Comments regarding ‘Can bracing help adults with chronic back pain and scoliosis? Short-term results from a pilot study’ by Zaina et al.

I would like to thank the authors for introducing this very important topic to Prosthetics and Orthotics International. However, I am a bit disappointed that the authors have provided a very selective review, omitting papers on this topic which provide promising mid-term results for a larger number of patients (n = 67).^1,2 These two papers, published as early as 2009, provide much more evidence than this short-term pilot study. They should therefore have been cited and discussed.

Furthermore, the authors present a distribution of sagittal Schwab modifiers. It is my understanding that there is a certain variation of the sagittal modifiers within the sample presented in this pilot investigation. Therefore, it might have been helpful to include a simple clinical test which was able to distinguish between different types of low back pain. ³ This is important as the approach to treatment may vary for different types of low back pain, and low back pain may not necessarily be managed successfully by a single brace design. ³

The delordosing brace presented in the paper may be beneficial for patients with low back pain due to instability. However, if the patient is in pain and presents with lumbar kyphosis, they will most likely need a brace increasing lordosis, which is a different approach.^{1 –4} This is especially important when we consider two facts: (1) loss of lumbar lordosis correlates highly with the incidence of chronic low back pain in adulthood,^5,6 and (2) the restoration of lumbar lordosis corrects the scoliotic curves in frontal plane as well as in the sagittal plane.^7,8

As discussed above, there is a considerable amount of additional information that may be important for the treatment of chronic pain in patients with idiopathic scoliosis in adulthood.

In addition, there are a number of anecdotal papers that present case reports of patients with pain who were successfully treated with a pattern-specific Chêneau-style scoliosis brace. ⁹

It would also have been interesting to know which specific variables were analysed using a t-test, which were analysed using non-parametric statistics and which specific non-parametric tests were used.

It is also known that the final author in this paper holds stocks originating in the ISICO company and receives money from Janssen Pharmaceutical and Medtronic (https://www.srs.org/UserFiles/file/am17-FP-book-v6.pdf). It is therefore my opinion that the declaration of conflicting interests for this author is not complete. Perhaps this conflict of interest is the reason why all the papers authored by H.-R. Weiss have not been mentioned.

Furthermore, the final author has a direct competing interest as he distributes his own braces. As all this information has not been disclosed upon submission of the paper, it is my belief that this undeclared competing interest has compromised the peer-review process.

Yours respectfully,