Making the Most of Scoliosis Compliance Monitors

Compliance monitors are used to help track brace adherence in patients with scoliosis. In recent years, they have advanced technologically, with some even allowing patients and their families to access the brace usage data. While studies show they can help with brace wear time, experts caution that they should be used wisely. Research has demonstrated that the act of tracking has helped prompt patients to increase their brace wear time. A 2012 study found that patients who had monitors wore their braces, on average, about five more hours a day than those without monitors. 1 However, while the monitors have proven to help with brace adherence, they can also add stress to an already stressful situation, says Megan Glahn Castille, MS, CPO/L, assistant professor at Baylor College of Medicine, Texas. “To me, they don’t get to the root cause of why a patient may not be wearing the brace as often as they should,” she says. “It might lead to the desired end result, but it doesn’t make [patients] less stressed. If anything, I imagine they may be more stressed because they are getting a ‘report card’ about their wear-time.” Sun Hae (Sunny) Jang, PhD, CO, FAAOP, Eastern Michigan University, says she chooses not to use the monitors for her patients. “Even if you know the fact, there may be limitations on what we can do as orthotists,” she says. “And we have to consider a patient’s privacy issue.” She says the monitors are most effective and have less of a mental toll on the patients, when they are used along with other strategies to increase adherence. Children’s Hospital of Philadelphia has been using compliance monitors as a standard part of the brace since 2018, though families are allowed to opt out, says Christopher Nelson, CPO, clinical director at the hospital. Looking at the data, he can tell why some braces make a difference, and why some don’t. “It’s quite clear when you look at your outcomes that kids who have good results also have good wear-time data.” He says the monitor, which he calls a sensor to his patients, is a tool to help him, his patients, and their families. When used correctly, patients can better monitor brace usage, which helps them make smart choices, he says. “In this day and age, many families have complex and varied schedules,” Nelson says. “Being able to check their own wear time and bank time offers flexibility and facilitates direct involvement of the patient in the process.” Kara Davis, CPO, clinical coordinator at Scottish Rite for Children, Texas, says the monitors are just one of the tools she uses to help with adherence. “It equips them with the tools they need so the patients and their parents can be aware of how they are doing,” she says. Davis says she has been using the monitors for years. At first, some families declined their use because they didn’t want their children to be tracked or didn’t know how the information would be used. But now when she explains how helpful the tool it can be, most families agree to use one, she says. “If we tried to sell it as a police monitor, then a lot of families might decline,” she says. “We don’t use it as a big brother type of thing. When I fit the brace, I tell them this is a tool to give you the knowledge and feedback of what your wear schedules are, so you are self-aware.” Maria St. Louis-Sanchez can be contacted at msantray@yahoo.com . Read more in " How to Address t he Psychological Impact of Scoliosis Bracing" from our May 2023 issue. Miller, D. J., J. M. Franzone, and H. Matsumoto H, et al. 2012. Electronic monitoring improves brace-wearing compliance in patients with adolescent idiopathic scoliosis: a randomized clinical trial. Spine 37(9):717–21.

Making the Most of Scoliosis Compliance Monitors

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