Accuracy in the Prediction and Estimation of Adherence to Bracewear Before and During Treatment of Adolescent Idiopathic Scoliosis

Background: Because bracing for scoliosis may prevent curve progression, it is important to recognize nonadherence. We used temperature sensors to determine actual bracewear and examined: ( 1) the ability of a new pretreatment questionnaire to predict bracewear, ( 2) the ability of the physician and orthotist to predict bracewear before treatment, and ( 3) the ability of physicians, orthotists, patients, and parents to accurately estimate bracewear during the first year of treatment. Methods: Sixteen males and 108 females with adolescent idiopathic scoliosis were fitted with a Boston brace equipped with a temperature sensor and told that investigators were examining comfort. Before treatment, each patient completed an 18-item Brace-Beliefs Questionnaire (BBQ), and physicians/orthotists rated the likelihood that their patient would be adherent. During treatment, physicians, orthotists, patients, and parents provided estimates of daily bracewear. Data obtained at 1 to 3, 4 to 7, and 9 to 12 months into treatment were analyzed. Results: Scores from the BBQ were related to actual adherence (r = 0.46, P < 0.001). No patient scoring more than 1 SD below the BBQ sample mean had an adherence level more than 40%. Correlations of physician/orthotist pretreatment predictions with actual adherence were minimal. Overall, patients wore the brace 47% of the prescribed time, although they were estimated to have worn it 64%, 66%, 72%, and 75% by physicians, orthotists, parents, and patients, respectively. Physicians/orthotists incorrectly identified at least 1 of every 4 nonadherers. Conclusions: Predicting a patient's adherence before treatment is difficult, but a pretreatment questionnaire may be helpful. During treatment, all respondents overestimated adherence. Health care providers should be mindful of overreports of bracewear and skeptical of their own assessments of adherence. Clinical Relevance: Potential nonadherence may be predicted by a brief treatment-specific questionnaire. Treatment teams should not assume that patients follow their instructions or that family members are accurate sources of adherence information during treatment. Health care providers also should not assume that they can accurately predict adherence based on subjective expectations.