Impact of Computer-Aided Design and Computer-Aided Manufacturing Boston Brace on Level of Dyspnea among Patients with Adolescent Idiopathic Scoliosis

Abstract

Background: Adolescent Idiopathic Scoliosis (AIS) is a prevalent spinal deformity characterized by a lateral curvature exceeding 10°. Bracing, particularly with the Boston brace, is a common conservative treatment aimed at halting the progression of spinal curvature. However, the impact of bracing on pulmonary function and the resultant dyspnea remains a concern, especially in developing countries like Pakistan where larger scoliotic curves are more common. Objective: This study aimed to evaluate the effect of the CAD/CAM Boston brace on dyspnea levels in patients with AIS and to examine the correlation between dyspnea severity, Cobb's angle, and the duration of brace wear. Methods: Necessary approvals were obtained from the institutional ethical review board, and informed consent was secured from all participants. The study included 145 participants (aged 10-19 years) diagnosed with AIS, recruited through non-probability convenient sampling. The sample size was calculated using the WHO sample size calculator, ensuring a minimum of 134 participants. Data collection involved the 6 Minute Walk Test (6MWT) followed by the Modified Borg Scale (MBS) to assess dyspnea. Participants were instructed to walk a distance of 400 to 700 meters within 6 minutes. Post-test, participants rated their dyspnea on a scale of 0 to 10. Demographic data and brace wear duration were also collected. Data were analyzed using SPSS version 25. Means and standard deviations were calculated for continuous variables, and frequency tables were used for categorical variables. Pearson correlation coefficients were computed to determine the relationships between dyspnea levels, Cobb's angle, and brace wear duration. Results: The mean age of participants was 14.71 years (SD = 2.309). The mean Cobb's angle was 52.08° (SD = 5.3729), and the mean duration of brace wear was 26.08 hours per week (SD = 7.0458). Dyspnea severity varied, with 54.5% of participants reporting "somewhat severe" dyspnea, 15.9% reporting "very, very severe" dyspnea, and 9.0% reporting "moderate" dyspnea. Pearson correlation analysis revealed a strong positive correlation between dyspnea severity and Cobb's angle (r = 0.681), and a moderate positive correlation between dyspnea severity and brace wear duration (r = 0.414). Conclusion: The study highlights the significant impact of the CAD/CAM Boston brace on dyspnea levels among AIS patients. Higher Cobb's angles and longer brace wear durations were associated with increased dyspnea severity. These findings underscore the need for careful monitoring of respiratory symptoms in AIS patients undergoing bracing and suggest exploring alternative or adjunctive treatments to minimize pulmonary compromise.