Texas Scottish Rite Hospital for Children, Dallas, Texas
Texas Scottish Rite Hospital for Children, Dallas, Texas.
J Bone Joint Surg Am. 2016 Jan 6;98(1):9-14. doi: 10.2106/JBJS.O.00359.
Outcomes of orthotic management of idiopathic scoliosis depend on patient compliance with brace wear. The purpose of this study was to determine if counseling based on objective compliance data increases brace wear and therefore reduces the likelihood of surgery.
Two hundred and twenty-two patients with adolescent idiopathic scoliosis were prospectively enrolled in a study to determine if physician counseling based on data obtained from compliance monitors (sensors embedded in the brace) improves brace use and decreases curve progression. Patients were placed into two groups. In the counseled group, patients were aware of the compliance monitor in the brace and were counseled at each visit regarding downloaded brace-usage data. The patients in the noncounseled group were not told the purpose of the monitor in their brace, and the compliance data were not made available to the physician, orthotist, or patient.
Ninety-three patients who were counseled with use of the compliance data and seventy-eight patients who were not so counseled completed bracing or underwent surgery; twenty-five patients were lost to follow-up before completing brace treatment, and twelve were still undergoing brace treatment at the time of the study review. The average curve magnitude at the initiation of bracing was 33.2° in the counseled group and 33.9° in the noncounseled group (p = 0.21 [not significant]). Patients in the counseled group wore their orthosis an average of 13.8 hours per day throughout their management, while noncounseled patients wore their brace an average of 10.8 hours per day (p = 0.002). Of the counseled patients who finished brace treatment, 59% did not have curve progression of ≥6°, whereas 25% had progression to ≥50° or to surgery. In the noncounseled group, 46% did not have curve progression of ≥6°, whereas 36% had progression to ≥50° or to surgery. Noncounseled patients who had curve progression to a magnitude requiring surgery wore their brace an average of 9.6 hours per day compared with 12.6 hours per day for the counseled patients who required surgery. The amount of daily brace wear by children who did not have curve progression to a magnitude requiring surgery was significantly greater than that by children who did require surgery (p = 0.029).
Providing patients undergoing bracing for adolescent idiopathic scoliosis with feedback about their compliance with brace wear improves that compliance. Patients who wore their brace more hours per day had less curve progression. Patients in both groups who had curve progression to a magnitude requiring surgery wore their brace less than their counterparts for whom bracing was successful. Compliance monitoring and counseling based on that monitoring should become part of the clinical orthotic management of patients with adolescent idiopathic scoliosis.
支具治疗特发性脊柱侧凸的结果取决于患者对支具佩戴的依从性。本研究的目的是确定基于客观依从性数据的咨询是否可以增加支具的佩戴时间，从而降低手术的可能性。
222 例青少年特发性脊柱侧凸患者前瞻性入组本研究，以确定基于从依从性监测器（嵌入支具中的传感器）获得的数据进行医生咨询是否可以改善支具的使用情况并减少曲线进展。患者被分为两组。在咨询组中，患者知道支具中有依从性监测器，并在每次就诊时根据下载的支具使用数据接受咨询。未告知非咨询组患者支具中监测器的目的，也不向医生、矫形师或患者提供依从性数据。
93 名接受依从性数据咨询的患者和 78 名未接受咨询的患者完成了支具治疗或接受了手术；25 名患者在完成支具治疗前失访，12 名患者仍在接受支具治疗。咨询组患者在开始支具治疗时的平均曲线幅度为 33.2°，非咨询组为 33.9°（p=0.21[无统计学意义]）。咨询组患者平均每天佩戴支具 13.8 小时，而非咨询组患者平均每天佩戴支具 10.8 小时（p=0.002）。在完成支具治疗的咨询组患者中，59%的患者没有出现≥6°的曲线进展，而 25%的患者出现≥50°或需要手术。在非咨询组中，46%的患者没有出现≥6°的曲线进展，而 36%的患者出现≥50°或需要手术。需要手术的非咨询组患者中，出现需要手术的曲线进展幅度的患者平均每天佩戴支具 9.6 小时，而需要手术的咨询组患者平均每天佩戴支具 12.6 小时。没有进展到需要手术的曲线幅度的儿童每天佩戴支具的时间明显长于需要手术的儿童（p=0.029）。
为接受青少年特发性脊柱侧凸支具治疗的患者提供有关其支具佩戴依从性的反馈信息可以提高其依从性。每天佩戴支具时间更长的患者曲线进展更少。两组中出现需要手术的曲线进展幅度的患者佩戴支具的时间均少于支具治疗成功的患者。基于监测的依从性监测和咨询应该成为青少年特发性脊柱侧凸患者临床支具治疗的一部分。
