Does bracing affect self-image? A prospective study on 54 patients with adolescent idiopathic scoliosis

Abstract

IntroductionAs brace treatment of idiopathic scoliosis has proven effective and has become accepted as a realistic treatment alternative [11], the psychological impact of its use on children has become a major concern. The psychosocial effect of bracing has been discussed in many reports. The studies have focused on children's ability to cope with the stress of chronic disability [5,10,14,17,19], on the longterm effect of scoliosis treatment, either by brace or operation [1,2,4,6,12], and on identifying factors contributing to non-compliance [15,18]. Most of these studies have included patients treated with the Milwaukee brace, and adequate age-matched control groups have not been used. Brace wear has been found to be related to a negative body-image, lower level of self-esteem, and increased stress [6,9]. Factors such as an intellectual understanding of scoliosis and bracing, optimistic view of outcome, active decision to wear the brace, and support of family and Abstract To evaluate the effect of brace treatment on self-image in patients with adolescent idiopathic scoliosis, 54 consecutive patients admitted for brace treatment were interviewed before bracing. A prevalidated questionnaire including the following five aspects of self-image was used: (1) body-image, (2) selfperception of skills and talents, (3) emotional well-being, (4) relations with family, and (5) relations with others. As a control group, the answers of 3465 normal school children were used. Forty-six patients participated in a follow-up interview 1.7 (range 0.8-3.0) years later. In addition, during the first interview, the scoliosis patients answered selected questions about their social circumstances and attitudes towards their forthcoming brace treatment. Grossly, the patient group lived in stable family conditions with a high percentage (40%) of fathers and/or mothers with an academic education or with a high employee status. The patients' relations with families were generally good. Nearly all believed that the brace would affect their posture, but only a few thought that wearing the brace would influence their growth. Two-thirds believed that it would be difficult to wear the brace, and often reflected on the use of it. There were no statistically significant differences between the scoliosis patients and the age-matched controls at the pre-bracing nor at the follow-up interviews. Neither were there any statistically significant differences between the answers of the scoliosis patients in the pre-bracing and follow-up interviews. This was valid for the total score as well as for each subscale item score. It is concluded that wearing the brace does not affect the self-image of adolescents with idiopathic scoliosis negatively.

Outcome in adolescent idiopathic scoliosis after brace treatment and surgery assessed by means of the Scoliosis Research Society Instrument 24

“…Comparing the findings of the present study with those of other studies employing normal matched control groups, other studies do not find significant differences between the control groups and treated patients, especially in relation to brace-treated patients and controls [14,17,[24][25][26]. They do not find self-image to be adversely influenced by brace treatment in comparison to a normal control group.…”

“…The instrument comprises seven domains: pain (questions 1, 2, 3,6,8,11,18), general self-image (questions 5, 14, 15), function from back condition (questions 7, 12, 13), general level of activity (questions 4, 9, 10), post-treatment self-image (questions 19,20,21), posttreatment function (questions 16,17), and satisfaction with the treatment (questions 22,23,24); each of these domains can be evaluated independently and/or by summarizing all questions in a total outcome score.…”

“…Eleven questions (3-8, 14, 20, 22-24) have five answer categories which are quantified by 1-5: 1 was the most negative response and 5 the most positive; seven questions (12,13,(16)(17)(18)(19)21) have three answer categories quantified by 1, 3, and 5: decrease counts one point, no change or the same three points, and increase five points; three questions have two answer categories quantified by 1 and 5: no counts as one point and yes as five points; two questions (1, 2) have scales with a range from 1 to 9, rating the sensation of pain; 1 is no pain and 9 severe pain: 1 and 2=5 points, 3 and 4=4 points, 5=3 points, 6 and 7=2 points, and 8 and 9=1 point. One question (15) has a scale with a range from 1 to 9 rating the feeling of selfimage; 1 is very low and 9 is extremely high self-image; 1 and 2=1 point, 3 and 4=2 points, 5=3 points, 6 and 7=4 points, and 8 and 9=5 points.…”

“…Measurement of quality of life or treatment outcome by subjective data has become an important tool in evidence-based medicine [8][9][10][11][12][13][14][15][16][17][18]. The Scoliosis Research Society instrument for outcome assessment (SRS 24) was designed to measure outcome after surgery, particularly in adolescent idiopathic scoliosis (AIS) patients [19][20][21].…”

Health-related quality of life in patients with adolescent idiopathic scoliosis: a matched follow-up at least 20 years after treatment with brace or surgery

“…The present study did not, however, establish a causal relationship for these findings. Another recent study [36] showed that brace wearing did not affect the self-image during the treatment of adolescents with idiopathic scoliosis, except in patients with low scores for relations with family.…”