Scoliosis and the Human Spine: a Critical Review of Clinical Approaches to the Treatment of Spinal Deformity in the United States, and a Proposal for Change.

Hawes MC. Tucson, AZ 85745, West Press, 2002, paperback, 155 pp, illus, ISBN: 0-9719546-0-7, $74.95.

Scoliosis and the Human Spine is intended to be a critical review of published information on the topic of scoliosis and to stimulate discussion and research in this area. The book cites 498 separate pieces of literature from peer-reviewed medical and scientific sources. At this writing, the book is available only through the National Scoliosis Foundation, where 50% of the profits will be donated for patient support, education, and research. The intended audience is the research community, although I feel a broader audience is appropriate. I believe that this book would be a useful resource for any class on scoliosis for health care workers--such as physical therapists, physical therapist assistants, and nurses--and a useful resource for students of research design. In her foreword, the author, Martha C Hawes, PhD, frankly expresses her opinion that the current medical treatment of scoliosis in the United States is "inadequate and inappropriate" and that further basic research is needed.

This book is well written and well organized. Section I provides a general overview of spinal deformities over 2 chapters. The first chapter covers technical definitions, measuring scoliosis, scoliosis screening, potential causes of scoliosis, idiopathic scoliosis, prevalence of scoliosis, the natural history and progression of scoliosis, and specific variables that affect the development of scoliosis. A model of the development and progression of spinal deformity is presented. The chapter ends with a statement on the difficulty of predicting the course of an individual's spinal deformity.

Chapter 2 provides a thorough overview of the signs and symptoms of idiopathic scoliosis in children and adults, along with the potential implications for pulmonary dysfunction and the potential psychiatric impact. Again, a model of the signs, symptoms, and progression of idiopathic scoliosis is presented.

Section II addresses the treatment of spinal deformity with a chapter on the management of idiopathic scoliosis (chapter 3), including observation only, bracing, and surgery. Chapter 4 focuses on reviewing peer-reviewed articles addressing the outcomes of those same interventions, with a significant discussion of issues other than the reduction of the spinal deformity, including complications, pain, pulmonary distress, and psychological distress.

Section III addresses the need and rationale for changing the way the medical community in the United States approaches the management of spinal deformity. Chapter 5 presents a literature review on the use of exercises in the management of idiopathic scoliosis and concludes that there is a dearth of research that addresses exercise-based interventions. Chapter 6 presents a research-based framework for the use of exercises in the management of idiopathic scoliosis. Chapter 7 reviews the use of exercises in the management of idiopathic scoliosis, focusing on an inpatient rehabilitation model.

Chapter 8 notes that surgeons are generating the majority of published information on the surgical and nonsurgical management of scoliosis and the outcomes of these interventions, and the author questions why other health care professionals are not conducting research in this area. According to Hawes, one possible explanation is that focus of research has been on surgical rather than nonsurgical intervention. Because surgeons make the decision whether to monitor the patient, prescribe a brace, or perform surgery and then provide follow-up care, they have ready access to the information needed to publish short-term and long-term follow-up articles on treatment outcome. The author notes that it would behoove surgeons to encourage other disciplines to perform research in order to diminish the appearance of a conflict of interest.

Chapter 9 calls for a new research paradigm for scoliosis and specifically notes the role of physical therapy as part of a multidisciplinary approach to management and research. This chapter also provides an overview of the pitfalls of past research and potential alternatives for setting up clinical testing, such as a multidisciplinary perspective and better descriptions of the interventions being evaluated. Better descriptions are needed because surgical techniques are specifically explained, whereas other interventions such as exercise or modalities are lumped together and poorly described. The author argues that if other disciplines were more involved in the research on scoliosis, more emphasis would be placed on describing, isolating, and documenting the nonsurgical interventions. The author also proposes that a pool of research subjects exists for noninvasive interventions in the population of adults with stable spinal curves.

Although the book makes no recommendations on the management of scoliosis, I feel that physical therapists treating spinal dysfunction would benefit from reading this book. Specifically, physical therapists who conduct research in the area of spinal deformities and physical therapists interested in evidence-based treatments might find this book thought-provoking. The author notes that the majority of articles she reviewed indicate that exercise does not provide long-term benefit in the treatment of scoliosis. Again, the author specifically questions why the physical therapy profession has not conducted more research on the effects of specific therapeutic exercise on scoliosis. This book also would be useful in physical therapist and physical therapist assistant education programs as an overview of scoliosis and to promote discussion.

Lisa Kloc, PT

Gibson-Pike-Warrick Special Education

Cooperative

Evansville, Ind

Ms Kloc works at Gibson-Pike-Warrick Special Education Cooperative in Indiana. She is the state liaison from the Section on Pediatrics and works actively with the State Department of Education, Division of Exceptional Learners.