Effects of adherence to bracing treatment in children with adolescent idiopathic scoliosis: a preliminary study
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OBJECTIVE: The objective of this study is to determine the different biological, psychological, and social factors that affect patient adherence in bracing treatment for adolescent idiopathic scoliosis. By comparing adherent and non-adherent bracing patients, we hope to gain insight into how to improve patient adherence in bracing as a means of primary treatment and to avoid secondary and tertiary treatments such as surgery. METHODS: Of the 19 patients (15 adherent, 4 non-adherent) who were examined for this study, the majority of them completed all psychosocial surveys at one time point in their bracing treatment. Patients answered surveys for multidimensional anxiety, generalized anxiety, pain-related fear and avoidance, pain catastrophizing, and quality of life. Quantitative sensory testing was performed on only 5 of the 19 patients at the time of writing. Sensory testing was conducted to gather information on thermal sensitivities and thresholds. Statistical t-test significance was determined for all surveys distributed to adherent and non-adherent bracing groups, and scaled T-scores were calculated for each survey measure to determine clinical significance. RESULTS: There were no statistically significant differences in any measures examined between adherent and non-adherent bracing patients. The only statistically significant difference was the number of hours of brace wearing, with the adherent group wearing their brace over 11 hours more than the non-adherent group (p < 0.0004). CONCLUSIONS: Because of the underpowered nature of this study, measures for multidimensional anxiety, generalized anxiety, pain-related fear and avoidance, pain catastrophizing, and quality of life should be reexamined for potential differences between adherent and non-adherent bracing patients. Quantitative sensory testing should be included as a measure of possible sensory differences between the two groups. A future study with a larger sample size may provide greater understanding into the motivations for bracing adherence in an effort to help patients avoid more invasive means of intervention in treating adolescent idiopathic scoliosis.