Nicholson G P, Ferguson-Pell M W, Smith K, Edgar M, Morley T
Centre for Disability Research and Innovation, Institute of Orthopaedics and Musculo Skeletal Sciences, University College London, Brockley Hill, Stanmore, Middlesex HA7 4LP, United Kingdom.
Spine (Phila Pa 1976). 2003 Oct 1;28(19):2243-50; discussion 2250-1. doi: 10.1097/01.BRS.0000085098.69522.52.
Technology development and prospective study.
Develop instrumentation for discrete, reliable, and objective measurement of brace use patterns between routine follow-ups and without patient involvement.
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.
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.
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.
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.
技术开发与前瞻性研究。
开发一种仪器，用于在常规随访期间且无需患者参与的情况下，离散、可靠且客观地测量支具使用模式。
为了解脊柱支具在青少年特发性脊柱侧凸保守治疗中的疗效和临床效果，测量和记录诸如脊柱生理、力分布和依从性等混杂变量至关重要。历史上，依从性是通过患者访谈、衬垫/束带压力或温度来测量的。这些测量是主观的，仅限于实验室或仅短期监测，需要患者干预，或者缺乏日期/时间记录。
定制的无孔胸腰骶矫形器配备离散数据记录器，以16分钟为间隔、带有日期/时间戳记录皮肤与支具界面的温度，最长记录88天，无需患者参与。10名患有青少年特发性脊柱侧凸且将脊柱支具作为治疗方案一部分的女性患者（年龄15岁，标准差1.2）在14个月（标准差4.5个月）内参与了该研究。
治疗方案的依从性范围为8%至90%，平均为65%。患者往往高估其依从性150%（标准差50%）。工作日和周末的依从性无显著差异，但佩戴模式不同。夜间佩戴明显多于白天佩戴（P < 0.01）。依从性非常好的患者仅在洗澡或锻炼期间取下支具，但在依从性差的情况下，支具仅在白天偶尔佩戴。
温度提供了佩戴支具时间的清晰信号，可用于使用离散仪器进行长期数据记录，为帮助识别和理解依从性差背后的原因提供了一种工具。
