Takemitsu Masakazu, Bowen J Richard, Rahman Tariq, Glutting Joe J, Scott Claude B
Nemours Children's Clinic Wilmington, Wilmington, Delaware, USA.
Spine (Phila Pa 1976). 2004 Sep 15;29(18):2070-4; discussion 2074. doi: 10.1097/01.brs.0000138280.43663.7b.
Prospective, blinded study to evaluate compliance with treatment.
To evaluate objectively idiopathic scoliosis patients' compliance with Wilmington brace treatment.
Patients' compliance with brace treatment for idiopathic scoliosis traditionally has been determined from patient or parent interviews or both; however, the hours reported by patients are subjective and consequently are not accurate.
Study participants were 61 consecutive patients with idiopathic scoliosis: 54 girls and 7 boys. Inclusion criteria were curvature of more than 20 degrees and less than 45 degrees of Cobb angle before brace treatment. Actual hours worn per day were measured using a compliance monitor, and compliance was determined by the percentage of actual hours worn in accordance with the prescribed regimen. Accuracy of compliance from hours reported by patients was compared with actual hours measured by the monitor. Correlations between compliance and prescribed regimen and age were analyzed.
The overall compliance measured by the monitor was 75 +/- 27% (mean +/- S.D.), and the frequency distribution was similar to a Gaussian distribution. The compliance determined from hours reported by patients was 85 +/- 24%, which was higher than that from actual hours measured by the monitor (P = 0.01). There was a negative correlation between age and compliance (rho = -0.30, P = 0.025); 10-, 12-, and 14-year-old patients had 84, 77, and 60% average compliance, respectively. Compliance among patients with different prescribed regimens (8, 12, 16, or 23 hours of wear) showed no statistical difference (P = 0.361).
Patients with idiopathic scoliosis complied with 75% of prescribed regimen on average and overreported their hours of brace wear to their physician. Age affected compliance. There was no statistical difference in compliance among patients with different prescribed regimens. The present study confirms the need for a compliance monitor to accurately evaluate use and outcome of brace treatment.
一项前瞻性、盲法研究，旨在评估治疗依从性。
客观评估特发性脊柱侧凸患者对威尔明顿支具治疗的依从性。
传统上，特发性脊柱侧凸患者对支具治疗的依从性是通过患者或家长访谈或两者结合来确定的；然而，患者报告的时间是主观的，因此并不准确。
研究参与者为61例连续的特发性脊柱侧凸患者，其中54例女孩，7例男孩。纳入标准为支具治疗前Cobb角大于20度且小于45度。使用依从性监测仪测量每天实际佩戴的时间，并根据规定方案中实际佩戴时间的百分比来确定依从性。将患者报告的时间的依从性准确性与监测仪测量的实际时间进行比较。分析依从性与规定方案和年龄之间的相关性。
监测仪测量的总体依从性为75±27%（平均值±标准差），频率分布类似于高斯分布。根据患者报告的时间确定的依从性为85±24%，高于监测仪测量的实际时间的依从性（P = 0.01）。年龄与依从性之间存在负相关（rho = -0.30，P = 0.025）；10岁、12岁和14岁的患者平均依从性分别为84%、77%和60%。不同规定方案（佩戴8、12、16或23小时）的患者之间的依从性无统计学差异（P = 0.361）。
特发性脊柱侧凸患者平均依从规定方案的75%，并向医生多报了支具佩戴时间。年龄影响依从性。不同规定方案的患者之间的依从性无统计学差异。本研究证实了需要使用依从性监测仪来准确评估支具治疗的使用情况和结果。
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