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To identify and synthesise the content of knee bracing interventions in randomised controlled trials (RCTs) of knee osteoarthritis (OA). In this scoping review, three electronic databases (PubMed, Web of Science, Cochrane) were searched up to 10th June 2024. Nineteen previous systematic reviews of knee bracing for knee OA and four recent international clinical practice guidelines were also hand searched. Identified studies were screened for eligibility by two independent reviewers. Information on bracing interventions was extracted from included RCT reports, informed by Template for Intervention Description and Replication (TIDieR) guidelines. Data were synthesised narratively. Thirty-one RCTs testing 47 different bracing interventions were included. Braces were broadly grouped as valgus/varus, patellofemoral, sleeve, neutral hinged, or control/placebo knee braces. Brace manufacturer and models varied, as did amount of recommended brace use. Only three interventions specifically targeted brace adherence. Information on brace providers, setting, number of treatment sessions, and intervention modification over time was poorly reported. Adherence to brace use was described for 32 (68%) interventions, most commonly via self-report. Several mechanisms of action for knee braces were proposed, broadly grouped as biomechanical, neuromuscular, and psychological. Many different knee brace interventions have been tested for knee OA, with several proposed mechanisms of action, a lack of focus on adherence, and a lack of full reporting. These issues may be contributing to the heterogeneous findings and inconsistent guideline recommendations about the clinical effectiveness of knee bracing for knee OA to date. [ABSTRACT FROM AUTHOR]

Study Design. Retrospective chart review. Objective. To determine the effect of conservative measures on radiographic outcomes in those with isolated spondylolysis. Summary of Background Data. Spondylolysis is a common cause of low back pain in pediatric patients, affecting between 4.4% and 4.7% of all pediatric patients. This rate is even higher in high-level athletes, with recent studies suggesting a rate of 47% in this population. Conservative measures are recommended for treating symptomatic spondylolysis and are effective in controlling symptoms, but there is little evidence regarding their effect on radiographic outcomes. Methods. A retrospective review was conducted of patients diagnosed with spondylolysis who were treated at a single academic institution between January 1, 2012, and January 1, 2022. Data collected included demographics, presentation characteristics, pretreatment and post-treatment radiologic findings, types of treatments employed, and final symptomatic status at follow-up. The Student t test and the Wilcoxon rank sum test were used to compare continuous variables. The χ² test was used to compare categorical variables. Results. A total of 119 patients were included in the study. There was an 81.5% rate of healing on advanced imaging for those treated with conservative measures. When comparing those with healing on advanced imaging to those without, those with healing were more likely to have an acute fracture (P= 0.04), have symptomatic improvement (P<0.01), and return-to-play (P= 0.02) compared with those without. Those with healing also had an odds ratio of 6.9 (P< 0.01) and 4.5 (P=0.02) to achieve symptomatic improvement and return to their sport, respectively, compared with those who did not. Conclusion. Our study found those with isolated spondylolysis who were treated with conservative measures had a high healing rate on advanced imaging and those with healing had significantly higher odds of having symptomatic improvement and returning to play compared with those without. [ABSTRACT FROM AUTHOR]

Awaiting news of uncertain outcomes is distressing because the news might be disappointing. To prevent such disappointments, people often "brace for the worst," pessimistically lowering expectations before news arrives to decrease the possibility of surprising disappointment (a negative prediction error, or PE). Computational decision-making research commonly assumes that expectations do not drift within trials, yet it is unclear whether expectations pessimistically drift in real-world, high-stakes settings, what factors influence expectation drift, and whether it effectively buffers emotional responses to goal-relevant outcomes. Moreover, individuals learn from PEs to accurately anticipate future outcomes, but it is unknown whether expectation drift also impedes PE-based learning. In a sample of students awaiting exam grades (N = 625), we found that expectations often drift and tend to drift pessimistically. We demonstrate that bracing is preferentially modulated by uncertainty; it transiently buffers the initial emotional impact of negative PEs but impairs PE-based learning, counterintuitively sustaining uncertainty into the future. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study was to assess the changes in flexibility during night-time bracing in skeletally immature adolescent idiopathic scoliosis (AIS) with curves in the surgical range. Materials and methods: We included a consecutive cohort of 89 AIS patients with curves ≥ 45° and an estimated growth potential. All patients were eventually treated with fusion surgery, and all patients had side-bending radiographs prior to both bracing and surgery. Curves were classified as structural or non-structural curves according to Lenke at both timepoints. Results: The main curve progressed by a mean of 12 ± 10° and the secondary curve by 8 ± 8°. Flexibility of the main curve decreased from 50 ± 19% to 44 ± 19% (p = 0.001) and the underlying curve from 85 ± 21% to 77 ± 22% (p = 0.005). In 69 patients (79%), the Lenke category did not progress during bracing. In 14 patients (15%), the progression in Lenke type occurred in the thoracic region (i.e., Lenke type 1 to type 2), while six patients (7%) progressed in the lumbar region (i.e., type 1 to type 3). In the 69 patients that did not progress, we found that the last touched vertebra moved distally by one or two levels in 26 patients. Conclusions: This is the first study to describe that curve flexibility decreases during bracing in severe AIS. However, this had only a modest impact on the surgical strategy. Bracing as a holding strategy can be applied, but the risk of losing flexibility in the lumbar spine should be outweighed against the risks of premature fusion surgery. [ABSTRACT FROM AUTHOR]

Core stability training is crucial for competitive athletes, individuals who want to improve their health and physical performance, and those undergoing clinical rehabilitation. This study compared the ultrasound (US) muscle thickness of the abdominals and lumbar multifidus (LM) muscles between seven popular trunk stability exercises performed using hollowing and bracing maneuvers. Forty-four healthy young adults, aged between 21 and 32 years, performed a plank, bird dog, beast crawl, dead bug, Pilates tap, bridge, and side planks using the bracing and the hollowing maneuver. The thickness of the transversus abdominis (TrA), internal oblique (IO), and LM muscles was measured simultaneously using two ultrasound machines. Analysis of variance designs indicated that during hollowing, the bird dog and side plank exercises resulted in the greatest increase in the muscle's relative thickness overall. The relative thickness of all muscles was significantly greater (p < 0.001) during hollowing (22.7 ± 7.80 to 106 ± 24.5% of rest) compared to bracing (18.7 ± 7.40 to 87.1 ± 20.9% of rest). The TrA showed the greatest increase in thickness (p < 0.001) compared to the IO and LM. Additionally, the IO had a greater increase in thickness (p < 0.001) than the LM. In conclusion, our findings indicate that the bird dog and side plank exercises, when performed with hollowing, showed the most significant total muscle thickness increase. Notably, the hollowing maneuver enhances the thickness of the TrA, IO, and LM muscles more than the bracing maneuver. This contributes to the discussion on optimal strategies for dynamic core stabilization. [ABSTRACT FROM AUTHOR]

Purpose of Review: Bracing represents a prevalent conservative, non-surgical approach used in the management of chronic spinal conditions such as spondylosis, degenerative disc disease, and spondylolisthesis. A wide variety of orthoses are available to aid in addressing cervical, thoracic, lumbar, thoracic, and SI joint pain. In this review, we aim to comprehensively examine brace types with their current applications and implications of usage. Recent Findings: There are multiple cervical bracing options, such as soft and rigid collars, to assist in managing acute trauma and chronic degenerative conditions. The review highlights the nuanced decision-making process between hard and soft collars based on the severity of bone or ligamentous injury and neurological findings. Orthoses for low back pain are commonly used. Summary: The review highlights the challenges of chronic neck and lower back pain, emphasizing the importance of clinicians exploring all treatment strategies including braces which can improve function and reduce pain. [ABSTRACT FROM AUTHOR]

Abstract Serial casting as one of the applications to treat early-onset scoliosis has been reported efficiently to improve deformity, but no report has focused on the efficacy of braces in the treatment of congenital early-onset scoliosis and comparison with progressive idiopathic early-onset scoliosis. Patients with progressive EOS treated with braces in our institution with a minimum of 4 years follow-up were reviewed. Two groups according to the etiological diagnosis were analyzed and compared: the congenital scoliosis (CS) group and idiopathic scoliosis (IS) group. The success cases and the failure cases were also compared. 27 patients with an average main Cobb angle of 38.19° (20–55) underwent initial bracing at an average age of 55.7 months (24–108), the average follow-up time was 76.19 months (49–117). In IS group the main Cobb angle was corrected to 18.69 ± 12.06° (48.61%) following the first bracing; the final Cobb angle was 23.08 ± 22.15°(38.76%) after brace removal. In CS group the main Cobb angle was corrected to 33.93 ± 10.31°(17.1%) following the first bracing and 37.93 ± 14.74°(3.53%) after brace removal. Both coronal chest width and T1-T12 height increased dramatically from pre-bracing to the last follow-up. Patients diagnosed as IS tended to have a better result in main Cobb angle correction than that of CS (P = 0.049). By the time of last follow-up, 8 patients had undergone surgery, and the operation time was postponed by 68.88 ± 26.43 months. For patients with progressive early-onset scoliosis, bracing is an efficient nonsurgical alternative to casting, and some of them can be cured; if not, eventual surgical intervention can be delayed for a period of time without restrictions on the thoracic cavity.

Background: The effectiveness of knee orthoses as part of conservative treatment for patients with medial knee osteoarthritis has not been fully explored. The purpose of this study was to evaluate the effects of a novel semi-rigid knee orthosis on pain, physical activity, and functional capacity. Methods: Pain levels, physical activity, and functional capacity were assessed in 24 participants experiencing symptomatic medial knee osteoarthritis one week before (i.e., pretest) initiating a six-week orthosis intervention and again during the final week of the intervention (i.e., post-test). Results: Night pain, pain during walking, pain during stair climbing, and pain during sitting consistently decreased by 41% to 48% while wearing the knee orthosis. Device-based measured physical activity showed a 20.2-min increase in vigorous physical activity during the post-test, while light and moderate physical activity did not show significant changes. After six weeks of orthosis application, there was a 5% increased distance for the six-minute walk test, and participants reported fewer limitations both in everyday and athletic activities, as well as an enhanced quality of life. Conclusions: These findings highlight the potential effectiveness of a semi-rigid knee orthosis to enhancing functional capacity and quality of life. More extensive and longer clinical trials are needed to improve confidence in these findings and understand their impact on disease progression. [ABSTRACT FROM AUTHOR]

• Patients with congenital or juvenile idiopathic scoliosis had similar health-related quality of life in adulthood compared with a national cohort of normative data on most SF-36 domains. • However, patients with congenital or juvenile idiopathic scoliosis had lower SF-36 scores on the vitality and mental health domain compared with age-matched national norm scores. • Differences between conservatively and surgically treated patients in both scoliosis cohorts were minimal. However, surgically treated juvenile idiopathic scoliosis patients had a significantly lower score on the SRS-22r pain domain and conservatively treated congenital scoliosis patients had a significantly lower score on the SRS-22r mental health domain. Congenital and juvenile scoliosis are both early-onset deformities that develop before the age of 10. Children are treated to prevent curve progression and problems in adulthood such as back pain and a decreased quality of life but literature on long-term outcomes remains scarce. To evaluate the health-related quality of life (HRQoL) and potential disability of children with congenital scoliosis (CS) or juvenile idiopathic scoliosis (JIS) after a minimum of 20 years follow-up. Comparative cohort study. A consecutive cohort of CS and JIS patients were retrospectively identified from a single-center scoliosis database. Patients born between 1968 and 1981 and treated during skeletal growth were eligible for participation. HRQoL (SF-36, SRS-22r, ODI). The primary aim was to evaluate the HRQoL of CS and JIS patients using the general SF-36 questionnaire. Both patient cohorts were compared with age-matched national norms. The secondary aim was to analyze the differences between conservatively and surgically treated patients using the scoliosis-specific Scoliosis Research Society-22r questionnaire (SRS-22r) and the Oswestry Disability Index (ODI). T-tests were used for statistical comparison. In total, 114 patients (67% of the eligible patients) completed the questionnaire, with a mean follow-up of 25.5±5.5 years after their final clinical follow-up. Twenty-nine patients with CS were included with a mean age of 44.4±3.8 years (79.3% female), and 85 patients with JIS with a mean age of 43.7±4.2 years (89.4% female). Of the SF-36 domains, only the vitality score (60.6±18.0 for CS and 58.1±17.6 for JIS cohort) and mental health score (70.0±18.4 for CS and 72.1±18.1 for JIS cohort) were significantly lower compared with the general population (68.6±19.3 for vitality, and 76.8±17.4 for mental health). These decreased scores were larger than the determined minimum clinically important difference threshold of 4.37. Surgically treated JIS patients had a significantly lower score on the SRS-22r pain domain than their nonsurgically treated peers (3.6±0.9 vs 4.1±0.7l p=.019). Surgically treated CS patients had a significantly higher score on the SRS-22r mental health domain than their nonsurgically treated peers (4.3±0.5 vs 3.5±1.0; p=.023). No significant differences were found in the other domains. Except for vitality and mental health domains, congenital and juvenile idiopathic scoliosis patients treated during skeletal growth had similar HRQoL on most SF-36 domains in adulthood compared with national norms. Surgical treated JIS patients experienced more pain compared with brace treated patients, while braced CS patients had a significantly lower mental scores compared with surgical treated patients. These long-term outcomes are essential to inform patients and can guide shared decision-making between clinicians and patients. [ABSTRACT FROM AUTHOR]

BackgroundJuvenile idiopathic scoliosis (JIS) outcomes with brace treatment are limited with poorly described bracing protocols. Between 49 and 100% of children with JIS will progress to surgery, however, young age, long follow-up, and varying treatment methods make studying this population difficult. The purpose of this study is to report the outcomes of bracing in JIS treated with a Boston brace™ and identify risk factors for progression and surgical intervention.MethodsThis is a single-center retrospective review of 175 patients with JIS who initiated brace treatment between the age of 4 and 9 years. A cohort of 140 children reached skeletal maturity; 91 children had surgery or at least 2 year follow-up after brace completion. Standard in-brace protocol for scoliosis 320° was a Boston brace for 18-20 h/day after MRI (n = 82). Family history, MRI abnormalities, comorbidities, curve type, curve magnitude, bracing duration, number of braces, compliance by report, and surgical interventions were recorded.ResultsChildren were average 7.9 years old (range 4.1-9.8) at the initiation of bracing. The Boston brace™ was prescribed in 82 patients and nine used night bending brace. Mid-thoracic curves (53%) was the most frequent deformity. Maximum curve at presentation was on average 30 ± 9 degrees, in-brace curve angle was 16 ± 8 degrees, and in-brace correction was 58 ± 24 percent. Patients were braced an average of 4.6 ± 1.9 years. 61/91 (67%) went on to posterior spinal fusion at 13.3 ± 2.1 (range 9.3-20.9) years and curve magnitude of 61 ± 12 degrees. Of those that underwent surgery, 49/55 (86%) progressed > 10°, 6/55 (11%) stabilized within 10°, and 0/55 (0%) improved > 10° with brace wear. No children underwent growth-friendly posterior instrumentation. Of the 28 who did not have surgical correction, 3 (11%) progressed > 10°, 13/28 (46%) stabilized within 10°, and 12/28 (43%) improved > 10° with brace wear.ConclusionsThis large series of JIS patients with bracing followed to skeletal maturity with long-term follow-up. Surgery was avoided in 33% of children with minimal to no progression, and no child underwent posterior growth-friendly constructs. Risk factors of needing surgery were noncompliance and larger curves at presentation.

Background: Anterior cruciate ligament (ACL) restoration has been divided into repair versus reconstructive approaches. We present an ACL repair using FiberTape sutures as an internal brace and an adjustable cortical button fixation on the femur. Indications: ACL rupture is a condition in which restoration is essential to regaining adequate knee function. ACL repair may be indicated in patients with an acute tear (<4 weeks), Sherman classification type I or II tear, 35 years old or older, and with a mild-to-moderate activity level. Technique Description: ACL tightrope repair initially requires identification of the ACL tear. Following, there is femoral wall preparation and the creation of a drill tunnel in the femoral and tibial walls. FiberRing sutures are passed through the intact portion of the ACL as many times as desired. An ACL Tightrope is then fed through the FiberRing sutures. The ACL Tightrope and cortical button are passed through the femoral tunnel. FiberTape sutures are passed through a tibial tunnel to act as an internal brace. Range of motion and tension is assessed and adjusted as needed. Results: Patients meeting indications for ACL repair and undergoing repair via Tightrope implants may have outcomes comparable to counterparts undergoing ACL reconstruction. Patient-completed functional knee scores, such as International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Lysholm, are similar between the 2 restoration techniques. However, younger patients undergoing an ACL repair appear to have a higher failure rate compared with reconstruction. Conclusion: ACL repair can be an adjuvant treatment option with acute femoral sided tears. Caution should be exercised when performing this procedure on younger, higher level athletes. In our technique, use of adjustable cortical button minimizes bone loss on femoral wall while providing adequate fixation. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication. [ABSTRACT FROM AUTHOR]

Abstract Objectives To identify the existing assessment methods used to measure the spinal flexibility of adolescents with idiopathic scoliosis before bracing and to evaluate the predictive effect of spinal flexibility on bracing outcomes. Methods A broad literature search was performed in the PubMed, Web of Science, EMBASE, CINAHL, Scopus, and Cochrane Library databases to obtain relevant information about spinal flexibility and bracing outcomes. All literature was retrieved by October 14, 2023. The inclusion and exclusion criteria were meticulously determined. The quality of each included study and the level of evidence were evaluated by the Quality in Prognosis Studies (QUIPS) method and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system, respectively. Results After screening 1863 articles retrieved from databases, a total of 14 studies with 2261 subjects were eligible for the final analysis in this review. Overall, nine methods of flexibility assessment were identified, including supine radiographs, supine lateral bending radiographs, lateral bending radiographs but without clear positions, hanging radiographs, fulcrum bending physical method, and ultrasound imaging in the positions of supine, prone, sitting with side bending and prone with side bending. In addition, five studies demonstrated that flexibility had a strong correlation with in-brace correction, and eleven studies illustrated that spinal flexibility was a predictive factor of the bracing outcomes of initial in-brace Cobb angle, initial in-brace correction rate, curve progression, and curve regression. The results of GRADE demonstrated a moderate-evidence rating for the predictive value of spinal flexibility. Conclusion Supine radiography was the most prevalent method for measuring spinal flexibility at the pre-brace stage. Spinal flexibility was strongly correlated with the in-brace Cobb angle or correction rate, and moderate evidence supported that spinal flexibility could predict bracing outcomes.

Introduction: Bracing is one of the first-line treatment for early-onset idiopathic scoliosis (EOIS) to control curves from progression. This study aimed to explore the determinants that govern bracing effectiveness in EOIS. Methods: One hundred and eleven patients with EOIS (mean age of 8.6 ± 1.25 at diagnosis) received bracing treatment and had a final follow-up beyond skeletal maturity were identified from records between 1988 and 2021. Demographic data and clinical features of spinal curvature were obtained for correlation analyses to determine the associations between curve outcomes and clinical features. Results: Most patients were female (85.6%) and had a major curve on the left side (67%). The mean baseline Cobb angle of major curves was 21.73 ± 7.92°, with a mean Cobb angle progression of 18.05 ± 19.11°. The average bracing duration was 5.3 ± 1.9 years. Only 26 (23.4%) of them underwent surgery. The final Cobb angle and curve progression at the final follow-up with a Cobb angle of ≥50° were positively correlated with the initial Cobb angle (r = 0.206 and r = 0.313, respectively) and negatively correlated with maturity parameters. The lumbar curve type was found to correlate with a smaller final Cobb angle. Conclusions: The majority of patients had a final Cobb angle < 50°, which was considered a successful bracing outcome. The final Cobb angle correlated with the initial Cobb angle and curve types observed in EOIS. [ABSTRACT FROM AUTHOR]

Introduction: Traumatic fractures of the thoracolumbar junction (T10-L3) are the most common fractures of the spinal column. Themanagement of these injuries can be operative or nonoperative, and braces are often used, including the Boston Overlap Brace (BOB), a type of thoracolumbosacral orthosis (TSLO). Methods: All patients admitted to the Alfred Hospital in 2015 and managed in a BOB for 2- or 3-column thoracolumbar burst fractures (without neurology) were included in the study. In-hospital and 6- and 12-month patient-reported outcome measures were collected. A random-effects regression model analysis for each outcome (self-reported) pain and functional outcome measures by the Glasgow Outcomes Scale-Extended (GOS-E) was undertaken. Results: A total of 115 patients (62 male) were included with a median age of 53 years. Using a random-effects model, having a lower-limb fracture or a regional kyphosis angle >8° was associated with not having a good recovery after taking into account all other factors with a univariate relationship with this outcome. In terms of the outcome of self-reported pain, only female sex was associated with reporting pain. Conclusions: This study included a large cohort of patients withmanagement of a traumatic fracture with a BOB-type TLSO and provided information that should guide a larger study to review whether the factors associated with poorer outcome, including female sex and local kyphotic angle, need to be considered before deciding on the management of these fractures. Clinical Relevance: The association between degree of deformity of fracture (>8°) and associated lower-limb injury with poorer patient outcomesmay need to be taken into account before deciding to manage thoracolumbar fractures with a BOB-type TLSO although further longitudinal studies are required. [ABSTRACT FROM AUTHOR]

Introduction: Current treatment options for idiopathic scoliosis include three main strategies: physiotherapy, bracing and surgery, which are used combined or successively, but in many cases are not efficient. This study aimed to develop a targeted, efficient, and appropriately calibrated approach for continuously monitoring of scoliosis therapy. Methods: Six patients with idiopathic scoliosis (IS) participated in this consecutive sample study. The study group (n = 6) underwent a physical rehabilitation program that utilized motion capture and myometry for control. Both before and after program completion, all patients underwent X-ray revaluations. Repeated assessments of muscle thickness were conducted to establish a correlation between biomechanical spine remodeling and paraspinal muscle development. Results. Results of MoCap spinal curvature assessment correlate positively with the x-ray measurements (f2 =0.35). The same ratio of difference in x-ray angle measurement results was revealed after the study completion (P<0.001). Both the muscle thickness and the body muscle mass measurements showed negative correlation with the changes in Cobb's angle measurements (the angle was decreased in all measurements, whereas the muscle thickness and mass were increased). Correlation for the SMI (R=-0.88) was close to -1.0. For the measurements in the study group the minimum R value was - 0.92 and for paraspinal muscles L3-L4 and SMM (%) the correlation index was -0.96. These results indicate that the improved muscle thickness and muscle mass (particularly the SMM (%)) support the posture correction and assist in spinal stability. Conclusion. The MoCap and myometry controlled assessment is an efficient, safe and reliable monitoring model to control the outcomes of scoliosis rehabilitation. [ABSTRACT FROM AUTHOR]

Earthquakes are a severe issue for construction. The building collapsed due to the earthquake because it could not bear the earthquake load. Even more so, it was constructed using outdated and different building regulations that do not comply with modern building codes that account for seismic loads. As a result, disaster mitigation methods, such as retrofitting, must be implemented. Retrofitting procedures are commonly used in many developed countries. The bracing system is a typical retrofitting method used on building structures. In this study, a retrofitting program was carried out on The State Finance Building II Semarang, which was built in the 1980s, one of the old buildings in Semarang City, using a reinforced portal structure. This study's bracing system is a Concentrically Brace Frame (CBF) with Inverted V Brace and V Brace variations. The structural analysis software ETABS V.18.2.0 analyzes the building's structure. The structural review includes story drift, the P-Delta effect, and horizontal torsion irregularities. According to the results, steel bracing can minimize the period and displacement associated with story drift, making the structure more stable, with a maximum displacement reduction of 59.66% for inverted V-type steel bracing. Aside from that, steel bracing also can minimize the occurrence of torsion in the building. As a result, steel braces can be used to strengthen the structure. [ABSTRACT FROM AUTHOR]

Aims: Scoliosis is a lateral curvature of the spine with associated rotation, often causing distress due to appearance. For some curves, there is good evidence to support the use of a spinal brace, worn for 20 to 24 hours a day to minimize the curve, making it as straight as possible during growth, preventing progression. Compliance can be poor due to appearance and comfort. A night-time brace, worn for eight to 12 hours, can achieve higher levels of curve correction while patients are supine, and could be preferable for patients, but evidence of efficacy is limited. This is the protocol for a randomized controlled trial of ‘full-time bracing’ versus ‘night-time bracing’ in adolescent idiopathic scoliosis (AIS). Methods: UK paediatric spine clinics will recruit 780 participants aged ten to 15 years-old with AIS, Risser stage 0, 1, or 2, and curve size (Cobb angle) 20° to 40° with apex at or below T7. Patients are randomly allocated 1:1, to either full-time or night-time bracing. A qualitative sub-study will explore communication and experiences of families in terms of bracing and research. Patient and Public Involvement & Engagement informed study design and will assist with aspects of trial delivery and dissemination. Discussion: The primary outcome is ‘treatment failure’ (Cobb angle progression to 50° or more before skeletal maturity); skeletal maturity is at Risser stage 4 in females and 5 in males, or ‘treatment success’ (Cobb angle less than 50° at skeletal maturity). The comparison is on a non-inferiority basis (non-inferiority margin 11%). Participants are followed up every six months while in brace, and at one and two years after skeletal maturity. Secondary outcomes include the Scoliosis Research Society 22 questionnaire and measures of quality of life, psychological effects of bracing, adherence, anxiety and depression, sleep, satisfaction, and educational attainment. All data will be collected through the British Spine Registry. Cite this article: Bone Jt Open 2023;4(11):873–880.

Application of a bracing skeletal system is an additional steel structure that can strengthen a column by transferring weights and force to the received column. The broad use of flensa steel bracing type v diagonally and inverted gradually on each floor. It is possible to determine the junction of the junction if the building is brewed and not braced. The junction to cross section of the building does not use bracing, which USES bracing type v diagonal and inverted is 0.385:0.321:0.294. Bracing inverted type v is more rigid and sturdy than bracing diagonal types shown by the deviation of horizontal bracing the inverted type v smallest and volume 12.5 percent greater than bracing the type diagonal.

Psychosocial interventions can improve teenagers' self-esteem, mental health and bracing compliance. There is a need to compile available evidence of psychosocial care in adolescent idiopathic scoliosis. This systematic review aimed to identify and evaluate the effects of existing interventional studies of psychosocial care for the adolescent idiopathic scoliosis population. A comprehensive search of relevant literature published from the inception to March 2023 was conducted using nine databases. A google scholar search was performed on 1 July 2023, to update the searching results. Two reviewers independently assessed the methodological quality and extracted details of the included studies. Given the heterogeneity of the selected articles, the findings were synthesized narratively without conducting a meta-analysis. Four randomized controlled trials reported in six articles involving 385 teenagers were included. The interventions appeared acceptable with high recruitment rates and low dropout rates reported. Psychosocial interventions had shown significant positive effects on postoperative pain, engagement in daily and social activities as well as brace use, coping abilities and anxiety. Psychosocial interventions are generally feasible and acceptable among the adolescent idiopathic scoliosis population and have produced positive effects on a variety of physical and psychosocial outcomes. Study findings need to be interpreted with caution due to the limited number of available articles and the methodological concerns of the reviewed articles. Well-designed clinical trials are warranted in people from cultural backgrounds to develop and implement effective psychosocial interventions for teenagers with adolescent idiopathic scoliosis, not only for those at the post-surgery stage but also for those receiving conservative treatment. • Psychosocial interventions are highly feasible and acceptable among the adolescent idiopathic scoliosis population. • Psychosocial interventions have significant positive effects on a variety of physical and psychosocial outcomes. • The psychosocial interventions are essential to enhance thewell-being of teenagers with adolescent idiopathic scoliosis. [ABSTRACT FROM AUTHOR]

(1) Background: Frequent exposure to ionising radiation is often used to determine the diagnosis of adolescent idiopathic scoliosis (AIS), a lateral curvature of the spine in those aged between 10 and 18 years, and a treatment plan according to Cobb angle. This narrative review outlines the clinical utility of surface topography (ST), a radiation-free imaging modality. (2) Methods: Publicly available databases were searched to yield literature related to ST. Identified articles were classified based on the equipment used and in order of how it was developed, i.e., historical, recent developments, and state-of-the-art developments. (3) Conclusions: ST is a reliable cost-effective non-invasive technique that provides an alternative to radiation-based imaging to aid with the diagnosis and potential screening of AIS. Several scanning methods are available, which allows ST to be used in several clinical environments. Limitations of inter-reliability and differences of apparatus resulting in variations of data have been noted through this narrative review. [ABSTRACT FROM AUTHOR]

Purpose of Review: In this article, we review the most recent advancements in the approaches to EOS diagnosis and assessment, surgical indications and options, and basic science innovation in the space of early-onset scoliosis research. Recent Findings: Early-onset scoliosis (EOS) covers a diverse, heterogeneous range of spinal and chest wall deformities that affect children under 10 years old. Recent efforts have sought to examine the validity and reliability of a recently developed classification system to better standardize the presentation of EOS. There has also been focused attention on developing safer, informative, and readily available imaging and clinical assessment tools, from reduced micro-dose radiographs, quantitative dynamic MRIs, and pulmonary function tests. Basic science innovation in EOS has centered on developing large animal models capable of replicating scoliotic deformity to better evaluate corrective technologies. And given the increased variety in approaches to managing EOS in recent years, there exist few clear guidelines around surgical indications across EOS etiologies. Despite this, over the past two decades, there has been a considerable shift in the spinal implant landscape toward growth-friendly instrumentation, particularly the utilization of MCGR implants. Summary: With the advent of new biological and basic science treatments and therapies extending survivorship for disease etiologies associated with EOS, the treatment for EOS has steadily evolved in recent years. With this has come a rising volume and variation in management options for EOS, as well as the need for multidisciplinary and creative approaches to treating patients with these complex and heterogeneous disorders. [ABSTRACT FROM AUTHOR]

Adolescent idiopathic scoliosis (AIS) is a spine deformity whose progression during growth is affected by asymmetrical loads acting on the spine. The conservative brace treatment aims to limit the deformity's progression until the end of skeletal growth. This study's objective was to develop a patient‐specific finite element model (FEM) simulating immediate in‐brace (IB) correction and subsequent growth modulation over 2 years of treatment. Thirty‐five retrospective AIS cases with documented correction over 2 years were analyzed. For each case, a patient‐specific FEM was built and IB correction was simulated. Vertebral growth and its modulation were modeled using simulated pressures on epiphyseal vertebral growth plates, including a compliance factor representing the recorded brace wear. The simulated Cobb angles, thoracic kyphosis, lumbar lordosis, and apical vertebral rotation were compared with the actual measurements immediately IB and out‐of‐brace (OOB) at the 2‐year follow‐up. Treatment outcomes according to simulated compliance scenarios of no brace‐wear versus full brace‐wear were also computed. The average immediate IB difference between the simulated and actual Cobb angle was 4.9° (main thoracic [MT]) and 3.7° (thoraco‐lumbar/lumbar [TL/L]). Two‐year OOB, it was 5.6° (MT) and 5.4° (TL/L). The no brace‐wear and full brace‐wear compliance scenarios resulted respectively in 15/35 (43%) and 31/35 (89%) simulated spine deformities progressing by <5° over 2 years of treatment. Clinical significance: the FEM's ability to simulate the final correction with an accuracy on the order of the radiological measurements' interoperator reproducibility, combined with its sensitivity to brace‐wear compliance, provides confidence in the model's predictions for a comparative context of use like improving a brace's design before its application. [ABSTRACT FROM AUTHOR]

Floating offshore wind turbine (FOWT) is an innovative technology with little industry guidance for its hull design. Various FOWT floaters with different hull shapes claim to support the same turbines. Structural integrity and material expense analyses of different pontoon shapes were conducted, and it was found that some configurations, such as those with every two columns connected by both pontoon and bracing, have advantages over others. However, it is important to note that the choice of pontoon shape should be based on the wave loading conditions the floater will be exposed to. While a T-shaped pontoon provides a cost-effective solution under certain wave loading scenarios, it may not be the best option for all conditions. Specifically, ring pontoon designs with full bracing were found to be necessary for withstanding certain wave loads. Therefore, it is important to consider different Dominant Load Parameters (DLP) and ensure that a FOWT floater can withstand all applicable DLPs. An uneven hexahedral column shape, which combines the best attributes of square and round shapes, is proposed as a better alternative to cylindrical columns. It offers ease of manufacture and reasonably low drag. Bracing is found to be necessary for withstanding the wind turbine's incurred moment and forces. The conclusion is that platform design should prioritize manufacturing costs and strength over maximizing hydrodynamic performance. [ABSTRACT FROM AUTHOR]

Core stability training is crucial for competitive athletes, individuals who want to improve their health and physical performance, and those undergoing clinical rehabilitation. This study compared the ultrasound (US) muscle thickness of the abdominals and lumbar multifidus (LM) muscles between seven popular trunk stability exercises performed using hollowing and bracing maneuvers. Forty-four healthy young adults, aged between 21 and 32 years, performed a plank, bird dog, beast crawl, dead bug, Pilates tap, bridge, and side planks using the bracing and the hollowing maneuver. The thickness of the transversus abdominis (TrA), internal oblique (IO), and LM muscles was measured simultaneously using two ultrasound machines. Analysis of variance designs indicated that during hollowing, the bird dog and side plank exercises resulted in the greatest increase in the muscle’s relative thickness overall. The relative thickness of all muscles was significantly greater (p < 0.001) during hollowing (22.7 ± 7.80 to 106 ± 24.5% of rest) compared to bracing (18.7 ± 7.40 to 87.1 ± 20.9% of rest). The TrA showed the greatest increase in thickness (p < 0.001) compared to the IO and LM. Additionally, the IO had a greater increase in thickness (p < 0.001) than the LM. In conclusion, our findings indicate that the bird dog and side plank exercises, when performed with hollowing, showed the most significant total muscle thickness increase. Notably, the hollowing maneuver enhances the thickness of the TrA, IO, and LM muscles more than the bracing maneuver. This contributes to the discussion on optimal strategies for dynamic core stabilization.

Context: Protonics™ knee brace has been suggested as an intervention for patients with patellofemoral pain syndrome. However, the effectiveness of this knee brace compared with traditional conservative methods knee rehabilitation is lacking. Objective: To compare the effect of Protonics™ knee brace versus sport cord on knee pain and function in patients with patellofemoral pain syndrome. Design: Randomized controlled trial. Setting: Loma Linda University. Participants: There were 41 subjects with patellofemoral pain with a mean age of 28.8 (5.0) years and body mass index of 25.6 (4.7) kg/m² participated in the study. Intervention: Subjects were randomized to 1 of 2 treatment groups, the Protonics™ knee brace (n = 21) or the sport cord (n = 20) to complete a series of resistance exercises over the course of 4 weeks. Main Outcome Measures: Both groups were evaluated according to the following clinical outcomes: anterior pelvic tilt, hip internal/external rotation, and iliotibial band flexibility. The following functional outcomes were also assessed: Global Rating of Change Scale, the Kujala score, the Numeric Pain Rating Scale, and the lateral step-down test. Results: Both groups showed significant improvement in the outcome measures. However, the Protonics™ knee brace was more effective than the sport cord for the Global Rating of Change Scale over time (immediate 1.0 [2.1] vs post 2 wk 3.0 [2.2] vs 4 wk 4.6 [2.3] in the Protonics™ brace compared with 0.0 [2.1] vs 1.3 [2.2] vs 3.0 [2.3] in the sport cord, P < .01), suggesting greater satisfaction. Conclusions: Both study groups had significant improvements in the clinical and functional symptoms of patellofemoral pain. The Protonics™ knee brace group was significantly more satisfied with their outcome. However, the sport cord may be a more feasible and cost-effective method that yields similar results in patients with patellofemoral pain syndrome. [ABSTRACT FROM AUTHOR]

• What is currently known about this topic? • What new information is contained in this article? • Pectus carinatum is increasingly treated with dynamic compression therapy. Factors for success for are relatively unknown. • The pressure of initial correction and height of deformity are predictors for the total treatment time and the time to correction. Chest scores improved in the first months after start of treatment. Scores remained high. Pectus carinatum (PC) is a congenital chest wall deformity. In childhood, it is increasingly treated with dynamic compression therapy. Factors for success for dynamic brace therapy are relatively unknown. Between 2013 and 2020, 740 patients treated with the Dynamic Compression System (DCS), were studied. This included the effect of age, gender, pectus height, symmetry and pectus rigidity on treatment time and symptoms with linear multiple regression analyses. Carinatum height and high pressure of initial correction at the start of treatment were associated with a prolonged duration of treatment. For each cm increase in carinatum height, the total treatment duration increased with 1.9 months (p -value= 0.002, 95% CI: 0.70–3.13). An initial correction pressure of ≥7.6 pounds per square inch (psi), increased the treatment duration with 3.5 months (p -value 0.006, 95% CI: 1.04–6.01) compared to an initial correction pressure of ≤5.0 psi. A high initial pressure of correction of ≥7.6 psi increased the odds of having somatic symptoms with 1.19 (p -value= 0.012, 95% CI: 1.04–1.45) and psychosocial symptoms with 1.13 (p -value= 0.04, 95% CI: 1.01–1.27) compared to a low initial pressure of correction of ≤5.0 psi. An initial pressure of correction of 5.1–7.5 psi increased the odds of having somatic symptoms with 1.14 (p -value 0.046, 95% CI: 1.00–1.29) compared to an initial pressure of correction of ≤5.0 psi. Patients with asymmetric chests were more likely to abandon therapy High carinatum height and high initial pressure of correction are associated with prolonged bracing treatment and a higher failure rate. III [ABSTRACT FROM AUTHOR]

Block shear rupture is a potential failure mode in welded steel gusset plates. The research on this failure mode in welded connections is scarce, and in available few studies, only concentric loading condition has been considered. Nevertheless, gusset plates are often loaded eccentrically, either in-plane or out-of-plane, depending on the connection. This paper examines the block shear failure in welded gusset plates under eccentric loading. First, an advanced nonlinear finite element model with ductile fracture prediction capability was developed and verified in detail against the authors' experiment. Then, a comprehensive parametric study consisting of 260 connections was performed. Based on the results, the eccentricity of the applied load made the tensile and shear stress distributions on the failure planes uneven. The ratio of the eccentricity to the connection length was the main parameter that affected block shear strength under eccentric loads. In out-of-plane eccentric cases, gusset plate thickness was also a significant factor. Moreover, the findings implied that current block shear strength equations suggested for welded gusset plates did not take into account load eccentricity-induced effects and overestimates the connection capacity. Accordingly, modified design equations are proposed that predict the block shear strength under eccentric loading with greater accuracy. [ABSTRACT FROM AUTHOR]

Optimal design of the crossbeam is essential for the economical design of bridge towers as the crossbeam could considerably enhance the lateral stiffnesses of these towers by providing a special bracing for the tower columns. By using a reliability-based approach, this paper studies the optimal design of the crossbeam stiffness factor in bridge towers; this is defined as a dimensionless crossbeam stiffness relative to the tower column stiffness. A novel second-order matrix stiffness method (MSM) is applied to obtain a closed-form solution of the lateral stiffness of the bridge tower. The structural second-order stiffness matrix consists of combinations of the second-order element stiffness matrices and coordinate transformations. Subsequently, a reliability analysis to study the optimal design of the bridge tower is performed by considering the uncertainties arising from the design and construction of the bridge tower. The lateral stiffness of the bridge tower is set as an objective function while the total usage of materials is set as a constraint condition. Then, the influence of the crossbeam stiffness factor on the lateral stiffness of the bridge tower, including the fragility curve and the probabilistic behavior, is examined. Based on the reliability analysis, optimal design recommendations on the crossbeam stiffness of the bridge tower are presented. [ABSTRACT FROM AUTHOR]

To systematically review the literature to determine whether external ankle supports influence ankle biomechanics in participants with chronic ankle instability (CAI) during sport-related tasks. A literature search of MEDLINE, SPORTDiscus, and CINAHL databases was conducted in November 2021. Included studies were randomized crossover or parallel-group controlled trials in which researchers assessed ankle biomechanics during landing, running, or change of direction in participants with CAI using external ankle supports compared with no support. Two authors independently identified studies, extracted data, and assessed risk of bias (Cochrane risk-of-bias tool version 2) and quality of evidence (Grading of Recommendations Assessment, Development and Evaluation). Random-effects meta-analysis was used to compare between-groups mean differences with 95% CIs. Grading of Recommendations Assessment, Development and Evaluation recommendations were used to determine the certainty of findings. A total of 13 studies of low to moderate risk of bias were included. During landing, very low-grade evidence indicated external ankle supports reduce frontal-plane excursion (mean difference [95% CI] = −1.83° [−2.97°, −0.69°], P =.002), plantar-flexion angle at initial contact (−3.86° [−6.18°, −1.54°], P =.001), and sagittal-plane excursion (−3.45° [−5.00°, −1.90°], P <.001) but not inversion angle at initial contact (−1.00° [−3.59°, 1.59°], P =.45). During running, very low- to low-grade evidence indicated external ankle supports reduce sagittal-plane excursion (−5.21° [−8.59°, −1.83°], P =.003) but not inversion angle at initial contact (0.32° [−2.11°, 1.47°], P =.73), frontal-plane excursion (−1.31° [−3.24°, 0.63°], P =.19), or plantar-flexion angle at initial contact (−0.12° [−3.54°, 3.29°], P =.94). Studies investigating changes of direction were insufficient. Very low-grade evidence indicated external ankle supports reduce frontal-plane excursion but not inversion angle at initial contact in participants with CAI during landing. Limiting frontal-plane excursion may reduce ankle-sprain risk. Frontal-plane ankle kinematics were not influenced by external ankle supports during running. Sagittal-plane reductions were observed with external ankle supports during landing and running with low to very low certainty, but their influence on ankle-sprain risk is undetermined. [ABSTRACT FROM AUTHOR]

Scoliosis and Scheuermann's disease are common spinal deformities that affect a substantial population, particularly adolescents, often impacting their quality of life. This comprehensive review aims to present a detailed understanding of these conditions, their diagnosis, and various treatment strategies. Through an extensive exploration of current literature, the review discusses the etiology of these spinal deformities and the use of diagnostic tools such as X-rays and MRI. It further delves into the range of treatment options available, from conservative approaches such as physiotherapy and bracing to more invasive surgical interventions. The review underscores the necessity of an individualized treatment approach, taking into account factors such as the patient's age, the severity of the curvature, and overall health. This all-encompassing perspective on scoliosis and Scheuermann's disease will aid in evidence-based decision making in their management with the goal of improving patient outcomes. [ABSTRACT FROM AUTHOR]

In the 1950s and 1960s, some Louisiana's bridges were constructed using steel twin-girder or truss systems, in which floorbeams are carried by the main members and continuous (spliced) stringers are supported by the floorbeams. The main members are either two-edge (fascia) girders or trusses. One of the byproducts of this type of design is that stringer bottom flanges are in compression in the negative moment region over the floorbeams, which could result in lateral torsional buckling (LTB) should inadequate lateral bracing be provided. When the continuous stringers are load-rated using AASHTOWare Bridge Rating analysis software (BrR 7.1), their LTB resistance is calculated in accordance with American Association of State Highway Officials (AASHTO) LRFD Bridge Design Specifications, which do not account for potential bracing provided by a noncomposite deck and could underestimate flexural strength. As a result, the rating may be low enough to require restrictive load posting or even bridge closure. This paper summarizes extensive experimental and numerical studies investigating the behavior of this type of floor system by testing two-span, continuous, steel stringers in a grillage that included three stringer lines, an interior transverse support (floorbeam), and transverse diaphragms at the end supports. The tests and finite-element analysis studies encompassed a variety of unbraced lengths and support conditions with steel diaphragms or timber ties acting as bracing members. The findings demonstrated that, for the systems examined, minimal bracing could substantially enhance LTB resistance and supported the use of higher flexural strengths than those currently predicted using AASHTO Specifications. This paper illustrates the use, challenges, and successes in LTB modeling beams with various support and bracing conditions. The most flexible cases were the most difficult to achieve close agreement with experimental results. [ABSTRACT FROM AUTHOR]

The aim of current research was to establish the relationship between the stress state of the ribbed-ring dome framework and the degree of its bracing. It was assumed that the meridional ribs and rings of the dome framework are made of metal. The framework of the dome consists of 24 ribs and 7 rings. The study was performed for a ribbed-ring dome of spherical shape with a span of 39.3 m and a height of 11.0 m on computer models. The initial computer model of the framework of a ribbed-ring dome made of steel I-beams without bracing has been developed. On the basis of the initial model, additional models were developed for the frameworks with bracing between meridional edges in four, eight cyclically symmetric sectors and in all sectors. Both for the initial model and for all models of the dome framework with bracing, computer calculations were performed for the effect of the load from the own weight of the load-bearing and enclosing structures, and two variants of the snow load. During the calculations, deformations, internal forces and stresses in the meridional ribs, upper and intermediate rings of different models were determined, which were compared with each other. Graphs of changes in deformations of the frame, graphs and diagrams of changes in internal forces and stresses in the meridional ribs, in the upper and intermediate rings of the dome, depending on the degree of bracing in the framework, are obtained. An assessment of the influence of bracing on the stress state of the rib-ring dome frame is performed. The peculiarities of the influence of different coupling schemes on the stressed state of the dome frame are noted.

Abstract Background Bracing and exercise methods were used in scoliosis rehabilitation and proven effective. There was little evidence about the efficacy of insoles on scoliosis. Objective This study aimed to investigate the effects of 3D personalized insoles on curve magnitude, postural stability, and quality of life (QOL) in moderate adolescent idiopathic scoliosis (AIS) patients. Methods Thirty-six volunteers with adolescent idiopathic scoliosis, who had moderate curves (20°-45°), were randomly divided into the experimental and control groups. The control group received traditional rehabilitation with bracing and exercises, and the experimental group received the insole interventions in addition to traditional rehabilitation. The outcome measures were Cobb angle, angle of trunk rotation (ATR), postural stability, and quality of life (Scoliosis Research Society-22 questionnaire). Measurements were conducted at baseline examination, two months and six months. Results After two and six months of treatment, the Cobb angle and ATR in both groups were significantly decreased as compared with the baseline (p 0.05). There was a significant difference in the sagittal balance index at six months compared to the control group (p 0.05). Conclusion Combining bracing with exercise in patients with moderate AIS is effective. 3D personalized insoles cannot reduce the Cobb angle and angle of trunk rotation of patients with moderate AIS but might have the potential to improve postural stability.

Bracing can reduce curve progression in order to prevent or delay scoliosis surgery in growing children. Brace treatment is effective in adolescent idiopathic scoliosis (AIS), but there is less evidence of its efficacy in early-onset or non-idiopathic scoliosis. We assessed the outcome of bracing at the end point of treatment, including the patients' perception of clinical results. We reviewed 480 patients treated using Boston brace from 2010–2020 (70% female); 249 patients completed bracing (52%) and 118 patients (47.4%) did not require surgery, with 83% having idiopathic scoliosis. Brace success was considered scoliosis below 50° at the end of bracing, with the patient skeletally mature. A total of 131 patients required scoliosis surgery after bracing (64% had idiopathic scoliosis; adolescents 57% and juveniles 43%). All patients had a minimum two-year follow-up after bracing or after scoliosis correction, with the quality of life assessment questionnaires. A total of 98 out of 182 patients with idiopathic scoliosis did not require surgery (54%). Thoracic scoliosis improved with bracing by a mean of 3.4° and thoracolumbar/lumbar scoliosis by a mean of 6.8°. A total of 85 patients with AIS (64%) but only 9 patients with JIS (20%) did not need surgery. In the AIS group, 97 patients had scoliosis of 20–40°; 71 of these patients (73.2%) did not require scoliosis correction at the end of bracing. In total, 84 patients with idiopathic scoliosis had surgery at a mean of 14 years (surgery was delayed by a mean of 3.2 years). In total, 20 of 67 patients with non-idiopathic scoliosis did not need surgery (30%). Thoracic scoliosis improved with bracing by a mean of 8.4° and thoracolumbar/lumbar scoliosis by a mean of 0.8°. A total of 47 patients with non-idiopathic scoliosis required surgery at a mean of 13.1 years (surgery was delayed by a mean of 5.2 years). Multivariate regression analysis showed that idiopathic scoliosis, AIS, closed triradiate cartilage, post-menarche status, higher Risser grade and smaller scoliosis angle at initial presentation predicted brace success. Patients reported good function and self-image, reduced pain and high satisfaction after treatment in both the bracing-only and the bracing followed by surgery groups. [ABSTRACT FROM AUTHOR]

Study Design.: Prospective cohort study. Objective.: The purpose of this study was to evaluate the relationship between patient-reported experience measures (PREMs) and patient-reported outcome measures (PROMs) in adolescent idiopathic scoliosis (AIS) managed nonsurgically with bracing or observation. Summary of Background Data.: PREMs and PROMs are increasingly used to assess the effectiveness of patient-centered health care provision. To date, no study has attempted to study the relationship between PREMs and PROMs in AIS. Methods.: All patients who visited our one-stop, tertiary center for AIS between 2020 and 2021, were asked to complete pairs of PREMs and PROMs questionnaires. PREMs were evaluated using our institution's outpatient experience survey adapted from Hospital Consumer Assessment of Healthcare Providers and Systems survey. PROMs were determined via the Scoliosis Research Society-22 revised (SRS-22r) and European Quality of Life Five-Dimension Five-Level (EQ-5D-5L) forms. Results.: In total, we included 730 patients who completed pairs of PREMs and PROMs questionnaires. 451 patients were treated by observation and 279 were braced. In the observation group, there was no association between patient experience and SRS-22r or EQ-5D-5L scores. In the brace group, improved SRS-22r were associated with higher PREM scores. In particular, having confidence and trust in treating physicians (r =0.34), reporting that their worries and concerns were addressed during treatment (r =0.34) and being taught self-care (r =0.33, P <0.0001 for all) were most highly correlated with better SRS-22r scores. Conclusions.: In patients with AIS treated with bracing, improved patient experience was positively correlated with better patient reported outcomes, especially if patients' concerns were addressed during treatment and they received supportive care and education on self-care. In contrast, patient experience did not correlate with PROMs in children and adolescents with AIS who were under observation. [ABSTRACT FROM AUTHOR]

In order to improve the force performance of traditional anti-buckling energy dissipation bracing with excessive non-recoverable deformation caused by strong seismic action, this paper presents a prestress-braced frame structure system with shape memory alloy (SMA) and investigates its deformation characteristics under a horizontal load. Firstly, this paper establishes a theoretical analysis model by analyzing the geometric relationship between the deformation of SMA cables and inter-story displacement based on the internal force balance equation. The model is used to solve the anti-lateral displacement stiffness of the SMA cable-supported frame structure and to derive a reasonable formula for calculating the initial prestress and cross-sectional area of SMA cables. Then, the mechanical behavior of the SMA cable-supported frame structure system under an equivalent horizontal load is simulated using ABAQUS software and compared with the calculated results of conventional tie-supported and non-dissipative-supported frame structures. The results show that the force performance of the frame structure system determined by the SMA cable design method proposed in this paper is significantly improved under the horizontal load. Furthermore, it can ensure a certain ductility requirement of the frame structure system, which verifies the effectiveness of the design method of the SMA cable frame structure system proposed in this paper. [ABSTRACT FROM AUTHOR]

This research investigates the impact of thermal loads on reinforced concrete (RC) buildings in Saudi Arabia and how they behave on sloped terrain. The study analyzed the effects of different types of support systems (hinged and fixed supports) and strengthening systems (with and without bracings) using the software ETABS-V20. Ground + 9 typical floors frame RC models on sloped terrain subjected to seismic loads were used for the investigation. The dynamic analysis of the ETABS models was performed to evaluate the lateral displacement, storey drift, column shear forces, and base shear forces of the buildings. The study found that using a bracing system and fixed supports under seismic loads increases the model's displacement and storey drift compared to models with hinged supports and no bracing system. The maximum shear forces values were also higher for models with bracing systems and fixed supports, while the minimum values were for models without bracing systems and with hinged supports. [ABSTRACT FROM AUTHOR]

Purpose: The postoperative use of a rehabilitative knee brace after isolated primary anterior cruciate ligament (ACL) reconstruction (ACLR) using a hamstring tendon (HT) autograft is controversial. A knee brace may provide subjective safety but can cause damage if applied incorrectly. The aim of this study is to evaluate the effect of a knee brace on clinical outcomes following isolated ACLR using HT autograft. Methods: In this prospective randomised trial, 114 adults (32.4 ± 11.5 years, 35.1% women) underwent isolated ACLR using HT autograft after primary ACL rupture. Patients were randomly assigned to wear either a knee brace (n = 58) or no brace (n = 56) for 6 weeks postoperatively. An initial examination was performed preoperatively, and at 6 weeks and 4, 6, and 12 months. The primary endpoint was the subjective International Knee Documentation Committee (IKDC) score to measure participants' subjective perceptions. Secondary endpoints included objective knee function assessed by IKDC, instrumented knee laxity measurements, isokinetic strength tests of the knee extensors and flexors, Lysholm Knee Score, Tegner Activity Score, Anterior Cruciate Ligament—Return to Sport after Injury Score, and quality of life determined by Short Form-36 (SF36). Results: There were no statistically significant or clinically meaningful differences in IKDC scores between the two study groups (3.29, 95% confidence interval (CI) −1.39 to 7.97, p = 0.03 for evidence of non-inferiority of brace-free compared with brace-based rehabilitation). The difference in Lysholm score was 3.20 (95% CI −2.47 to 8.87); the difference in SF36 physical component score 0.09 (95% CI −1.93 to 3.03). In addition, isokinetic testing did not reveal any clinically relevant differences between the groups (n.s.). Conclusions: Brace-free rehabilitation is non-inferior to a brace-based protocol regarding physical recovery 1 year after isolated ACLR using HT autograft. Consequently, the use of a knee brace might be avoided after such a procedure. Level of Evidence: Level I, therapeutic study. [ABSTRACT FROM AUTHOR]

The prevalence and treatment of severe scoliosis and other spinal anomalies in patients with Turner's syndrome (TS) is not well reported. This is the largest case series to date regarding the treatment course and outcomes of severely scoliotic TS patients. A retrospective chart review was performed to identify all patients with TS seen at a single center academic pediatric institution from 2007 to 2021. Of these, the presence of concomitant severe scoliosis or other spinal anomalies was determined, defined by a major coronal curve measuring 45° or greater. Demographic, clinical, surgical, and radiologic data was collected at both pre- and post-intervention time points. A retrospective chart review identified 306 patients with TS. Of those, six were identified to have severe scoliosis or other severe spinal anomalies requiring fusion. All four posterior spinal fusion (PSF) patients demonstrated improvement of their spinal curvature. One patient who electively pursued only bracing demonstrated minimal improvement and surgery was subsequently recommended, but not pursued. One patient expired from a pre-existing heart condition prior to intervention. All postoperative complications resolved with no further complications. The only brace-related complication was an allergic rash related to the brace material. All four patients who underwent PSF demonstrated significant improvement of their spinal curvature with few post-surgical complications. None of the patients in the bracing cohort demonstrated stabilization of their spinal curvature. Therefore, these data corroborate with prior studies, suggesting that operative management consisting of spinal fusion with instrumentation provides optimal clinical outcomes, compared to bracing only. [ABSTRACT FROM AUTHOR]

A sensitivity analysis for loading conditions and muscle deconditioning on astronaut response for spaceflight transient accelerations was carried out using a mid-size male human body model with active musculature. The model was validated in spaceflight-relevant 2.5–15 g loading magnitudes in seven volunteer tests, showing good biofidelity (CORA: 0.69). Sensitivity analysis was carried out in simulations varying pulse magnitude (5, 10, and 15 g), rise time (32.5 and 120 ms), and direction (10 directions: frontal, rear, vertical, lateral, and their combination) along with muscle size change (± 15% change) and responsiveness (pre-braced, relaxed, vs. delayed response) changes across 600 simulations. Injury metrics were most sensitive to the loading direction (50%, partial-R2) and least sensitive to muscle size changes (0.2%). The pulse magnitude also had significant effect on the injury metrics (16%), whereas muscle responsiveness (3%) and pulse rise time (2%) had only slight effects. Frontal and upward loading directions were the worst for neck, spine, and lower extremity injury metrics, whereas rear and downward directions were the worst for head injury metrics. Higher magnitude pulses and pre-bracing also increased the injury risk. [ABSTRACT FROM AUTHOR]

Adolescent idiopathic scoliosis (AIS) affects between 0.5% and 5.2% of adolescents and is progressive in two-thirds of cases. Bracing is an effective non-operative treatment for AIS and has been shown to prevent up to 72% of curves from requiring surgery. This paper explores the presentation of AIS in the UK and identifies who would be suitable for bracing, as per guidelines published by the Scoliosis Research Society (SRS) and British Scoliosis Society (BSS), through curve severity and skeletal maturity at presentation. There were 526 patients with AIS eligible for inclusion across three tertiary referral centres in the UK. The study period was individualised to each centre, between January 2012 and December 2021. Only 10% were appropriate for bracing via either SRS or BSS criteria. The rest were either too old, skeletally mature or had a curve size too large to benefit. By the end of data collection, 38% had undergone surgery for their scoliosis. In the UK, bracing for AIS is only suitable for a small number at presentation. Future efforts to minimise delays in specialist review and intervention will increase the number of those with AIS suitable for bracing and reduce the number and burden of operative interventions for AIS in the UK. [ABSTRACT FROM AUTHOR]

Study Design.: A prospective comparative study. Objective.: To investigate the benefits of postoperative application of lumbosacral orthosis after single-level discectomy for lumbar disk herniation (LDH). Summary of Background Data.: Although many surgeons use postoperative lumbosacral orthosis for patients with LDH, there is no clear evidence to support or deny its effectiveness. Materials and Methods.: Ninety-nine consecutive patients who underwent the microscopic discectomy were included. They were divided into two groups: orthosis group and nonorthosis group, before surgery. The recurrence rate and reoperation rate were compared between the two groups at four-week, six-month, and one-year follow-up. Japanese Orthopaedic Association Score for lumbar spine (L-JOA score) at two-week and one-year follow-up, lower extremities and low back pain's visual analog scale (VAS) and Oswestry Disability Index (ODI) at six-month and one-year follow-up were compared. Results.: Forty-two patients in the orthosis group and 39 patients in the nonorthosis group were followed up for at least one-year after surgery. Recurrence occurred in three patients (7.1%) in the orthosis group and six (15.4%) in the nonorthosis group within one-year. Two patients (4.8%) in the orthosis group and two patients (5.1%) in the nonorthosis group underwent reoperation. There were no significant intergroup differences in the recurrence rate and in the reoperation rate. No significant difference was also observed between the two groups in L-JOA score, ODI, VAS of low back pain, and leg pain at one-year after surgery. Furthermore, at any other follow-up period, no significant differences were observed between the two groups in recurrence rate, reoperation rate, L-JOA score, VAS of low back/leg pain, or ODI. Conclusions.: The use of a postoperative orthosis did not reduce recurrence or reoperation rates, nor did it improve postoperative clinical symptoms. The routine use of an orthosis may not be necessary after single-level lumbar discectomy. [ABSTRACT FROM AUTHOR]

Study Design.: Retrospective cohort study. Objective.: To assess if initial adherence to prescribed brace wear for adolescent idiopathic scoliosis (AIS) predicts future adherence and curve improvement. Summary of Background Data.: AIS bracing can be effective if patients adhere to prescribed brace wear. Previous research has associated age, sex, and brace prescription length with future adherence. We hypothesize that a patient's initial adherence to brace wear may be associated with future adherence and outcomes. Materials and Methods.: Consecutive AIS patients who met the Scoliosis Research Society (SRS) criteria for bracing from 2015 to 2019 at a single center were reviewed. Patients were stratified into groups based on their adherence during the initial one-month brace wean-in period—adherent patients were defined as wearing the brace >80% of the daily prescribed amount. Brace wear was recorded by a thermosensor and assessed during the wean-in period, six-, 12-, and 24-month postbracing appointments. Statistical testing was conducted to analyze if initial adherence was associated with future adherence, curve change, and bracing success —defined as reaching Risser stage 4 with a Cobb angle <40°. Results.: Sixty patients (mean age=12.5 yr) were included, of which the majority were females (83%) with thoracic curves (70%). Thirty-two patients were considered adherent, and this cohort demonstrated improved adherence relative to the nonadherent group at the six-, 12-, and 24-month appointments (P <0.001). Adherent patients also showed a significant reduction in their scoliosis at the 12-month appointment, unlike nonadherent patients (P <0.001). Ninety-seven percent of adherent patients achieved bracing success compared with 71% of nonadherent (P =0.016). Females were more likely to be adherent than males. Conclusions.: Initial adherence to prescribed AIS brace wear was associated with future adherence, bracing success, and curve improvement. Early recognition of nonadherence may offer an opportunity for supportive intervention to improve brace wear behavior. [ABSTRACT FROM AUTHOR]

Context: In-season glenohumeral instability is a common clinical dilemma faced by physicians who care for athletes. Both nonoperative and operative management of athletes with in-season glenohumeral instability have been well described. Functional bracing remains less understood as a treatment modality. This review aims to provide an update on the most recent literature regarding the use of functional bracing for shoulder instability. Evidence Acquisition: MEDLINE (PubMed and Ovid platforms), Web of Science, Embase, and Cochrane Database of Systemic Reviews were searched for articles available in English through June 1, 2021. The search terms shoulder brace, shoulder instability, athlete, in-season, glenohumeral instability, anterior shoulder instability, posterior shoulder instability, and bracing were used. Study Design: Clinical review. Level of Evidence: Level 3. Results: Research on the clinical outcomes of functional bracing remains mixed for patients with shoulder instability. Two studies have demonstrated improved return to play with functional bracing, while 1 study demonstrated no difference in return to play between braced athletes and nonbraced athletes with anterior instability. One previous study demonstrated that prophylactic use of bilateral shoulder stabilizing braces significantly decreased time lost due to injury in athletes with posterior instability. Previous biomechanical studies have demonstrated improved proprioception with brace wear as well as successful limitation of active shoulder range of motion. Conclusion: Bracing in athletes with shoulder instability remains an important nonoperative treatment modality. While clinical benefits are yet to be validated through high-quality studies, preliminary results suggest a potential benefit to recovery, with minimal downsides. Nevertheless, the use of bracing remains an individual choice but is especially recommended in settings of high-risk sports for shoulder instability, such as football. [ABSTRACT FROM AUTHOR]

Congenital talipes equinovarus is one of the most prevalent birth defects, affecting approximately 0.6 to 1.5 children per 1000 live births. Currently, the Ponseti method is the gold-standard treatment for idiopathic clubfeet, with good results reported globally. This literature review focuses on common errors encountered during different stages of the management of idiopathic clubfeet, namely diagnosis, manipulation, serial casting, Achilles tenotomy, and bracing. The purpose is to update clinicians and provide broad guidelines that can be followed to avoid and manage these errors to optimize short- and long-term outcomes of treatment of idiopathic clubfeet using the Ponseti method. A literature search was performed using the following keywords: "Idiopathic Clubfoot" (All Fields) AND "Management" OR "Outcomes" (All Fields). Databases searched included PubMed, EMBASE, Cochrane Library, Google Scholar, and SCOPUS (age range: 0–12 months). A full-text review of these articles was then performed looking for "complications" or "errors" reported during the treatment process. A total of 61 articles were included in the final review: 28 from PubMed, 8 from EMBASE, 17 from Google Scholar, 2 from Cochrane Library, and 6 from SCOPUS. We then grouped the errors encountered during the treatment process under the different stages of the treatment protocol (diagnosis, manipulation and casting, tenotomy, and bracing) to facilitate discussion and highlight solutions. While the Ponseti method is currently the gold standard in clubfoot treatment, its precise and intensive nature can present clinicians, health care providers, and patients with potential problems if proper diligence and attention to detail is lacking. The purpose of this paper is to highlight common mistakes made throughout the Ponseti treatment protocol from diagnosis to bracing to optimize care for these patients. [ABSTRACT FROM AUTHOR]