Activity Scale for Kids: Performance Version 2018
The former information has been reviewed. There aren’t any updates to the ASKp at this time.
Sewell MD, Platinum J, Askin GN, et al. Do Growing Rods for Idiopathic Early Onset Scoliosis Improve Activity and Participation for Children? The Journal of Pediatrics. 2017;182. doi:10.1016/j.jpeds.2016.11.031.
Purpose: Considering surgery is the recommended treatment for children with rapidly progressing scoliosis who have already utilized conservative interventions, the purpose of this study was to evaluate the effect of surgery (growth rod placement) versus bracing on activity and participation.
Population: Participants included 60 children (22 males, 38 females) with idiopathic early onset scoliosis between the ages of 5-10 years old. Children were included if they were the appropriate age, demonstrated progressing scoliosis (>5 deg increase in one year), and had a Cobb angle of >40 degrees.
Methods: This study was conducted over a 6 year period from 2009-2015. Participants were allotted to the brace or surgery group based on which they wished to undergo; therefore, participants were not randomized. Instead, the first 30 who met the inclusion criteria and decided to undergo surgery were allotted to the surgery group, and the first 30 who met the inclusion criteria and opted not to undergo surgery were placed in the brace group. Outcome measures were utilized prior to the intervention and 1 year post intervention. Outcomes included a measure of activity and performance, a pain assessment, and radiographic changes.
Outcome measures: Outcome measures included the Activities Scale for Kids performance version (ASKp), the pain severity question from the Child Health Questionnaire, and radiographic measurements. Radiographic measurements included the Cobb angle, lumbar lordosis, thoracic kyphosis, and spinal length from T1-S1.
Intervention: Of the two intervention groups, brace versus surgery, there were two different types of surgical procedures utilized. 18 of the 30 procedures were performed with a conventional growth rod, and the remaining 12 were performed with a magnetic growth rod. There were also case-by-case differences in single versus dual rod usage. Nine used single rod, whereas, the remaining 21 were given dual rod.
Results: 17 children in the surgery group and 6 in the brace group reported a decrease in the ASKp; whereas, 5 in the surgery group and 7 in the brace group reported an increase in the ASKp. The reductions in ASKp scores correlated with surgical complications and increased pain reports among the surgical group. As expected, the number of children in the surgical group that reported a worsened pain level increased at the 1 year follow up compared to baseline. The number of participants who reported pain at baseline did not increase upon follow up for the brace group. Growth rod placement was associated with decreased Cobb angle, and brace use was associated with increased Cobb angle at follow up.
Strength: One of the strong points of this study was the use of radiographic measure (Cobb angle) to determine the changes and severity of the scoliosis. Cobb angle is considered to be the “gold standard” for scoliosis measurement. Additionally, the ASKp has been found to be a valid and reliable measure to detect change in activity and participation; therefore, the use of this measure strengthens the study’s ability to determine impact of the two separate interventions.
Limitations: Considering surgery is an optional and invasive intervention, it would not be ethical to perform a RCT comparing these two interventions. Another limitation was the absence of a control group that did not receive either intervention. This may have helped with determining the effectiveness of bracing. Additionally, since there were differences in surgical technique and the presence of surgical complications with some of the participants, it is difficult to assess the effect of surgery on the measures that were utilized without factoring in those variables. Finally, considering the invasive nature and potential long term impact of the surgical procedure, it may have been beneficial to do an additional follow-up between 2 and 5 years.
Overall conclusion: Surgical intervention is more effective in reducing the severity of scoliosis while maintaining the ability for spinal growth, but it appears to have a greater negative impact on reported pain and ASKp scores compared to bracing.
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