Health-related quality of life of adolescents conservatively treated for idiopathic scoliosis in Korea: a cross sectional study
Lee H, Choi J, Hwang J, Park J
Scoliosis and Spinal Disorders 2016, 11 :11 (31 March 2016)
I think we (medical professionals, parents and adolescents with scoliosis) can all agree that adolescents, no matter where they live, can experience psychological distress from physical deformities that can occur from scoliotic changes and that this can negatively affect their body image. Unless adequate treatment is provided within a timely manner, AIS can lead to increasing physical, psychological and social problems. This includes limited physical activities, musculoskeletal pain, poor body image, self-depreciation, maladjustment at school and difficulty in peer relationships. This study was undertaken to evaluate how the stresses of scoliosis and related factors affect the health-related quality of life (HRQoL) in young Koreans with idiopathic scoliosis. While the study took place in Korea, I do believe its topic of interest is universal.
In this study 110 adolescents with idiopathic scoliosis were recruited. Background medical information was collected such as severity of curves, type of treatment received and age at which the diagnosis was made. Then their health related quality of life(HRQoL) was measured using a Korean version of a questionnaire originally produced by the Scoliosis Research Society (SRS-22).
Health related quality of life of adolescents with idiopathic scoliosis, as measured by the SRS-22r, differed by age of diagnosis and type of treatment. Those that were diagnosed at earlier ages, between 9-12, reported higher HRQoL (better quality) than those diagnosed at a later age. This may be attributed to the fact that severity of curves will be milder early on and that conservative treatment can be effective in halting progression of curves. Therefore, early detection of scoliosis will help to identify young children with scoliosis before mild curves turn into significant physical deformity. The American Academy of Pediatrics recommends screening at ages 10, 12, 14 and 16 but the Scoliosis Research Society recommends annual screenings for all children ages 10 -14 years.
Bracing is known to negatively affect quality of life and the type of bracing used further affects results. However, this study reported that adolescents who were under regular observation, even if they used a brace, fared better than those who were not followed at all and were instructed to only perform exercise on their own at home. It was also discussed that bracing reduces body asymmetry and that those with better symmetry, despite curve measurement, experienced higher HRQoL. In this regard the study found no difference in HRQoL by curve severity. Health related quality of life, however, was significantly affected by perception of one’s body image. Self-image is one of the major factors affecting the development of friendships and the ability of adolescents to adapt socially. It is also known that the prevalence of idiopathic scoliosis is greater in females than males and that in general body dissatisfaction is also more common among adolescent girls with or without scoliosis. It is important that that these psycho-social issues be taken into consideration.
In conclusion this study found that young female adolescents with spinal deformity are more likely to experience psychosocial problems from spinal deformity. Self- image in adolescents with more severe curves is worse than those with mild or moderate curves and more so in females. An earlier diagnosis combined with conservative treatment relates to a higher quality of life. Regular school scoliosis screenings are warranted to optimize early detection of milder curves in all children and adolescents.
Therefore, if I may add my own two cents and repeat my usual mantra, “wait and see” remains detrimental. Get your kids screened early and regularly for scoliosis. If even a small curve is noted run to your nearest Best Practice Scroth practitioner and prevent physical as well as pyscho-social issues from occurring or escalating. A few hours is all it will take.
It’s that easy!
Summer – JUST DO IT!
Summer is here and tis the season many of us look forward to all year. It is a time that allows many adults and children to be more active, especially outdoors.
One of the questions I am frequently asked by scoliosis patients and parents of scoliosis patients is if they or their child should stop engaging in a particular sport or physical activity. The answer is a definitive NO! Movement and exercise are GOOD – for both the body and the mind. So get out there and JUST DO IT or go ahead and keep on doing it! Scoliosis does not mean you can’t do what you enjoy.
If you wear a brace and can do what you wish with the brace on then definitely wear your brace during your activity time. If your brace interferes it is okay to take it off for a short while to get your exercise in. Just put it right back on as soon as you can.
If you feel an activity or sport contributes to poor loading of your spine (as needed for your curve and as learned in a Schroth course) then attempt to correct it as best you can during your activity and make sure you get a good Schroth session in sometime that day following your activity.
The only no-no for those with Scoliosis (or “contraindication” as the pros call it) are certain moves and positions done in Yoga. Either stay away from Yoga completely or consult with your Schroth therapist as to what is acceptable and what is not for your curves.
Otherwise – go out and play baseball, volleyball, badminton, tennis. Go swimming or jogging or skating. Take a dance class. Do some weight lifting. Have FUN! Just stay aware of the corrective postures for your curves and keep up with your Schroth program or sign up for one if you have Scoliosis and haven’t done so yet. It is one of the best things you can do to halt your Scoliosis.
ENJOY THE REST OF YOUR SUMMER 🙂
May – Looking Good!
Just a short note this month to talk about compliance to your exercises and ADL activities. It must be emphasized once again how VERY important it is to comply to your prescribed program and to keep on doing it.
Just going through a Short Term Intensive Scoliosis Rehab program or knowing what to do is NOT enough. For your exercises to work you actually HAVE TO DO THEM!!!!!!
Of course it’s a pain- we get that- but doing your ADL, ADL with breathing, Physiologic and power Schroth exercises on a DAILY basis is the ONLY way the exercises can help stabilize your spine. At Scol-Rx we want each and every patient to be successful…to FEEL GOOD and to LOOK GOOD.
And-if YOU look good…WE look good. We all want to “look good!”
So, please, continue to do your very best to stay motivated and do like the song title from the Broadway show, In The Heights, says, “Just Breathe!”….AND…. DO YOUR SCHROTH EXERCISES 6-7 times per week.
Don’t forget to check out this article…
April – Costs Effectiveness of a Schroth Method Program
When I take inquiry calls about Scolrx’s Schroth Method Short Term Scoliosis Programs, I feel and hear the demeanor of the caller change when they hear the cost of the program or that their medical insurance may not fully cover the expenses.
I get it. I really do. It isn’t cheap. And… it is difficult to explain on the phone, without visuals, exactly what the program does or how much it can help. On top of that doctors may not always recommend a Schroth program because they have little knowledge of it.
I was in this SAME position when one of my children was in need. At the time, I ended up taking out a small short-term loan and pondered long and hard if I was making the right decision. I stressed. I drove my family crazy. I bombarded our future provider’s office with questions by email. My daughter, however, was so miserable with the treatment she was receiving that I ultimately felt that even the “hope” of something else working was worth the cost. In hindsight, my outlay of time and money (with the added expense of travel and a week away from home) was definitely worth it! Even as an experienced physical therapist, I was extremely impressed with how well the exercises worked and how easily they fit into daily routines. I became a true believer quickly and then worked hard to become a certified provider so I could share this wonderful program with others. As a mother I was grateful for the level of competency and motivation my child developed by the completion of the course. She was able to work independently at improving her scoliosis without nagging and has continued to do so.
- Schroth method as a short term conservative treatment approach for Scoliosis, as good as it is, is still a rarity in the United States. It is relatively unknown here, receiving much more popularity in Europe, especially Germany where it originated and in Spain. Schroth methodology is not taught in Physical Therapy or Chiropractic Programs in this country or in medical schools. Trainings to become a Certified Schroth Practitioner, especially in the Schroth Best Practice™ Method, are scarce in the U.S. and may even involve a trip overseas for a practitioner to complete training.
- Very few therapists offer Schroth as Scoliosis Short-Term Rehabilitation based on the European curriculum. (European programs take place in in-patient clinics where classes are taught in large groups and a stay is generally 4-6 weeks.) Scolrx is one of the few outfits in the U.S. that provides complete Schroth programs in a short amount of time. Each individual receives undivided, one to one training with their therapist for 12-21 hours where they learn and build on the skills needed to succeed. Exercises, postures and activities of daily living are devised specifically for each client as they relate to their individual curve patterns.
Do you or your child really have 4-6 weeks available, not to mention the cost of a month in Europe, to spend learning an exercise and posture program when you can learn it individually in 12-21 hours?
Some hospital outpatient programs do exist in the New York area, but few give condensed, individualized programming or manuals to take home. Schroth trained therapists who treat at individual sessions for hourly rates can certainly be found but hourly rates add up quickly and may cost more than completing a short-term program in the long run. Plus, it has been noted that…
The patients who generally get the BEST RESULTS are the ones who learn the whole program in a short amount of time and OWN it.
- In addition to the hours spent directly with the client, several more hours are spent behind the scenes preparing that all important, totally individualized manual. Pictures and videos taken at the sessions are compiled and set with explicit written instructions. This makes for easy reference if one has doubt about something or anything from their training.
- At Scolrx we also provide ongoing support for our clients. When one is on their own with their exercises the treating therapist will remain available for questions that may arise, for being a cheering squad if necessary, for sharing accomplishments and even disappointments – as long as is needed. We can assist via phone, email, on computer or in person. One never has to feel alone on the journey.
SO TO RECAP
The cost of a Schroth Best Practice Program is based on specialized training, expertise, content devised specifically for each individual, time, and ongoing support.
And, while a Schroth program doesn’t come cheaply, the benefits have been shown (in the literature and in the clinics) to be significant. One learns how to manage their specific scoliosis in an efficient manner, in a relatively short amount of time (as compared to ongoing hourly sessions or in-clinic stays.) One gains some control over their condition, determination and a sense of accomplishment. One becomes independent in performing their exercises, which then assists in halting or possibly decreasing curves. (This may also cut down on brace time and doctor visits in some cases.) In addition better posture and cosmetic appearance can be achieved and back pain management is learned for life.
Now IMAGINE a happier child or a happier you, because you or your child feel better, look better and are keeping your curves from getting worse. You might even be decreasing those curves. By being proactive you will gain some degree of control over the situation and so your Scoliosis diagnosis will cause less stress. And how much is it worth to even have a chance to get out of a brace sooner or avoid surgery? You decide.
Investing in a Schroth Method program gives one skills that can be used for life.
At Scolrx we are always willing to discuss payment options in advance and do our utmost to assist you with the process of reimbursement. Program costs are based on estimated hours for the entire program and are adjusted only if there is a large time factor discrepancy. That some insurance companies don’t reimburse for programs that have been documented to be so beneficial, which can save them untold amounts of money in the long run is a travesty and something parents, patients and providers need to band together to fight. (Maybe another blog?)
We invite you to bombard us with all your questions (preferably via email so we can answer when convenient and not during someone’s treatment time – but any way you wish to contact us is ok!) We remain passionate about the benefits of this improved Schroth approach and feel everyone with Scoliosis should have access to it.
The BOTTOM STRAIGHT LINE (pun intended) is that a Schroth Method Program may seem expensive but the benefits definitely make it cost effective in the long run.
Contact us now to get started on the best and straightest path for the conservative treatment of Scoliosis. It is a mathematical fact that the shortest distance between two points is a straight line – not a curved one!
During initial conversations I am often asked what the difference is between “regular “ Schroth and Schroth Best Practice. Let me try to explain…
Schroth was designed originally for thoracic curves exceeding 80° and for kyphosis (round back) of the trunk due to spinal rotation and rib humps. It took into account the coronal (side to side) and transverse (rotary) planes of the body but not the sagittal (front to back.) As time went on in the European clinics some of the original practices were minimized to address more lumbosacral corrections and only strived to get to midline rather than overcorrecting. Schroth treatment methodology became more and more complex and fine details were often more the focus than the main curve. Patients with curves less than 40° with flatback deformities were not seeing any significant development, especially in that sagittal plane.
Using more than 30,000 evaluations of in brace x-rays, Dr. Hans Rudolf Weiss, grandson of Katharina Schroth, along with Dr. Marc Moramarco have continuously improved in brace corrections and the effectiveness of corrective movements.
Since 2004 training times have been shortened but concepts remain based on the original 3 dimensional approach of Katharina Schroth. Schroth Best Practice™ was officially established in 2010. With this updated training patients can now achieve results within a week or less in contrast to the 4-6 weeks of in-patient rehabilitation. This Scoliosis Short-Term Rehabilitation (SSTR) has shown results that have been repeatable worldwide. In addition Schroth Best Practice™ has added corrections in the Sagittal plane, making treatment 3-dimensional. This has been found to be an integral part of treatment, especially in the early stages.
Noted as well is that 30 minutes of daily scoliosis exercise without the knowledge of CURVE-PATTERN SPECIFIC ADL’S (which is part of Schroth Best Practice™) is less effective because without them the curve(s) continue to be improperly loaded during the rest of the day.
In conclusion, Schroth Best Practice™ is indeed “Schroth” but the newest evolution is preferred in curves less than 70° because it is simpler for the patient, can be learned in about a week, addresses all three planes of the body, makes the patient aware of the
importance of unloading the spine and emphasizes the maintenance of postural corrections throughout the day.
February – Proximal Junctional Kyphosis
Sagittal Balance Is More Than Just Alignment: Why PJK Remains An Unresolved Problem
This research report, undertaken by Steven D. Glassman, Mark P. Coseo and Leah Y. Carreon and published in the journal, “Scoliosis and Spinal Disorders” in January 2016 states that “the durability of adult spinal deformity surgery remains problematic.” It cites that revision rates of adults undergoing surgical spinal correction is greater than 20% and that Proximal Junctional Kyphosis remains a difficult problem to solve.
The term Proximal Junctional Kyphosis or PJK is presently used to describe any failure or loss of spinal alignment above a spinal fixation, whether that fixation is caused by surgery or other means such as a compression fracture or spondylolisthesis. The article states that generally PJK is seen as a result of poor bone quality, overaggressive deformity or inadequate fixation.
The study goes on to suggest that failure to control the rate of PJK after surgical correction may be “related in part to the narrow focus on mechanical factors” and that many patients with PJK have co-existing neuromuscular diseases. (Schroth method exercises address spinal mechanisms in 3 dimensions and are effective with people who have neuromuscular diseases.) It also states that a patient’s brain may not properly register a new alignment following fixation. (Schroth provides increased postural awareness and sensory feedback for spinal alignment.) The article concludes with “multiple efforts to avoid PJK via alterations in surgical techniques have been largely unsuccessful.” The authors hope that recognizing multifactoral causes of PJK may lead to some successful strategies.
WELL…a successful strategy for assisting spinal alignment already exists and since Scoliosis is rarely life threatening there is little evidence that surgical correction is ever indicated. Schroth exercises, if performed regularly, assist spinal alignment naturally from within the body and work to halt progression of curves whether the cause of mal-alignment is unknown (idiopathic) or from neuromuscular, other disease entities or a result of the surgery itself. In addition the postures, positioning, elongation of the trunk and the conscious, focused movement of air in the lungs gives one increased postural awareness and improved sensory feedback. All of this works to assist spinal alignment and address issues this article brings up.
SO…who wants to tell these authors that they should look into a Schroth Method Program to assist their patients and who wants to tell these patients that they may get better results practicing Schroth exercises a few minutes a day than undergoing one or more surgical procedures, which are clearly stated to not be all that successful????????
January – Good News: More Blogging!
Hope 2016 is a good year for all. We are going to start paying more attention to this blog page! Hope you will find it informative and helpful as well as give our readers a forum for expression. Our plan is to present and discuss issues and concerns followers, and yet to be followers, may have regarding Schroth Method Programs for Scoliosis. In addition we will keep you updated on current articles and research that appear in the literature regarding Scoliosis.
We will always welcome your comments, opinions, questions or other feedback. Just shoot us an email at Scolrx@gmail.com so we can hear what you have to say and give us the opportunity to address your specific concerns.