Providence Bracing in Idiopathic Scoliosis: A Scoping Review.

Abstract

<h4>Background</h4>The Providence nighttime brace (PNB) is an emerging conservative treatment modality in adolescent idiopathic scoliosis (AIS). The purpose of this study was to map the extent and nature of published evidence on the PNB, to summarize outcomes and patient-reported effects, and to identify gaps for future investigation.<h4>Methods</h4>This study followed Joanna Briggs Institute methodology and was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. A keyword search was queried in PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science Core Collection, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus databases. Included studies were original articles focused on PNB utilization in AIS treatment. Non-peer-reviewed, opinion, editorial, or review articles were excluded.<h4>Results</h4>A total of 24 studies were included, encompassing 2,262 patients. Six studies compared outcomes to full-time orthoses; eleven examined ways to improve PNB success; three evaluated the PNB's impact on quality of life. The literature suggests the PNB consistently prevents curve progression in indicated patients, especially in curves measuring <35° and those with an apex at or below T9. Most comparative studies report that the PNB achieves similar outcomes to full-time orthoses when patients are appropriately selected. However, differences in study design, patient selection, and outcome definitions limit firm conclusions. The PNB was generally reported to have a manageable impact on quality of life. Innovations such as ultrasound custom fitting, predictive models, and temperature sensors may improve brace fit, adherence, and outcomes.<h4>Conclusions</h4>The literature identifies the Providence brace as a viable, patient-compliant treatment in mild to moderate AIS. While the PNB shows promise, variability in study design and indications underscores the need for prospective, randomized studies. Researchers should use Scoliosis Research Society criteria for inclusion and assessment, as well as objective compliance measures when feasible. Continued innovation with predictive models, custom brace-fitting, and temperature sensors may further improve outcomes.<h4>Key concepts</h4>(1)The Providence nighttime brace (PNB) effectively prevents curve progression in adolescent idiopathic scoliosis (AIS), especially in lumbar or thoracolumbar curves measuring <35°.(2)Most comparative studies suggest the PNB achieves similar outcomes to full-time orthoses in appropriately selected patients, but heterogeneity in study design, patient selection, and outcome definitions limits firm conclusions.(3)Preliminary evidence suggests the PNB may offer an acceptable quality of life profile, although current data are limited and further comparative studies using validated instruments are needed.(4)Prospective studies using Scoliosis Research Society criteria with standardized outcomes, predefined subgroups, and objective compliance measures are needed to solidify indications and patient education.(5)Predictive models, custom brace-fitting, objective compliance monitoring, and adjunctive physiotherapeutic exercises are promising innovations for improving PNB outcomes.<h4>Level of evidence</h4>V.