Dr. Weinstein was able to show that bracing was able to allow 75% of the children/adolescents who were braced were able to keep a curve below 50 degrees, with 50 degrees at time of skeletal maturity being considered a "failure" and all others considered a "success."
After the session was over, I got a chance to go up and speak to Dr. Weinstein, and to Dr. Lori Dolan, his co-author for U. Iowa to discuss the paper in greater depth. Both were very gracious with their time, and I got a chance to talk to Lori at greater length. Several key points from our dialogue emerged:
1) Current indications for scoliosis bracing is far too broad and needs to be narrowed. We are bracing too many children and adolescents who are not benefiting from treatment.
2) Scoliosis Bracing does benefit a subgroup of patients, but the children/adolescents must be willing to wear the brace for 13-18 hours per day to have a reasonable chance to see any benefit.
3) Lori agreed that we can't fully declare "success" with no surgery or curve less than 50 degrees at skeletal maturity, since some of those patients will continue to progress and/or have pain in adulthood and may eventually need surgery.
4) The emotional/family effect of wearing a brace during adolescent growth period should be considered when making the decision and personalized for each situation.
I also had some time this afternoon to see a couple of good science blogs talk about the article as well:
Here's an extended quote from the ScientificBlogging Site that gives a nice summary of the paper and some quotes from Dr. Weinstein: For the study, investigators enrolled 383 subjects at 25 institutions in the United States and Canada between March 2007 and Feb 2011. Although the study began as a completely randomized clinical trial, the team eventually added a "preference cohort," where patients and families could choose their own treatment. About 40 percent of study participants were randomly assigned to bracing or to close observation without bracing. The remaining participants made their own choice regarding bracing or observation.