Serial casting had negative effect on health-related quality of life for patients with idiopathic EOS

Providers should consider risks and benefits of treatments for early-onset scoliosis, including how they effect on quality of life.

2-year-old Odehn wearing his 3D printed scoliosis brace. Children’s Hospital of Wisconsin

by Monica Jaramillo, Healio Orthopedics Today June 25, 2018

Serial casting was a safe and noninvasive treatment for early-onset scoliosis, but this treatment had a negative impact on the patient’s health-related quality of life, even after the cast was removed, according to a presenter, here.

“[Casting] does cause widespread negative effects in quality of life and burden of care during the treatment,” David Price Roye MD, said at the Scoliosis Research Society Annual Meeting. “Providers must be careful and consider the risks and benefits of treatments for [early-onset scoliosis] EOS including the impacts on quality of life.”

Roye and his colleagues performed a retrospective cohort study and identified 91 patients with EOS from the Children’s Spine Study Group and Growing Spine Study Group databases. Patients were initially casted at a mean age of 2.1 years and casts were removed after a mean of 4.1 years. For 8 weeks to 16 weeks, patients were serially casted, and, after casting, various treatment was used. There were 59 patients who were placed in the idiopathic EOS group and 32 patients who were placed in the non-idiopathic EOS group. Investigators then compared idiopathic and non-idiopathic patients with age-matched norms. The 24-item EOS questionnaire score was used to compare health-related quality of life before, during and after serially casting.

The pre-cast baseline scores in the idiopathic group were similar to those of the age-matched controls, apart from the burden domains. Transfer and emotion declined in the idiopathic group while they were in-cast and they did not recover afterwards. Physical function, daily living, overall health-related quality of life (HRQoL), and burden decreased in the idiopathic group, as well. However, decreases in transfer and emotion scores were the only changes detected in the non-idiopathic group.

“During casting, more of the quality of life measures dropped among both patient cohorts; not surprising given the restrictive nature of casting,” he said. “However, the idiopathic and non-idiopathic groups behaved differently after casting. The idiopathic group had a low HRQoL to start. Out-of-cast, the non-idiopathic [group’s] quality of life exceeded baseline in most subdomains. The idiopathic group saw no improvement or negative quality of life persistence in the emotion and the transfer domains when they came out of the cast,” Roye said.

All that Glitters is Not Gold – Serial Casting for EOS Negatively Affects Health-Related Quality of Life even after Discontinuation of Serial Casting: A 2 Year Follow-up, Hiroko Matsumoto MA, Emily Auran BA, Chun Wai Hung MEng, Peter F Sturm MD, Sumeet Garg MD, James O Sanders MD, Matthew E Oetgen MD, David Price Roye MD, Michael Vitale MD MPH, Children’s Spine Study Group; Growing Spine Study Group. Paper #58 presented at Scoliosis Research Society Annual Meeting; Sept. 6-9, 2017; Philadelphia.

David Price Roye MD can be reached at Morgan Stanley Children’s Hospital of New York Presbyterian, Columbia University Medical Center, 3959 Broadway, Room 800 North, New York, NY 10032. Roye reports no relevant financial disclosures.

Perspective
Paper 58 is a retrospective cohort analysis of a multicenter database. The EOSQ-24, an EOS outcomes tool, is used to assess quality of life impact of serial casting for EOS. Scores were obtained on 91 patients pre-casting, during casting and a mean of 5 months after casting completion.The investigators reported lower EOSQ-24 scores in the 32 non-idiopathic patients both pre- and post-cast treatment, while the 59 idiopathic patients had pre-treatment scores similar to controls and a larger decline while undergoing treatment. The decline in scores recovered in the non-idiopathic group improved, but the idiopathic group’s scores remained lower after completion of casting.

This offers the clinician some insight into the effects of casting treatment on patients with EOS and their families, in particular that negative effects may persist after the conclusion of casting, especially in patients with idiopathic EOS. Although nonoperative treatment offers clear advantages in very young children with EOS, conservative treatment may have an unanticipated negative impact on HRQoL.

Limitations include both the retrospective study structure and the multicenter database data course, as well as the limitations inherent to any HRQoL assessment tool.

Laurel C. Blakemore MD, Professor and chief, pediatric orthopedics, University of Florida Department of Orthopedic Surgery and Rehabilitation, Gainesville, Florida. Blakemore reports she is a member of the Growing Spine Study Group.

Source Healio Orthopedics Today

Also see
Children’s Hospital of Wisconsin doctor pioneering 3D printed braces for early-onset scoliosis in Children’s Hospital of Wisconsin blog

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