Expert Opinions on Thermal Discomfort Related to Idiopathic Scoliosis Orthoses

Abstract

ABSTRACT Introduction The purpose of this study was to investigate expert opinions regarding the current status of and mitigation solutions for thermal discomfort associated with the use of thoracic-lumbar-sacral orthoses (TLSOs) in treating patients with idiopathic scoliosis (IS). Materials and Methods Qualitative data were gathered via interviews with experts in a variety of fields. Three primary categories of discussion were established: current status of thermal discomfort experienced by patients with IS treated with TLSOs, current mitigation strategies, and obstacles to implementation of a hypothetical novel TLSO. Data were analyzed utilizing Pell Institute's six-step method for qualitative data analysis. Results Six experts participated in this study: three spinal orthotics experts, who are orthotists currently treating IS with TLSOs; one thermal discomfort expert, who has been studying thermal discomfort for prosthetic devices; and two mechanical engineering experts, who conduct college courses on thermodynamics. Primary signs and symptoms of thermal discomfort identified by experts were heat rash, verbal complaint, and excessive sweating. Factors identified by experts as related to the occurrence of thermal discomfort fell into three categories: orthotic design, surrounding environment, and patient conditions. Experts also identified possible strategies used to mitigate thermal discomfort, which involved orthotic fabrication options, orthotic modification options, and patient behavioral changes. Conclusions Anecdotally, thermal discomfort experienced by TLSO users exists to varying degrees. The orthotic design, the environment, and the patient may impact the occurrence. Factors correlating to thermal discomfort may be skin temperature, friction, and moisture. Minimizing the quantity of skin surface area covered by the orthosis may be a primary thermal discomfort mitigation strategy. However, further investigation into the relationship between skin surface area coverage and thermal discomfort is required. Clinical Relevance This study introduces concepts and strategies that may be used by clinicians to reduce thermal discomfort experienced by patients with IS treated with a TLSO.