The objective measurement of spinal orthosis use for the treatment of adolescent idiopathic scoliosis

Study Design. Technology development and prospective study. Objectives. Develop instrumentation for discrete, reliable, and objective measurement of brace use patterns between routine follow-ups and without patient involvement. Background Data. To understand spinal bracing efficacy and clinical effectiveness in the conservative treatment of adolescent idiopathic scoliosis, it is essential to measure and record such confounding variables as spinal physiology, force distribution, and compliance. Historically, compliance was measured using patient interviews, pad/strap forces, or temperature. These measurements were subjective, limited to laboratory or short-term monitoring only, required patient intervention, or lacked date/ time recording. Methods. Custom-fitted nonperforated thoracic lumbar sacral orthoses were instrumented with discrete data loggers to measure and record temperature at the skin brace interface at 16-minute date/time-stamped intervals for up to 88-day periods without patient involvement. Ten female patients ( age 15 years, SD 1.2) with adolescent idiopathic scoliosis who had spinal bracing as part of their treatment regimen took part in the study over 14 months, SD 4.5 months. Results. Compliance with the treatment regimen ranged from 8% to 90%, average 65%. Patients tended to overestimate their compliance by 150% (SD 50%). There was no significant difference between weekday and weekend compliance but wear patterns differed. Night wear was significantly greater than day wear ( P < 0.01). Patients with very good compliance only removed their brace for washing or exercise periods, but where poor compliance was evident, the brace was only worn sporadically during the day. Conclusions. Temperature provides a clear signal of the time in brace and can be used for long-term data logging using discrete instrumentation, providing a tool to help identify and understand the reasons behind poor compliance.