The Effects Of Bracing Combined With PSSE On Balance Function In Rigo B AIS Patients A Randomized Controlled Study

Objective:Adolescent idiopathic scoliosis(AIS)is a three-dimensional deformity of the spine with unknown etiology.It has been suggested that the origin and progression of AIS may be associated with balance dysfunction.As the main method of orthotic in moderate AIS,the studies involved in the effects of bracing on the balance of AIS patients with different types are few.In addition,physiotherapy scoliosis-specific exercise(PSSE)is also widely used as an adjunctive therapy for moderate AIS,but whether it improves balance in AIS patients with bracing is also unclear.Therefore,the aim of this study was to investigate the effect of wearing brace combined with PSSE on the balance function in Rigo B AIS patients,so as to provide further theoretical support for its use as a strategy for conservative treatment of AIS.Methods:A randomized controlled study design was used for this project.A total of 45 Rigo B AIS patients(aged 10-15 years)who had custom-made braces were recruited from 2018.01 to 2020.9.The subjects were randomly divided into two groups: 22 patients in the brace group,who only performed non-specific exercises,and 23 patients in the brace+PSSE group,who received PSSE intervention in addition to the brace.Static balance and dynamic balance with or without brace were measured before and after the intervention.A German Zebris pressure plate was used to measure the static balance during single leg stance with eye-open and eye-closed,and the displacement of the centre of pressure(COP)including the 95% confidence ellipse area(95%CEA)and the mean speed of COP movement were analysed.Dynamic balance was assessed using the Star Excursion Balance Test(SEBT)and the bipedal jump single-leg landing test.The three-dimensional force plate was used to measure and calculate the dynamic stability index(DPSI).In addition,full spine X-rays were taken before and after the intervention and the scoliosis Cobb angle was measured.Paired t-tests were used to compare the differences of each balance parameter before and after the self-intervention,between the right and left sides,and with and without the brace.The T-tests were used to compare the differences of balance parameters between groups.P < 0.05 was considered a statistically significant difference.Results:1.Static balance ability test:(1)In single-leg stance with eyes open,the95%CEA and the mean speed of COP movement were significantly(P<0.05)increased with the brace than without the brace for both the right and left legs before the intervention,After 6 months of intervention,the 95%CEA was reduced in the brace+PSSE group when compared to the pre-intervention group(P<0.05)in both the left and right single-leg stance with eyes open,and was also reduced when compared to the post-intervention brace group alone(P<0.05).(2)In the eye-closed state,95%CEA was higher in the left single-leg stance than in the right single-leg stance before the intervention(P<0.05),but the difference in mean COP movement speed had no significant differences(P>0.05).After 6months of intervention in the brace + PSSE group,the 95%CEA was reduced when compared with that before the intervention in both sides with and without brace.However,when standing on one leg with eyes closed,there was no significant difference in the mean speed of COP movement in both sides with or without brace between the two groups(P>0.05).2.Dynamic balance test:(1)The SEBT revealed that the score with brace was lower than that without brace in the forward direction with the left single leg standing(P<0.05)before intervention;the scores of the brace + PSSE group with or without brace in post-intervention increased in both anterior and posterior directions when compared with pre-intervention(all P<0.05).While with the right single-leg brace,the post-intervention brace+PSSE group had increased scores with or without the brace in the forward-posterior direction when compared with the pre-intervention(all P<0.05).(2)The results of the bipedal jump single-leg landing test showed that DPSI with brace before the intervention was smaller than that without brace on both side landing(P<0.05);and in the brace group,the dynamic stability of the right leg standing was better than that of the left leg with or without brace(P<0.05).After the intervention,the dynamic stability of the left and right legs with and without brace in the brace + PSSE group was better than that before the intervention(P<0.05).The dynamic stability of left and right single-leg support without brace was also better than that with brace group(P<0.05).3.Both the brace alone and the brace combined with PSSE improved the Cobb angle in AIS patients with a mean decrease of 4°-6° after intervention(P<0.05).Conclusions:(1)Wearing a brace do not affect the single-leg standing static balance capacity in Rigo B patients with eyes-closed,but impaired the single-leg standing static balance capacity with eye-open.Wearing a brace improves the balance capacity in bipedal jump single-leg landing test in Rigo B AIS patients.(2)The brace combined with the PSSE intervention improves the eye-open single-leg standing static balance capacity with brace and dynamic balance capacity of bipedal jump single-leg landing without brace,but do not further improve Cobb angle in Rigo B AIS patients.