Donzelli Sabrina, Zaina Fabio, Negrini Stefano
ISICO (Italian Scientific Spine Institute), Via Bellarmino 13/1, 20141, Milan, Italy.
Physical and Rehabilitation Medicine, University of Brescia, Brescia, Italy.
Scoliosis. 2012 May 31;7(1):12. doi: 10.1186/1748-7161-7-12.
The effectiveness of bracing relies on the quality of the brace, compliance of the patient, and some disease factors. Patients and parents tend to overestimate adherence, so an objective assessment of compliance has been developed through the use of heat sensors. In 2010 we started the everyday clinical use of a temperature sensor, and the aim of this study is to present our initial results.
A prospective cohort of 68 scoliosis patients that finished at least 4 months of brace treatment on March 31, 2011: 48 at their first evaluation (79% females, age 14.2±2.4) and 20 already in treatment.
Bracing (SPoRT concept); physiotherapic specific exercises (SEAS School); team approach according to the SOSORT Bracing Management Guidelines.Methods. A heat sensor, "Thermobrace" (TB), has been validated and applied to the brace. The real (measured by TB) and referred (reported by the patient) compliances were calculated.Statistics. The distribution was not normal, hence median and 95% interval confidence (IC95) and non-parametric tests had to be used.
Average TB use: 5.5±1.5 months. Brace prescription was 23 hours/day (h/d) (IC95 18-23), with a referred compliance of 100% (IC95 70.7-100%) and a real one of 91.7% (IC95 56.6-101.7%), corresponding to 20 h/d (IC95 11-23). The more the brace was prescribed, the more compliant the patient was (94.8% in 23 h/d vs. 73.2% in 18 h/d, P < 0.05). Sixty percent of the patients had at least 90% compliance, and 45% remained within 1 hour of what had been prescribed. Non-wearing days were 0 (IC95 0-12.95), and involved 29% of patients.
This is the first study using a TB in a setting of respect for the SOSORT criteria for bracing, and it states that it is possible to achieve a very good compliance, even with a full time prescription, and better than what was previously reported (80% maximum). We hypothesize that the treating team (SOSORT criteria) plays a major role in our results. This study suggests that compliance is neither due to the type of treatment only nor to the patient alone. According to our experience, TB offers valuable insights and do not undermine the relationship with the patients.
支具治疗的有效性取决于支具的质量、患者的依从性以及一些疾病因素。患者和家长往往高估依从性，因此通过使用热传感器对依从性进行客观评估。2010年我们开始在日常临床中使用温度传感器，本研究的目的是展示我们的初步结果。
一个前瞻性队列，共68例脊柱侧弯患者，于2011年3月31日完成至少4个月的支具治疗：48例为首次评估（79%为女性，年龄14.2±2.4岁），20例已在接受治疗。
支具治疗（SPoRT理念）；物理治疗特定锻炼（SEAS学校方法）；根据SOSORT支具治疗管理指南采用团队治疗方法。方法：一种热传感器“Thermobrace”（TB）已得到验证并应用于支具。计算实际依从性（通过TB测量）和报告依从性（由患者报告）。统计学方法：分布不呈正态，因此必须使用中位数和95%置信区间（IC95）以及非参数检验。
TB平均使用时间：5.5±1.5个月。支具佩戴处方为每天23小时（h/d）（IC95 18 - 23），报告依从性为100%（IC95 70.7 - 100%），实际依从性为91.7%（IC95 56.6 - 101.7%），相当于每天20小时（IC95 11 - 23）。支具佩戴时间规定越长，患者依从性越高（23 h/d时为94.8%，18 h/d时为73.2%，P < 0.05）。60%的患者依从性至少为90%，45%的患者与规定佩戴时间的差异在1小时以内。未佩戴天数为0（IC95 0 - 12.95），涉及29%的患者。
这是第一项在遵循SOSORT支具治疗标准的情况下使用TB的研究，研究表明即使是全天佩戴处方，也有可能实现非常好的依从性，且优于之前报道的最高80%的依从性。我们推测治疗团队（SOSORT标准）在我们的研究结果中起主要作用。本研究表明依从性既不是仅由治疗类型决定，也不是仅由患者自身决定。根据我们的经验，TB提供了有价值的见解，且不会破坏与患者的关系。
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