Oral Presentation 50th International Society for the Study of the Lumbar Spine Annual Meeting 2024

Predicting Factors for Achieving Optimal Brace Compliance in Adolescent Idiopathic Scoliosis Treatment (#MP-8f)

Tomoyuki Asada 1 2 3 , Toshiaki Kotani 1 , Tsuyoshi Sakuma 1 , Yasushi Iijima 1 , Kotaro Sakashita 1 2 , Yosuke Ogata 1 2 , Tsutomu Akazawa 4 , Shohei Minami 1 , Seiji Ohtori 5 , Masao Koda 2 , Masashi Yamazaki 2
  1. Department of Orthopedic surgery, Seirei Sakura Citizen Hospital, Sakura, Chiba, Japan
  2. Orthopaedic Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
  3. Hospital for Special Surgery, New York, NY, USA
  4. Department of Orthopedic surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
  5. Department of Orthopedic surgery, Chiba University, Graduate School of Medicine, Chiba, Japan

Introduction

Brace treatment is a crucial treatment for adolescent idiopathic scoliosis. Brace compliance over 18 hours/day has been recommended to prevent the progression of the Cobb angle, which may ultimately require invasive surgical treatment. However, there is a scarcity of studies investigating the factors associated with achieving optimal bracing time. This study aims to find the factors that can predict the achievement of optimal bracing time.

 

Methods

We included patients aged 10-15 years with Cobb angles of 20°-40° and apex below T7. Patient-reported measures and outcomes and brace-induced psychological stress were assessed by SRS-22 and the Japanese version of BSSQ-brace (JBSSQ-brace), respectively. Compliance was measured using an intra-brace temperature sensor to determine detachments above 30℃ as compliant. Optimal bracing time was set as over 18 hours per day at the 6-month follow-up. After conducting univariable analysis with patients’ background, SRS22, and JBSSQ-brace, multivariable logistic regression was assessed for achieving the optimal bracing time with variables whose P-value < 0.10 except bracing time and total SRS-22 scores.

 

Results

Of 94 patients included in the analysis, 55 (58.5%) achieved the optimal bracing time. At 6 months after the initiation of the brace, the achieving group wore bracing for 21.3 hours/day, and the non-achievement group wore it for 8.9 hours/day (P<0.001). In the univariate analysis, several factors exhibited a P-value<0.10, including the satisfaction and mental health domains at the pre-bracing visit, JBSSQ-brace at 6 months, and the pain, mental health, and satisfaction domains at 6 months (Figure 1). Multivariable logistic regression revealed that the satisfaction domain at the pre-bracing (OR 9.76 [95%C.I. 2.01-47.3]; P=0.005) and pain domain at the 6 months (OR 3.53 [95%C.I. 1.15-10.8]; P=0.027) were independent factors predicting achieving the optimal brace compliance.

 

Discussion

Wearing a brace for >18 hours can prevent over 90% of scoliosis progression. Healthcare professionals are diligently working towards improving brace compliance. While numerous studies have been conducted to predict scoliosis progression, there is a limited body of research focusing on factors that can predict brace compliance. The findings of this study indicate that patients with lower satisfaction levels prior to brace initiation and those experiencing pain during the brace treatment are more likely to exhibit lower brace compliance at 6 months. As such, these measures can be utilized to identify patients at risk of noncompliance with brace treatment, enabling healthcare professionals to implement suitable interventions, such as psychological interventions, to achieve optimal bracing time.

 

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