Active Treatment for Idiopathic Adolescent Scoliosis (ACTIvATeS): a feasibility study
Background: The feasibility of conducting a definitive randomised controlled trial (RCT) evaluating the clinical effectiveness and cost-effectiveness of scoliosis-specific exercises (SSEs) for adolescent idiopathic scoliosis (AIS) is uncertain. Objectives: The aim of this study was to assess the fea...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
NIHR Journals Library
2015-07-01
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| Series: | Health Technology Assessment |
| Subjects: | |
| Online Access: | https://doi.org/10.3310/hta19550 |
| _version_ | 1818477973728133120 |
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| author | Mark A Williams Peter J Heine Esther M Williamson Francine Toye Melina Dritsaki Stavros Petrou Richard Crossman Ranjit Lall Karen L Barker Jeremy Fairbank Ian Harding Adrian Gardner Anne-Marie Slowther Neil Coulson Sarah E Lamb on behalf of the ACTIvATeS study group |
| author_facet | Mark A Williams Peter J Heine Esther M Williamson Francine Toye Melina Dritsaki Stavros Petrou Richard Crossman Ranjit Lall Karen L Barker Jeremy Fairbank Ian Harding Adrian Gardner Anne-Marie Slowther Neil Coulson Sarah E Lamb on behalf of the ACTIvATeS study group |
| author_sort | Mark A Williams |
| collection | DOAJ |
| description | Background: The feasibility of conducting a definitive randomised controlled trial (RCT) evaluating the clinical effectiveness and cost-effectiveness of scoliosis-specific exercises (SSEs) for adolescent idiopathic scoliosis (AIS) is uncertain. Objectives: The aim of this study was to assess the feasibility of conducting a large, multicentre trial of SSE treatment for patients with AIS, in comparison with standard care, and to refine elements of the study design. The objectives were to (1) update a systematic review of controlled trials evaluating the efficacy of SSE in AIS; (2) survey UK orthopaedic surgeons and physiotherapists to determine current practice, patient populations and equipoise; (3) randomise 50 adolescents to a feasibility trial of either usual care or SSE interventions across a range of sites; (4) develop, document and assess acceptability and adherence of interventions; (5) assess and describe training requirements of physiotherapists; and (6) gain user input in all relevant stages of treatment and protocol design. Design: Multicomponent feasibility study including UK clinician survey, systematic literature review and a randomised feasibility trial. Setting: The randomised feasibility study involved four secondary care NHS trusts providing specialist care for patients with AIS. Participants: The randomised feasibility study recruited people aged 10–16 years with mild AIS (Cobb angle of < 50°). Interventions: The randomised study allocated participants to standard practice of advice and education or a physiotherapy SSE programme supported by a home exercise plan. Our choice of intervention was informed by a systematic review of exercise interventions for AIS. Main outcome measures: The main outcome was feasibility of recruitment to the randomised study. Other elements were to inform choice of outcomes for a definitive trial and included curve severity, quality of life, requirement for surgery/brace, adverse events, psychological symptoms, costs and health utilities. Results: A UK survey of orthopaedic consultants and physiotherapists indicated a wide variation in current provision of exercise therapy through physiotherapy services. It also found that clinicians from at least 15 centres would be willing to have their patients involved in a full study. A systematic review update found five new studies that were generally of low quality but showed some promise of effectiveness of SSE. The randomised study recruited 58 patients from four NHS trusts over 11 months and exceeded the pre-specified target recruitment rate of 1.4 participants per centre per month, with acceptable 6-month follow-up (currently 73%). Adherence to treatment was variable (56% of participants completed treatment offered). The qualitative study found the exercise programme to be highly acceptable. We learnt important lessons from patient and public involvement during the study in terms of study and intervention presentation, as well as practical elements such as scheduling of intervention sessions. Conclusions: A definitive RCT evaluating clinical effectiveness and cost-effectiveness of SSE for idiopathic scoliosis is warranted and feasible. Such a RCT is a priority for future work in the area. There is a sufficiently large patient base, combined with willingness to be randomised within specialist UK centres. Interventions developed during the feasibility study were acceptable to patients, families and physiotherapists and can be given within the affordability envelope of current levels of physiotherapy commissioning. Trial registration: Current Controlled Trials ISRCTN90480705. Funding: This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 55. See the NIHR Journals Library website for further project information. |
| first_indexed | 2024-12-10T09:42:50Z |
| format | Article |
| id | doaj.art-1b7ddef75a904b53a93c403d7c05bf95 |
| institution | Directory Open Access Journal |
| issn | 1366-5278 2046-4924 |
| language | English |
| last_indexed | 2024-12-10T09:42:50Z |
| publishDate | 2015-07-01 |
| publisher | NIHR Journals Library |
| record_format | Article |
| series | Health Technology Assessment |
| spelling | doaj.art-1b7ddef75a904b53a93c403d7c05bf952022-12-22T01:53:56ZengNIHR Journals LibraryHealth Technology Assessment1366-52782046-49242015-07-01195510.3310/hta1955010/38/03Active Treatment for Idiopathic Adolescent Scoliosis (ACTIvATeS): a feasibility studyMark A Williams0Peter J Heine1Esther M Williamson2Francine Toye3Melina Dritsaki4Stavros Petrou5Richard Crossman6Ranjit Lall7Karen L Barker8Jeremy Fairbank9Ian Harding10Adrian Gardner11Anne-Marie Slowther12Neil Coulson13Sarah E Lamb14on behalf of the ACTIvATeS study groupNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UKWarwick Clinical Trials Unit, University of Warwick, Coventry, UKNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UKNuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UKWarwick Clinical Trials Unit, University of Warwick, Coventry, UKWarwick Clinical Trials Unit, University of Warwick, Coventry, UKWarwick Clinical Trials Unit, University of Warwick, Coventry, UKWarwick Clinical Trials Unit, University of Warwick, Coventry, UKNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UKNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UKNorth Bristol NHS Trust, Bristol, UKRoyal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UKHealth Sciences, Warwick Medical School, University of Warwick, Coventry, UKSchool of Medicine, University of Nottingham, Nottingham, UKNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UKBackground: The feasibility of conducting a definitive randomised controlled trial (RCT) evaluating the clinical effectiveness and cost-effectiveness of scoliosis-specific exercises (SSEs) for adolescent idiopathic scoliosis (AIS) is uncertain. Objectives: The aim of this study was to assess the feasibility of conducting a large, multicentre trial of SSE treatment for patients with AIS, in comparison with standard care, and to refine elements of the study design. The objectives were to (1) update a systematic review of controlled trials evaluating the efficacy of SSE in AIS; (2) survey UK orthopaedic surgeons and physiotherapists to determine current practice, patient populations and equipoise; (3) randomise 50 adolescents to a feasibility trial of either usual care or SSE interventions across a range of sites; (4) develop, document and assess acceptability and adherence of interventions; (5) assess and describe training requirements of physiotherapists; and (6) gain user input in all relevant stages of treatment and protocol design. Design: Multicomponent feasibility study including UK clinician survey, systematic literature review and a randomised feasibility trial. Setting: The randomised feasibility study involved four secondary care NHS trusts providing specialist care for patients with AIS. Participants: The randomised feasibility study recruited people aged 10–16 years with mild AIS (Cobb angle of < 50°). Interventions: The randomised study allocated participants to standard practice of advice and education or a physiotherapy SSE programme supported by a home exercise plan. Our choice of intervention was informed by a systematic review of exercise interventions for AIS. Main outcome measures: The main outcome was feasibility of recruitment to the randomised study. Other elements were to inform choice of outcomes for a definitive trial and included curve severity, quality of life, requirement for surgery/brace, adverse events, psychological symptoms, costs and health utilities. Results: A UK survey of orthopaedic consultants and physiotherapists indicated a wide variation in current provision of exercise therapy through physiotherapy services. It also found that clinicians from at least 15 centres would be willing to have their patients involved in a full study. A systematic review update found five new studies that were generally of low quality but showed some promise of effectiveness of SSE. The randomised study recruited 58 patients from four NHS trusts over 11 months and exceeded the pre-specified target recruitment rate of 1.4 participants per centre per month, with acceptable 6-month follow-up (currently 73%). Adherence to treatment was variable (56% of participants completed treatment offered). The qualitative study found the exercise programme to be highly acceptable. We learnt important lessons from patient and public involvement during the study in terms of study and intervention presentation, as well as practical elements such as scheduling of intervention sessions. Conclusions: A definitive RCT evaluating clinical effectiveness and cost-effectiveness of SSE for idiopathic scoliosis is warranted and feasible. Such a RCT is a priority for future work in the area. There is a sufficiently large patient base, combined with willingness to be randomised within specialist UK centres. Interventions developed during the feasibility study were acceptable to patients, families and physiotherapists and can be given within the affordability envelope of current levels of physiotherapy commissioning. Trial registration: Current Controlled Trials ISRCTN90480705. Funding: This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 55. See the NIHR Journals Library website for further project information.https://doi.org/10.3310/hta19550feasibility studyevidenceadolescent idiopathic scoliosisactive treatmentphysiotherapyspine |
| spellingShingle | Mark A Williams Peter J Heine Esther M Williamson Francine Toye Melina Dritsaki Stavros Petrou Richard Crossman Ranjit Lall Karen L Barker Jeremy Fairbank Ian Harding Adrian Gardner Anne-Marie Slowther Neil Coulson Sarah E Lamb on behalf of the ACTIvATeS study group Active Treatment for Idiopathic Adolescent Scoliosis (ACTIvATeS): a feasibility study Health Technology Assessment feasibility study evidence adolescent idiopathic scoliosis active treatment physiotherapy spine |
| title | Active Treatment for Idiopathic Adolescent Scoliosis (ACTIvATeS): a feasibility study |
| title_full | Active Treatment for Idiopathic Adolescent Scoliosis (ACTIvATeS): a feasibility study |
| title_fullStr | Active Treatment for Idiopathic Adolescent Scoliosis (ACTIvATeS): a feasibility study |
| title_full_unstemmed | Active Treatment for Idiopathic Adolescent Scoliosis (ACTIvATeS): a feasibility study |
| title_short | Active Treatment for Idiopathic Adolescent Scoliosis (ACTIvATeS): a feasibility study |
| title_sort | active treatment for idiopathic adolescent scoliosis activates a feasibility study |
| topic | feasibility study evidence adolescent idiopathic scoliosis active treatment physiotherapy spine |
| url | https://doi.org/10.3310/hta19550 |
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