Case study in orthopedics

Abstract

The aim of this chapter is to present a case study of why and how an umbrella review was conducted and reported within the context of the conservative management of adolescents with idiopathic scoliosis. We present and discuss the fi ndings of an umbrella review of systematic reviews regarding both the screening and the effectiveness of nonsurgical interventions for adolescents with idiopathic scoliosis. The mandate for school-based screening programs for adolescents with scoliosis is a highly contentious and strongly debated issue. As a result of numerous controversial and discordant recommendations presented over a number of years by different societies and organizations that have been based on poor-quality systematic reviews, patients, therapists, insurance providers, policy makers, and researchers remain uncertain and confused. Nonsurgical interventions for adolescents with idiopathic scoliosis, including scoliosis-specifi c exercise interventions and bracing, are also controversial. We evaluated the validity as well as the methodological quality of all existing systematic reviews on this topic. We summarized, appraised, analyzed, and synthetized all available studies meeting the minimal criteria for a systematic review. The methodological quality of the majority of the included 27 systematic reviews, as assessed with the AMSTAR risk of bias tool, was disappointingly low. More, good-quality primary and secondary studies of higher level designs are urgently needed in this topic. We demonstrated the role of an umbrella review, as a research tool, to prevent misleading information and erroneous guidance for stakeholders, resulting from poorly conducted systematic reviews.