The effect of bracing on pulmonary function in adolescent idiopathic scoliosis: a systematic review with meta-analysis.

In 30 seconds

This systematic review and meta-analysis examined controlled clinical trials of bracing and pulmonary function in adolescents with idiopathic scoliosis. Fourteen studies involving 548 participants were included. Pooled results showed short-term reductions in several measures, including FVC and FEV₁ at 1 month (SMD = - 0.68 to - 0.76, p < 0.001); these measures normalized at 2 months, with a moderate decline again at 6 months (SMD = - 0.62, p = 0.007). Persistent or irreversible impairment after brace removal was not demonstrated, and many reductions were measured while participants wore the brace.

Key findings

• Immediate total lung capacity decreased (SMD = - 0.83, p = 0.01); functional residual capacity also declined.
• FVC and FEV₁ fell at 1 month (SMD = - 0.68 to - 0.76, p < 0.001), normalized at 2 months, and declined moderately at 6 months (SMD = - 0.62, p = 0.007).
• At 6 months, the FEV₁/FVC ratio was reduced (SMD = - 1.05, p = 0.007).
• Out-of-brace or longer-term measurements were generally non-significant; persistent or irreversible impairment after brace removal was not demonstrated.

Why it matters

Pulmonary measurements during brace treatment may reflect temporary mechanical restriction rather than lasting physiological damage. Distinguishing in-brace changes from persistent impairment can help clinicians interpret respiratory testing and discuss potential effects of bracing with patients and families, while recognizing that the evidence does not demonstrate lasting harm after brace removal.

What to keep in mind

Many assessments were conducted in-brace, limiting conclusions about pulmonary function outside the brace; longer-term and out-of-brace findings were generally non-significant.