The outcome of orthotic management of adolescent idiopathic scoliosis (AIS) depends on patient compliance with brace wear. Toward this end, a new study was conducted to determine if physician counseling based on objective compliance data increases brace wear and reduces the likelihood of surgery. The research team, which included two certified prosthetist-orthotists, found that providing feedback to patients with AIS about their compliance with brace wear improves compliance. Patients who wore their braces more hours per day had less curve progression. Patients who had curve progressions to a magnitude requiring surgery wore their braces less than their counterparts for whom bracing was successful. The authors of the study, published in The Journal of Bone & Joint Surgery on January 6, suggest that compliance monitoring and counseling based on that monitoring should become part of the clinical orthotic management of patients with AIS.
Participants in the study included 222 patients with AIS who were split into two groups; both groups had compliance monitors (sensors) embedded in their braces. In the counseled group, patients were aware of the compliance monitor in their braces and were counseled at each visit regarding downloaded brace-usage data. The patients in the noncounseled group were not told the purpose of the monitor in their braces, and the compliance data was not made available to the physician, orthotist, or patient. The average curve magnitude at the initiation of bracing was 33.2 degrees in the counseled group and 33.9 degrees in the noncounseled group.
Ninety-three patients who were counseled with use of the compliance data and 78 patients who were not counseled completed bracing or underwent surgery (12 patients were still undergoing brace treatment at the time of the study and 25 were lost to follow-up before completing brace treatment).
Patients in the counseled group wore their orthoses an average of 13.8 hours per day throughout their management, while noncounseled patients wore their braces an average of 10.8 hours per day, according to the authors. Of the counseled patients who finished brace treatment, 59 percent did not have curve progression greater than 6 degrees, whereas 25 percent had progression to greater than 50 degrees or to surgery. In the noncounseled group, 46 percent did not have curve progression of greater than 6 degrees, whereas 36 percent had progression to greater than 50 degrees or to surgery.
Noncounseled patients who had curve progression to a magnitude requiring surgery wore their braces an average of 9.6 hours per day compared with 12.6 hours per day for the counseled patients who required surgery. The amount of daily brace wear by participants who did not have curve progression to a magnitude requiring surgery was significantly greater than that by those who did require surgery.