthosis and health-related quality of life of patients with Adolescent Idiopathic Scoliosis. Scoliosis. 2014;9:1.

4.       Aulisa AG, Guzzanti V, Galli M, Erra C, Scudieri G, Padua L. Validation of Italian version of Brace Questionnaire (BrQ). Scoliosis. 2013;8:13.

5.       Kinel E, Kotwicki T, Podolska A, Białek M, Stryła W. Quality of life and stress level in adolescents with idiopathic scoliosis subjected to conservative treatment. Stud Health Technol Inform. 2012;176:419-22.

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