Research Research Research
To put it simply, BRACING WORKS. Bracing treats scoliosis by working to prevent the progression of your curve. In general, bracing does not correct your curve, although there are some rare cases where the size of the curve has decreased. However, this is rare, so the goal of bracing is to prevent the curve from getting worse. With that being said, all scoliosis was not created equal. Some scoliosis cases are easily treated, while other cases are simply nasty and aggressive. Whatever the case, bracing gives you the chance to fight your curve without surgery. Ultimately, we as orthotists want to keep you from needing to have surgery to correct your curve.
Previous Research Shows the Effectiveness of Bracing: The BrAIST Study
Several research studies have previously shown that bracing is effective in treating idiopathic scoliosis. The BrAIST Study (Bracing in Adolescent Idiopathic Scoliosis Trial) is the most groundbreaking scoliosis research in recent history. Published in 2013, this study showed the effectiveness of scoliosis bracing and the relationship between brace wear-time and success.
242 patients with curves between 20 – 40 degrees participated in the BrAIST study. Patients were assigned to either the bracing group or the observation-only group. The patients in the bracing group were instructed to wear their brace 18 hours per day. The patients in the observation-only group received no additional treatment and did not wear a brace.
"Success" meant that the curve did not progress to 50 degrees and the patient reached skeletal maturity, while "failure" meant that the curve did progress to 50 degrees or worse.
The study was STOPPED EARLY because bracing was shown to be so effective. Encouraging patients to continue in the observation-only group without a brace was unethical.
72% of patients in the bracing group did not need surgery, while only 48% of patients in the observation-only group avoided surgery. In the bracing group, 90% of the patients who wore their brace for 13 or more hours a day avoided surgery. This shows that the amount of time you wear your brace is very important! The more you wear your brace, the more likely you are to prevent curve progression and avoid surgery.
Compliance is Complex
Even though research supports the effectiveness of bracing, compliance is a big problem, especially because success depends on how much the brace is worn. In a 2014 study of 100 scoliosis patients, only 31% of the subjects wore their brace for 10+ hours per day and only 13% wore it for 14+ hours per day.1 More recently, a 2017 study looked at the motivations for compliance in 39 female scoliosis patients, revealing that the desires to avoid surgery and prevent curve progression were the main reasons for complying. The majority of the subjects reported that having peer support would likely increase the amount of time that they wore their braces.2
These findings agree with two previous studies. When patients and their parents were asked what could be done to mitigate the psychological impact of initiating bracing, the most frequent recommendation was a support group for both the patients and parents.3 Similarly, a 1999 study suggested that seeking social support is characteristic of compliant girls. In this study, low self-esteem, low efforts to seek social support, and low expectations for success predicted poor compliance in girls. However, the opposite was observed in boys - high self-esteem, high amounts of seeking social support, and high expectations for success predicted poor compliance. These results suggest that social support may not be as beneficial in boys because social support may reinforce the irrational optimism that non-compliant boys seem to possess. In both females and males, sleeping problems predicted poor compliance.4
In summary, compliance is a very complex problem, but social support may help to increase wear-time.
[1] Sanders JO, Newton PO, Browne RH, Katz DE, Birch JG, Herring, JA. Bracing for idiopathic scoliosis: how many patients require treatment to prevent one surgery? J Bone Joint Surg Am. 2014; 96(8): 649-653.
[2] Brigham EM, Armstrong DG. Motivations for compliance with bracing in adolescent idiopathic scoliosis. Spine Deform. 2017; 5(1): 46-51.
[3] MacLean Jr WE, Green NE, Pierre CB, Ray DC. Stress and coping with scoliosis: psychological effects on adolescents and their families. J Pediatr Orthop. 1989; 9(3): 257-261.
[4] Lindeman M, Behm K. Cognitive strategies and self-esteem as predictors of brace-wear noncompliance in patients with idiopathic scoliosis and kyphosis. J Pediatr Orthop 1999; 19(4): 493-499.
Scolios-us Research
The goals of Scolios-us research include determining its helpfulness and usefulness for patients and validating it as an effective clinical tool to help bridge the gap between healthcare providers and patients. Our pilot study was completed in 2018. Scolios-us Founder, Megan Glahn, CPO, presented this study at the 2019 SOSORT and 2019 ACPOC meetings. Below is the presentation she gave at the SOSORT International Meeting.
