If your child has been diagnosed with adolescent idiopathic scoliosis (AIS) and has been told by his or her physician to wear a brace, it’s often the parents who end up feeling like the enforcer. It's a challenge to keep your child motivated to wear their brace.

Wearing a brace can be annoying and disruptive for a tween or teen. Although the brace may be worn under clothing, the child feels different from their peers. However, compliance is important because bracing may significantly decrease the progression (eg, size, magnitude) of high-risk curves. Preventing or slowing the progression of curve size may help the child avoid spine surgery. Furthermore, research shows the benefits of brace therapy increases with longer hours of brace wear.¹

Study Results
A study published in The Journal of Bone and Joint Surgery, reported patients who received compliance counseling about bracing wore their brace more than their counterparts who did not receive the counseling.² Research, led by Lori A. Karol, MD, of the Texas Scottish Rite Hospital for Children in Dallas, Texas, focused their study on patients with AIS who ranged in age from 10 to 16. One group of 93 patients received the counseling and another group of 78 did not.²

Compliance monitors—sensors embedded in the brace were used to monitor temperature and provided feedback about how many hours the brace was worn. Parents consented to have the temperature of their child’s brace monitored, and the patients in the counseled group were told that the sensors would be able to provide feedback about how many hours they were wearing their brace. The sensors logged the temperature of the brace every 15 minutes for three months. At each office visit, the data from the sensors was downloaded into a computer, and a brace use report was printed.

The researchers found that 98 patients who received compliance counseling wore their brace an average of 13.8 hours per day. Seventy-eight patients, who were not counseled, wore their braces for an average of 10.8 hours a day.²

Counseled Patient Results
•    59% did not have a curve progress equal to or greater than 6-degrees.
•    25% experienced curve progression equal to or greater than 50-degrees, or had surgery.

“The amount of daily brace wear by children who did not have curve progression to a magnitude requiring surgery was significantly greater than that by children who required surgery,” the study authors reported. “Previous research shows that increased time in the brace is associated with decreased spinal deformity progression and the necessity of surgical correction of the scoliosis,” stated Selina Poon, MD, a pediatric orthopaedic surgeon at Northwell Health. “With this new study, I think having the compliance data is a great tool for the doctor to help patients increase time in the brace.”

Dr. Karol, the study’s lead author, explained that patients who received compliance counseling were provided with positive feedback. “It was not sharing in a negative way, but in an informational way where we sat down together and looked to see where any difficulties may be,” she said. “With my patients, I use it as an opportunity to look back on the hours when they were supposed to be wearing a brace and to tell them, for instance, that I see on this day you did really well, but you had difficulty here. I’ll ask them, can we work on your schedule a little more? Can we make the brace more comfortable?”

So, should compliance counseling become a routine part of wearing a brace?
“I believe that counseling is key but above all, so is understanding the importance of bracing and the benefits of bracing,” said David Gurd, MD. Dr. Gurd is a spine surgeon and Head of the Pediatric Spinal Deformity Surgery Program within the Center for Pediatric Orthopaedics at Cleveland Clinic. “Sadly, though, it doesn’t answer all questions, as even among those patients who were counseled, 25% still went on to require surgery.” “It seems as if the younger patients, who are also more at risk for a higher risk for progression of scoliosis because of increased amounts of spine growth, had the lowest compliance of brace wear. It is important to figure out how to increase the brace compliance of younger patients,” noted Dr. Gurd.

Dr. Kent A. Reinker indicated this new study shows that counseling can improve patient compliance during bracing, and increased brace wear improved patient results. “Those who did not have curve progression requiring surgery wore their brace significantly longer per day than those who did have such progression,” Dr. Reinker stated. “We still do not know why approximately a quarter of the patients [25%] had curve progression despite bracing,” said Dr. Reinker. ³

Conclusion
The study shows that patient feedback in brace wear effectively persuades adolescents to wear their braces more hours. Compliance counseling is something Dr. Karol would like to see as part of standard treatment. She feels it paves the way for information-based communication with patients. “It opens the door for us to be able to speak to these teenagers and to provide patient-centered care,” she says.