EXPLORING ADHERENCE TO BRACING IN YOUNG PEOPLE WITH ADOLESCENT IDIOPATHIC SCOLIOSIS: A QUALITATIVE STUDY

M.L.E. Chong1,2, J.V. Simmonds1
1University College London, Great Ormond Street Institute of Child Health, London, United Kingdom, 2Royal Free London NHS Foundation Trust, London, United Kingdom

Background: Adolescent idiopathic scoliosis (AIS) can cause back pain, decrease lung function and reduce quality of life. Bracing can prevent AIS from worsening. However, research has demonstrated that many young people do not wear their brace for the recommended hours and this is associated with worsening of scoliotic curve and higher chance of requiring surgery. To find ways for improving adherence to bracing, young people’s views on what facilitates or hinders adherence were explored.

Purpose: This study aimed to explore facilitators and barriers to brace adherence in young people with AIS. The findings may offer insights into how healthcare professionals (HCPs) and family members can motivate young people to adhere to bracing.

Methods: A qualitative study was conducted using semi-structured interviews. Young people who were prescribed bracing for AIS and their parents were recruited using purposive sampling from five scoliosis organisations or support groups. Interviews were conducted online. Questions explored their perceived facilitators and barriers to brace adherence. Interview transcripts were analysed using thematic analysis.

Results:

Six young people and five parents participated in the interviews. All young people were adherent to bracing. Three main themes related to facilitators and barriers to brace adherence were generated:

  1. ‘Knowledge about bracing’ shows that adherence is facilitated by young people's understanding about treatment effectiveness, the impacts of AIS and worries about surgical intervention. The uncertainty about the effectiveness of Boston brace is a possible barrier to adherence.
  2. ‘Psychosocial factors’ explores the importance of emotional support from parents and young people’s autonomy on brace adherence. It suggests how negative perceptions of bracing could affect adherence.
  3. ‘Practicality’ illustrates the physical difficulties in brace wearing, particularly full-time brace and Boston brace. It also describes the participants’ strategies to improve adherence, such as parents’ assistance and taking short breaks.

Conclusions:
  • This is the first qualitative scoliosis and bracing study to include both boys and girls.
  • For young people interviewed in this study with good brace adherence, knowledge about bracing and emotional and practical support from parents facilitate their adherence. Barriers include negative perceptions of bracing and physical difficulties in brace wearing.
  • The study could be repeated with purposive sampling to explore the views of young people who are non-adherent to bracing. A randomised controlled trial is required to establish the effects of combining education by HCPs and parental support on brace adherence. There is also a need for randomised controlled trials or prospective studies to compare the effects of different types of braces. Night-time braces may be a better option to promote adherence if they are as effective as full-time braces.

Implications:
  • Adherence can be facilitated by knowledge about bracing, highlighting the significance of patient education.
  • Parents and HCPs can appreciate the negative emotions associated with bracing. Emotional support from parents may help promote adherence.
  • Although there are physical barriers to brace adherence, young people may overcome the discomfort with time, or manage the difficulties using the strategies identified in this study. Parents may also assist brace wearing physically. Some brace designs may make adherence easier.

Funding acknowledgements: This research was unfunded.

Keywords:
Adolescent idiopathic scoliosis
Bracing
Adherence

Topics:
Paediatrics
Orthopaedics
Musculoskeletal: spine

Did this work require ethics approval? Yes
Institution: University College London
Committee: University College London Research Ethics Committee
Ethics number: 19575/001

All authors, affiliations and abstracts have been published as submitted.

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