Why Don’t Adolescents Wear Their Brace? A Prospective Study Investigating Psychosocial Characteristics That Predict Scoliosis Brace Wear

Abstract

Background: Although bracing for adolescent idiopathic scoliosis can prevent curve progression and reduce the risk for future surgery, children frequently do not wear their braces as prescribed. The purpose of this study is to investigate how a broad array of psychosocial characteristics predict future compliance with scoliosis brace wear. Methods: This was a single institution, prospective cohort study. All adolescents prescribed a first-time brace for adolescent idiopathic scoliosis were eligible. Patients and their parents completed a separate series of questionnaires that assessed baseline psychosocial characteristics across 6 domains: (1) brace-specific attitudes; (2) body image and self-esteem; (3) school performance and social relationships; (4) psychological health; (5) family functioning; and (6) demographics and scoliosis-specific details (242 total questions across 12 validated questionnaires). Objective brace compliance was collected using temperature-sensitive monitors. Defining compliance as percentage of brace prescription completed, comparative analyses were performed to identify baseline psychosocial characteristics that were associated with future wear. A composite measure (Bracing Fidelity Follow-Up Scale [BFFS]) of the 12 most predictive individual questions across all domains (both parent and adolescent) was constructed to help assess which adolescents were at highest risk of failure to wear their brace. Total BFFS score for each parentadolescent dyad who completed all the included surveys was then determined by awarding one point for each factor that positively influenced future brace wear (maximum 12 points), and a correlation was calculated between total score and percent adherence to prescribed brace wear.Results: A total of 41 patients were included. On average, patients with high self-esteem, above average peer relationships and poor brace-specific attitudes had lower brace compliance, although patients with increased loneliness and parental religiousness had higher compliance. Body image, socioeconomic status, family dynamics, and school performance had no significant relationship with brace use. Total score on the Bracing Fidelity Follow-Up Scale (BFFS) was significantly associated with improved brace wear (r = 0.687,P < 0.001). Those with a score of 6 or above (n = 15/33 [45%], median compliance 96%) were more reliable users (15/15 with compliance > 75%), and those with a score of 5 or less (n = 18/33 [55%], median compliance 50%) had less consistent brace wear (9/18 with compliance <50%). Conclusion: This prospective study identifies numerous baseline psychosocial factors that are associated with future compliance with scoliosis brace wear. Although in need of further validation before widespread clinical application, the novel BFF scale offers a potential opportunity to partially discriminate between compliant and noncompliant scoliosis brace users such that supportive resources (eg, supportive counseling, peer-support groups, additional provider-based education, etc.) can be targe...

BrAIST-Calc

“…In order to make optimal decisions about whether and how many hours to brace, providers and families need accurate and reliable predictions about an individual patient’s risk without treatment and potential benefit with treatment. Parental and patient attitudes toward bracing and adherence improve when they anticipate a significant decrease in the risk of surgery 4–8 …”

“…Parental and patient attitudes toward bracing and adherence improve when they anticipate a significant decrease in the risk of surgery. [4][5][6][7][8] Therefore, the aims of this study were to 1) derive and validate a prognostic model predicting the probability of curve progression to surgical indications with 0 (close observation alone) to 18 hours of bracing; 2) inform decisions about daily hours of brace wear by comparing the net benefit over a range of wear time; and 3) define a group of low-risk patients who could be good candidates for observation alone.…”

Personal and Clinical Determinants of Brace-Wearing Time in Adolescents with Idiopathic Scoliosis

“…When it comes to bracing, factors such as high self-esteem, positive peer relationships, and negative attitudes towards the brace, especially by parents, have been linked to lower brace adherence [ 30 ]. In contrast, feelings of loneliness and heightened parental religiousness appear to be associated with improved brace wear [ 31 ]. Other characteristics like body image, socioeconomic status, family dynamics, and school performance did not exhibit significant associations with brace adherence [ 31 ].…”

“…In contrast, feelings of loneliness and heightened parental religiousness appear to be associated with improved brace wear [ 31 ]. Other characteristics like body image, socioeconomic status, family dynamics, and school performance did not exhibit significant associations with brace adherence [ 31 ].…”

The effectiveness of scoliosis treatment is not a matter of the type of brace

“…It depends on risk assessment, goals and the beliefs of the treating physician, the family's commitment and acceptance of the prescription by the adolescent. Recent evidence suggests the role of numerous baseline psychosocial factors associated with future compliance [ 5 ] It's clear that compliance goes beyond factors related to the “brace tool” [6] . Other members of the treating team can make a difference in helping compliance.…”