Scoliosis heart problems

As we've discussed on this blog previously, scoliosis is generally not considered a life-threatening condition. A curved spine can cause a great deal of pain and discomfort (among other complications), but cases where the patient's very life is at risk are vanishingly few and far between.

Leaving out the risk of suicide - see Scoliosis and Depression - the only exceptions occur when scoliosis is allowed to progress to the point where the body is so distorted that vital organs can no longer function properly.

Can scoliosis affect your heart?

In the vast majority of cases, no. If your condition is closely monitored and treated in a timely manner, you should never come anywhere near the point where your scoliosis begins to cause heart problems.

Theoretically, however, scoliosis can affect the heart if the curvature goes untreated and progresses unabated over an extended period of time. A severely curved spine can distort the rib cage, and a severely distorted rib cage can leave the heart and lungs with too little room to beat / inflate.

Thus, heart failure is a possible outcome of severe progressive scoliosis - but again, it's important to bear in mind that is an extremely rare occurrence.

Treat your scoliosis early!

The symptoms and complications associated with scoliosis vary enormously from one patient to the next - pain isn't always proportional to the angle of one's curve - but nevertheless, it's always better to catch the condition early and seek treatment right away than to let it progress.

Here at the Scoliosis SOS Clinic, we provide non-surgical scoliosis therapy for patients of all ages and curves of all sizes. Here's an example of a patient who came to us for early (almost pre-emptive) treatment after her older brother ended up requiring spinal fusion surgery:

Call Scoliosis SOS on 0207 488 4428 or use the links below to find out more about our ScolioGold treatment courses.

Upcoming Course Dates >   Book an Initial Consultation >

Erika Maude, our Clinic Principal, delivered a scientific presentation to the 2019 SOSORT conference in San Francisco last week.

Watch the video below to see her presentation in full.

Video Transcript

Erika Maude: Hello everybody, and thank you for having me along today. This is a continuation of the research that my colleague Jason Black first presented in Lyon two years ago looking at the cost-effectiveness of exercise therapy for adults with scoliosis.

Introduction - Health Economics

Adult patients with idiopathic scoliosis have been shown to present with impaired health-related quality of life. Therefore, in health systems globally, a key objective of treatment is to improve quality of life whilst maintaining cost-effectiveness. The cost-effectiveness of PSSEs [physiotherapeutic scoliosis-specific exercises] has not been researched, and thus conclusions about whether or not they are a viable economic alternative to surgery or bracing for healthcare systems cannot be made.

In the UK, the National Health Service offers spinal fusion surgery as the only treatment for adults with idiopathic scoliosis. They treat about 360 cases per year, each costing £24,853. Under cost-utility analysis, cost-effective analysis estimates the cost of treatment. It is used to inform funding decisions based on the benefit of treatment versus how much it costs. It requires extrapolation of data because it estimates the lifetime benefits of treatment.

Introduction - QALYs

The primary outcome of cost-utility analysis is the cost per quality-adjusted life year, or 'QALY' for short - otherwise known as the incremental cost-effectiveness ratio, which I'll come onto a bit more in a moment. QALYs analyse both the quality and the quantity of life years, where (rather morbidly) 0 equals death and 1 equals perfect health. QALY are accumulative, and thus a 0.2 QALY improvement lasting for 5 years equals 1 QALY for the patient.

The ICER [incremental cost-effectiveness ratio] is calculated as the difference in the expected cost of Intervention A compared to Intervention B divided by the difference in the expected QALYs produced by Intervention A and Intervention B. Generally, it is considered that the interventions costing the UK's National Health Service less than £30,000 per QALY gained are deemed to be cost-effective.

Introduction - EQ-5D

The EQ-5D is the measure preferred by the UK's National Institute of Clinical Excellence [NICE] for comparing cost-effectiveness. It's a descriptive system, and it defines health-related quality of life in terms of five dimensions:

  • Mobility
  • Self-care
  • Usual activities
  • Pain and discomfort
  • Anxiety and depression

Responses to each of these dimensions are divided into three levels (1st, no problems; 2nd, some to moderate problems; and 3rd, severe to extreme problems), thus generating a total of 243 possible health states. On the left is an example EQ-5D form, which can only be used with licensed permission.

Objectives

The aim of this study was to explore the cost-effectiveness of physiotherapeutic scoliosis-specific exercises for adult patients with idiopathic scoliosis using an intensive, group-based therapy approach.

Method

183 consecutively-recruited UK-based adult patients (with an average age of 38.5 years at the start of treatment) attending the Scoliosis SOS Clinic in London for intensive ScolioGold treatment filled out the EQ5D5L questionnaire at 5 different time points:

  1. Before treatment
  2. After treatment
  3. 6 months check-up
  4. 12 months check-up
  5. 18 months check-up

The EQ-5D results were then converted into QALYs using assumptions about the duration of treatment effect. A linear regression model was then used to statistically analyse the results.

Results - Response Rate

Due to the method of data collection, consecutive nature of patient recruitment, and time limitations imposed by the 3-year EQ5D5L licence, 100% of the participants completed the questionnaire pre-treatment, 91% immediately post-treatment, 68% at their 6-month check-up, with 51% at both 12- and 18-month check-ups.

Results - EQ5D5L Scores

Before treatment, the average EQ-5D score was 0.773, and immediately after treatment, this increased to an average of 0.881. At 6 months, the average was 0.862, and at both 12 and 18 months check-up, the average was maintained at 0.863. All of these changes were statistically significant.

Results - Calculation of QALYs

Although patient scores were statistically much improved at 12 and 18 months post-treatment, due to the fewer number of patients who reached the later time points, reliable data was only available up to 6 months following treatment, and therefore an assumption on the persistence of the treatment effect is required for later time points. To look at both extremes: assuming that the treatment benefit ended after just six months, additional QALYs were 0.045, which means that the ICER would be £90,000 per QALY. However, assuming that the treatment effect continued for 43.8 years (the average life expectancy of the patients in this study), then additional QALYs were 3.899, meaning the ICER would fall to just £1,000 per QALY.

Therefore, to meet NICE's requirements for health economics, the effects of treatment would need to persist for 1.5 years.

Conclusion

In conclusion, EQ-5D results improved with PSSE in adult patients with idiopathic scoliosis. If the treatment effect of the PSSEs persists for only 1.5 years, it is expected to be cost-effective in UK-based adults. Further long-term research is required to start planning for PSSE to become available within national healthcare services; with publication of these results, we hope to highlight that the input of physiotherapy in this patient group should warrant funding.

Limitations

We are aware that there are several limitations to this study, namely lack of a control group, limited long-term follow-up, and no data on cost savings from exercise therapy.

Thank you for listening.

More Scoliosis Research >   About Erika and the Team >

Gardening with Scoliosis

National Gardening Week has been taking place in the UK this week (29 April - 5 May 2019). The theme for 2019 is Edible Britain, and so gardeners all over the country have been sharing their love of home-grown produce on social media over the last few days.

Find out more on the RHS website >

 

Gardening with scoliosis

Gardening can be quite a physically demanding activity, and over the years, we at Scoliosis SOS have treated a number of keen gardeners who were having difficulties due to their scoliosis. Back pain and reduced flexibility are no help whatsoever when you're digging, planting, pruning and weeding!

Here are just some of the gardening enthusiasts our ScolioGold treatment programme has helped (click the links to view news articles in full):

How do we treat scoliosis?   Book an initial consultation

The final 2 days of the 2019 SOSORT (Society On Scoliosis Orthopaedic and Rehabilitation Treatment) meeting in San Francisco proved to be just as productive and educational as the start of the conference.

 Erika Maude SOSORT Presentation

Friday 26 April

Friday began with a variety of scientific paper award sessions, including those on the 'Impact of Sports Activities on Adolescent Scoliosis Patients' (from a team at the Italian Scientific Institute) and the 'Effects of Inspiratory Muscle Training on Respiratory Muscle Strength' (from a research group at Bezmiâlem University in Istanbul, Turkey). This was followed by a moving presentation from Dr. Scott Haldeman on the work of World Spine Care, a global charity on a mission to improve lives in under-served communities by aiming to create a world in which everyone has access to the highest possible quality of spine care.

Clinic Principal Erika Maude (pictured above) then presented the Scoliosis SOS Clinic's work: 'Exploring the Cost Effectiveness of an Intensive Physiotherapeutic Scoliosis Specific Exercise (PSSE) Programme in a UK Adult Population'. Many of our patients will recall being asked to complete quality of life questionnaires at various points during their treatment programmes, and we are very grateful to everyone who has helped to contribute to this ground-breaking piece of research and prove that our ScolioGold therapy is a cost-effective alternative to the existing treatments of bracing and surgery that are currently offered by the UK's National Health Service. We will be uploading the full video recording of Erika 's presentation at the San Francisco conference later next week.

The day concluded with a talk from orthopaedic specialist Mr Peter Newton, current president of the SRS (Scoliosis Research Society), on the organisation's work as a networking hub for spinal specialists from all over the world.

 

Georgie Frere SOSORT Presentation

Saturday 27 April

Saturday saw Rachel Mulvaney, Vice President of Curvy Girls, speak on the 'Power of Peer Support' and showcase the amazing work this society does to help girls with scoliosis across the globe.

Our Clinical Manager Georgie Frere (pictured above) also gave an excellent insight into the importance of 'Strategies to Improve Home Exercise Compliance in Patients with Scoliosis', something that we are very passionate about supporting our patients with when they return home after completing a treatment course at our clinic. Every patient receives a personalised exercise schedule, and we have also been trialling the use of paper exercise diaries for some of our patients to see if this improves their motivation at home. Georgie's presentation has also been recorded and will be uploaded to our YouTube channel shortly.

 

Looking ahead to SOSORT 2020

Next year's SOSORT conference will be held in Melbourne, Australia, and the Scoliosis SOS team are already hard at work finalising their scientific abstracts for submission before the deadline in October 2019. The 2020 conference looks set to be bigger than ever, and will be teaming up with SpineWeek to offer a scientific collaboration bringing together clinicians and scientists from around the world and from very different scientific societies.

Learn More About Scoliosis SOS >   Upcoming Treatment Course Dates >