I do what I want: are our patients adhering to bracing recommendations? Early results of a prospective cohort study

PURPOSE: Bracing is the mainstay of treatment for growing adolescents affected by idiopathic scoliosis with curves between 25° and 45°. Previous randomized trials and prospective studies have indicated that duration of bracing is an important factor in preventing curve progression. We aimed to compare actual in brace time to prescribed time. METHODS: We prospectively collected heat sensor data to assess bracing adherence. We aimed to assess brace prescription versus actual wear time and if any demographic or curve factors affected this relationship. RESULTS: We identified 104 patients with minimum 6-month follow-up brace heat sensor data. Average brace prescription was 16.5 h/day, and wear time, as indicated by heat sensor, was 12.9 h. This constituted 3.6 less hours worn than prescribed (2.4-4.3; p < 0.001). Thoracic curves had decreased brace wear versus target compared to thoracolumbar/lumbar (T/L) curves. Curve magnitude was positively associated with total brace wear average, but was not associated with adherence versus target brace wear. Diminishing returns in brace wear times were noted with prescriptions over 16 h. CONCLUSION: Brace adherence averages 3.6 h less than prescribed or 78.2% of the original prescribed time. Patients with larger curves were prescribed longer brace wear but did not have better adherence versus target. Thoracic curves had less adherence compared to T/L curves. The only modifiable independent risk factor we were able to determine for greater brace wear was prescribed hours. This information can be used to counsel patients during bracing treatment.