Clinical and quantitative assessment of headgear compliance: A pilot study

Introduction: This study was undertaken to evaluate the compliance of patients using headgear with a timing device and to determine the efficiency of the electronic module timer as a patient motivator. Methods: Twenty-one patients (average age, 14 years 10 months) were selected from the orthodontic clinic of Federal University of Parana on the basis of headgear wear for anchorage. The patients were instructed to wear their headgear 14 hours a day for a given number of days. The headgears were equipped with recorders (Compliance Science System and Affirm smart headgear modules, Ortho Kinetics, Vista, Calif). The patients were not told about the recorders, but they were instructed to keep track of their wear times. At the end of the test period (T1), the patients' reported wear times were compared with readings from the electronic modules. The patients were assigned a second period of headgear wear (T2) and told that their use would be monitored electronically. Again, the wear times reported by the patients were compared with the values from the electronic modules. Total time, number of hours accumulated between sessions, and quality time (uninterrupted use of headgear) were assessed. Results: Patients reported wearing their headgear an average of 13.6 hours per day; the electronic modules detected 5.6 hours per day in T1 and 6.7 hours per day in T2. Quality time was 1.8 hours per day in T1 and T2. The mean actual hours of daily wear relative to the provider's requirement was 56.7% in T1 and 62.7% in T2. Boys were more compliant than girls. After they learned of the electronic device, the girls' compliance improved. Younger patients were more compliant than older ones. The compliance rate of older patients improved slightly in T2. Conclusions: Patients tend to overreport their headgear wear times. The mean actual hours of daily wear relative to the providers' requirement was 56.7%. This increased to 62.7% when patients knew a recording device was being used. A monitoring system can provide feedback to the patient, facilitate parental involvement, and motivate patients to comply with headgear wear.