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Early Adherence to Prescribed Brace Wear for Adolescent Idiopathic Scoliosis is Associated with Future Brace Wear

Spine (Phila Pa 1976). 2022 Aug 2. doi: 10.1097/BRS.0000000000004446. Online ahead of print.


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.

METHODS: Consecutive AIS patients who met the Scoliosis Research Society (SRS) criteria for bracing from 2015-2019 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 greater than 80% of the daily prescribed amount. Brace wear was recorded by a thermosensor and assessed during the wean-in period, six-month, 12-month, and 24-month post-bracing 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 four with a Cobb angle less than 40 degrees.

RESULTS: Sixty patients (mean age – 12.5 y) 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 non-adherent 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 non-adherent patients (P<0.001). Ninety-seven percent of adherent patients achieved bracing success compared to 71% of non-adherent (P=0.016). Females were more likely to be adherent than males.

CONCLUSION: Initial adherence to prescribed AIS brace wear was associated with future adherence, bracing success, and curve improvement. Early recognition of non-adherence may offer an opportunity for supportive intervention to improve brace wear behavior.

PMID:35917288 | DOI:10.1097/BRS.0000000000004446

By Nevin Manimala

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