A 2008 study in the Journal of Pediatric Orthopaedics found that patients wore their braces 47 percent of their prescribed time. However, their estimates were they had worn it 75 percent of the prescribed time.1
To help track the patients’ wear times, and keep them motivated, it has become increasingly common for orthotists to put compliance monitors into the braces. The sensors, which detect a body’s heat when a brace is worn, report how much time the braces are worn. The experts called the addition of the monitors a game changer in helping with compliance.
“Before using data loggers, we were dependent on a patients’ self-report of adherence to wearing time and treatment plan,” says Luke Stikeleather, CO, president and chief orthotist of the National Scoliosis Center, headquartered in Fairfax, Virginia. “While some patients are very accurate and honest, the literature shows that self-report is very inaccurate and prone to overestimation.”
With the compliance monitors, there is no subjectivity.
“Now we have factual data that’s objective, and we can share that information to encourage them to keep doing well or do better,” he says.
At Texas Scottish Rite Hospital for Children in Dallas, it is standard practice to include a compliance monitor on every scoliosis brace.
“It’s pretty much become the gold standard to have a data logger to monitor how many hours they are wearing it,” says Kara Davis, CPO/L, FAAOP, clinical coordinator at the hospital. She says the monitors help hold the patients accountable and thus, they are more likely to wear their brace more.
“It’s all about accountability,” she says. “Will you cheat if you think you will be caught, or will you cheat if you don’t think you will be caught?”
When the staff at Scottish Rite first used the sensors, they did not share the data with the patients and used it simply to confirm or deny if the self-reported adherence was correct.
The monitors truly became effective when the healthcare team discussed the data with the patients and their families, and they all worked together to use the data to improve compliance.
“We saw a three-hour a day increase in wear time when patients were given their sensor feedback,” Davis says. “That’s significant.”
She says that its helpful to look at the data and ask patients why they might not be wearing their braces on certain days or at certain times.
“We can identify when they are struggling and can talk about intervention techniques to try to improve during those times.”
The sensors that are being piloted at Scottish Rite for Children may soon be shared with any interested patients anywhere in the country. Scottish Rite is also in the process of refining an app so patients and their families can track compliance on their mobile devices.
Maria St. Louis-Sanchez can be contacted at [email protected].
1. Morton, A., R. Riddle, and R. Buchanan et al. 2008. Accuracy in the prediction and estimation of adherence to bracewear before and during treatment of adolescent idiopathic scoliosis. Journal of Pediatric Orthopaedics 28(3): 336-341.