BRAIST is the first prospective, multicenter trial testing rigid bracing against observation in skeletally immature adolescents with idiopathic scoliosis at risk for surgical progression. It enrolled 242 patients (age 10–15, Risser 0–2, Cobb 20–40°) across 25 US and Canadian institutions, using both randomized and preference cohorts. The primary outcome was curve progression to 50° or more (failure) versus reaching skeletal maturity below that threshold (success).
For decades, bracing for AIS was recommended based on observational data and expert opinion, with no adequately powered prospective trial to back it up. Insurance coverage was inconsistent and families routinely asked whether bracing actually worked.
BRAIST answered that question definitively. When you see a 12-year-old girl with a 28° thoracic curve and Risser 1, bracing is indicated — and you can tell her family the evidence-based success rate is 75%, not a rough estimate.
The compliance data are equally essential for counseling. Wearing the brace fewer than 6 hours/day gives the same result as no treatment. Wearing it at least 12.9 hours/day yields 90–93% success. These numbers belong in every brace prescription conversation.
The NNT of 3.0 is one of the strongest in pediatric orthopedics. Context that helps frame the conversation when families push back on the inconvenience of bracing.
BRAIST is the first prospective, multicenter trial testing rigid bracing against observation in skeletally immature adolescents with idiopathic scoliosis at risk for surgical progression. It enrolled 242 patients (age 10–15, Risser 0–2, Cobb 20–40°) across 25 US and Canadian institutions, using both randomized and preference cohorts. The primary outcome was curve progression to 50° or more (failure) versus reaching skeletal maturity below that threshold (success).
For decades, bracing for AIS was recommended based on observational data and expert opinion, with no adequately powered prospective trial to back it up. Insurance coverage was inconsistent and families routinely asked whether bracing actually worked.
BRAIST answered that question definitively. When you see a 12-year-old girl with a 28° thoracic curve and Risser 1, bracing is indicated — and you can tell her family the evidence-based success rate is 75%, not a rough estimate.
The compliance data are equally essential for counseling. Wearing the brace fewer than 6 hours/day gives the same result as no treatment. Wearing it at least 12.9 hours/day yields 90–93% success. These numbers belong in every brace prescription conversation.
The NNT of 3.0 is one of the strongest in pediatric orthopedics. Context that helps frame the conversation when families push back on the inconvenience of bracing.