Comparison of Effectiveness Between Providence Nighttime Versus Full-Time Brace in Adolescent Idiopathic Scoliosis: A Narrative Review.

Background/

Objectives

Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine with multifactorial etiology. Its treatment is conservative and/or surgical. The most commonly used conservative method is a full-time brace. However, nighttime braces have recently gained prominence, offering improved tolerance and a positive impact on health-related quality of life. The main objective of this study was to conduct a narrative review of published articles comparing the effectiveness of Providence nighttime versus full-time brace use to determine whether nighttime use is an effective option for improving therapeutic adherence, health-related quality of life, and psychosocial impact.

Methods

A scientific literature search was conducted using the Scopus and PubMed databases. We searched for randomized controlled trials (RCTs), meta-analyses, systematic reviews and retrospective comparative studies reported in English from 2019 to 2024. The literature search was conducted from October to April 2024. Different combinations of the terms and MeSH terms "adolescent", "idiopathic", "scoliosis", "Providence", "full-time" and "brace" connected with various Boolean operators were included.

Results

Overall, 70 articles were reviewed from the selected database. After removing duplicated papers and title/abstract screening, 10 studies were included in our review. The results showed that nighttime brace use has similar results in terms of effectiveness to full-time brace use in mild to moderate curves. However, nighttime brace use improves therapeutic adherence, health-related quality of life and psychosocial impact. Nevertheless, the effectiveness of night braces depends on factors such as curve type, magnitude, and bone maturity. So, in patients with moderate-severe curves and high growth velocity, it is important to reconsider the type of brace, as in these cases night braces alone may be ineffective in slowing the progression of the curve.

Conclusions

Providence nighttime brace could be an effective treatment and better tolerated alternative to full-time brace in specific cases. This approach could improve therapeutic adherence. Nevertheless, more controlled and homogeneous studies are needed to establish definitive recommendations.