Early Adherence to Prescribed Brace Wear for Adolescent Idiopathic Scoliosis Is Associated With Future Brace Wear

Abstract

Study Design. Retrospective cohort study. Objective. To assess if initial adherence to prescribed brace wear for adolescent idiopathic scoliosis (AIS) predicts future adherence and curve improvement. Summary of Background Data. AIS bracing can be effective if patients adhere to prescribed brace wear. Previous research has associated age, sex, and brace prescription length with future adherence. We hypothesize that a patient's initial adherence to brace wear may be associated with future adherence and outcomes. Materials and Methods. Consecutive AIS patients who met the Scoliosis Research Society (SRS) criteria for bracing from 2015 to 2019 at a single center were reviewed. Patients were stratified into groups based on their adherence during the initial one-month brace wean-in period-adherent patients were defined as wearing the brace > 80% of the daily prescribed amount. Brace wear was recorded by a thermosensor and assessed during the wean-in period, six-, 12-, and 24-month postbracing appointments. Statistical testing was conducted to analyze if initial adherence was associated with future adherence, curve change, and bracing success-defined as reaching Risser stage 4 with a Cobb angle <40°.Results. Sixty patients (mean age = 12.5 yr) were included, of which the majority were females (83%) with thoracic curves (70%). Thirty-two patients were considered adherent, and this cohort demonstrated improved adherence relative to the nonadherent group at the six-, 12-, and 24-month appointments (P < 0.001). Adherent patients also showed a significant reduction in their scoliosis at the 12-month appointment, unlike nonadherent patients (P < 0.001). Ninety-seven percent of adherent patients achieved bracing success compared with 71% of nonadherent (P = 0.016). Females were more likely to be adherent than males. Conclusions. Initial adherence to prescribed AIS brace wear was associated with future adherence, bracing success, and curve improvement. Early recognition of nonadherence may offer an opportunity for supportive intervention to improve brace wear behavior.

Effectiveness of Orthotic Treatment on Clinical Outcomes of the Patients with Adolescent Idiopathic Scoliosis Under Different Wearing Compliance Levels

“…Subjects who wore orthoses >14.4 h/d during the adaptation period exhibited a significantly lower failure rate of 3.3% (defined as Cobb angle progressed to ≥40°), compared with the failure rate of 29.2% in subjects with <14.4 h/d compliance at the 12-month follow-up visit 22 . In addition, there was a significant difference in the surgery rate at orthosis-weaning visit between the compliance groups of >20 and <20 h/d (28% vs. 20.8%) 14 .…”

“…Landauer et al found a lower progression rate in the good compliance group than those in the lower compliance group (22.7% vs. 72.2%) 25 . The compliant group of .14.4 h/d (80% of prescribed time) had a lower curve progression rate compared with the incompliant group at the 24month follow-up, although this difference was not statistically significant (39.1% vs. 68.8%) 22 .…”

“…In 2 studies that enrolled the same cohort of patients, 57% were prescribed 23 hours/ day and 43% were prescribed 16 hours/ day 11,18 . In addition, the study conducted by Rahman et al in The objective-instructed compliance monitors, including force sensors 19,29 and temperature sensors 4,11,17,18,[21][22][23]28 , were used in 10 studies to assess orthosis-wearing time, whereas the other 9 studies estimated compliance through subjective evaluation methods, such as patient and family self-reports or daily orthosis-wearing log sheets 13,19,24,26 , orthopaedic surgeon's evaluation based on the patient's and family's responses and regular checking 14,20 , standardized compliance score systems 25 , or reviewing medical records 27 .…”

“…According to the SOSORT criteria, the primary aim of orthotic treatment is to halt curve progression with the consideration of the intraobserver Cobb angle measurement error 3,[30][31][32][33] . The measurement error threshold was either 5°1 3,20,22,[25][26][27][28][29] or 6°1 1,14,17,21,24 in the included studies. The orthotic treatment outcomes were defined as progression, stabilization, and improvement by the major curve Cobb angle change: increase of exceeding 5°or 6°, change within 5°or 6°, and decrease exceeding 5°or 6°, respectively, when compared with the pretreatment Cobb angle.…”

“…In total, at least 1,981 subjects with AIS were included in this review, with 1,709 female patients, 206 male patients, and 66 subjects whose sex was not reported. In addition, 13 of the 17 studies explicitly required subjects to have Risser Sign between 0 and 2 4,11,14,[17][18][19][20][21][22][23][24]26,27 . In the remaining 4 studies, only one did not mention specific inclusion criteria for chronological or skeletal age 28 .…”