Abstract
BackgroundOver the last years, evidence has accumulated in support of bracing as an effective treatment option in patients with idiopathic scoliosis. Yet, little information is available on the impact of compliance on the outcome of conservative treatment in scoliotic subjects. The aim of the present study was to prospectively evaluate the association between compliance to brace treatment and the progression of scoliotic curve in patients with idiopathic adolescent (AIS) or juvenile scoliosis (JIS).MethodsAmong 1.424 patients treated for idiopathic scoliosis, 645 were eligible for inclusion criteria. Three outcomes were distinguished in agreement with the SRS criteria: curve correction, curve stabilization and curve progression. Brace wearing was assessed by one orthopaedic surgeon (LA) and scored on a standardized form. Compliance to treatment was categorized as complete (brace worn as prescribed), incomplete A (brace removed for 1 month), incomplete B (brace removed for 2 months), incomplete C (brace removed during school hours), and incomplete D (brace worn overnight only). Chi square test, T test or ANOVA and ANOVA for repeated measures tests were used as statistical tests.ResultsThe results from our study showed that at follow-up the compliance was: Complete 61.1%; Incomplete A 5.2%; Incomplete B 10.7%; Incomplete C 14.2%; Incomplete D 8.8%. Curve correction was accomplished in 301/319 of Complete, 19/27 Incomplete A, 25/56 Incomplete B, 52/74 Incomplete C, 27/46 Incomplete D. Cobb mean value was 29.8 ± 7.5 SD at beginning and 17.1 ± 10.9 SD at follow-up. Both Cobb and Perdriolle degree amelioration was significantly higher in patients with complete compliance over all other groups, both in juvenile, both in adolescent scoliosis. In the intention-to-treat analysis, the rate of surgical treatment was 2.1% among patients with definite outcome and 12.1% among those with drop-out. Treatment compliance showed significant interactions with time.ConclusionCurve progression and referral to surgery are lower in patients with high brace compliance. Bracing discontinuation up to 1 month does not impact on the treatment outcome. Conversely, wearing the brace only overnight is associated with a high rate of curve progression.
Highlights
Over the last years, evidence has accumulated in support of bracing as an effective treatment option in patients with idiopathic scoliosis
Compliance to treatment was categorized as: brace worn as prescribed, brace removed for 1 month of a year, brace removed for 2 months of a year, brace removed during school hours, and brace worn overnight only
The results from our study showed that at follow-up the compliance was: brace worn as prescribed (Complete) 61.1%; brace removed for 1 month of a year 5.2%; brace removed for 2 months of a year 10.7%; brace removed during school hours 14.2%; brace worn overnight only 8.8%
Summary
Evidence has accumulated in support of bracing as an effective treatment option in patients with idiopathic scoliosis. The aim of the present study was to prospectively evaluate the association between compliance to brace treatment and the progression of scoliotic curve in patients with idiopathic adolescent (AIS) or juvenile scoliosis (JIS). Treatment (SOSORT) indicate adherence as a key element in determining the efficacy of bracing [13,14]. The aim of the present study was to prospectively evaluate the association between compliance to bracing and the progression of scoliotic curve, including surgery referral rate, in patients with idiopathic adolescent and juvenile scoliosis
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