While modern Scoliosis bracing represents a huge leap forward in the non-surgical treatment of Scoliosis it’s no secret that wearing a brace can be taxing, especially for young people. Modern braces like ScoliBrace have the additional benefit of being low profile, easy to move in and almost invisible under clothing, but no doubt wearing a brace is an additional stressor for a young person to cope with.
The Psychology of bracing
Although clinical evidence regarding bracing effectiveness continues to strengthen, there is still uncertainty regarding the impact of brace wear on psychosocial well-being, as well as the impact of psychological well-being on brace wear adherence. We’ve reported on numerous studies which have argued the case both ways on this issue – overall, it’s fair to say that the majority of research suggests that bracing can be a stain for patients, but that interventions designed to support them during the process are also effective in reducing any possible harm.
Some research has found that full-time brace wear can indeed negatively impact a patient’s, emotional, and social well-being, including a significant worsening of body image.[1] In addition, research has found that the adverse effects on a patient’s psychosocial well-being induced by brace treatment can then result in poor brace wear adherence[2] – on the flip side, some studies have confirmed that interventions aimed at improving poor psychological outcomes can improve brace adherence.[3]
While we might naturally expect these results, other research has found no negative impact on psychological well-being induced by brace treatment[4].
Recent study
A recent study has now added to the debate, by going beyond just the obvious question of wheather bracing has negative psychological impacts or not. Rather, the authors noted that some of the discrepancies in the brace wear adherence research could well be due to the type of brace wear data used to assess adherence. It’s an (unfortunate) fact that the majority of research on brace wear adherence is based on subjective reports, such as self-reports through brace wear diaries and logs – even at our clinic, were mostly reliant on patients accurately self-reporting their brace wear (or their parents doing so) in order to continue to tailor and tweak treatment as bracing progresses.
The new paper[5] points out that in many studies bracing adherence rates have ranged from 41% of wearing hours/prescribed to as high 100% of wearing hours prescribed – making it very difficult to make an accurate assessment of the linkage between actual brace wear and any potential negative effects. This study, therefore, addressed this limitation, by using body heat monitor data from the landmark BrAIST study, rather than self-reports to assess relationships between body image, quality of life (QOL), and brace wear adherence. The use of temperature monitors during the BrAIST study was one of the factors which made the research so impactful and the data is considered reliable.
Using this data, the study analyzed relationships among brace wear adherence, body image, and quality of life. Thanks to the BrAIST data, it was possible to compare those patients who wore their brace most consistently, for the longest time – and those who only wore it periodically. If the groups who were more adherent to the brace-wearing time experience more psychological issues than those who wore the brace very little, it would seem reasonable to suggest the two are correlated. When looking at differences between the least-adherent and the most-adherent brace wear groups, however, the findings from the study actually supply no evidence that the amount of brace wear negatively impacts body image or QOL, or that poor body image and poor QOL negatively impact brace wear adherence.
Important takeaway
This is perhaps not the result that many parents, in particular, would expect to see – nonetheless, the outcome of the study was to say that those patients who did not wear their braces as prescribed were no better off Psychologically for doing so – they did, however, most likely have a lower curve correction than otherwise would have been the case. Conversely, those who wore their braces as instructed and received the best curve correction possible faced no additional stress or strain for doing so – they simply gave themselves the best chance at an excellent result.
As a Scoliosis clinic, it’s easy for us to repeat the message on the importance of sticking to brace wear time – we’ve pointed out in many articles that doing so directly correlates with better outcomes – as a parent, of course, it’s harder to coerce a child into wearing their brace if you’re also concerned about the stress it might be causing them. This article isn’t to say that bracing isn’t hard (although we try to make it as easy and fun as possible!) but do keep these results in mind!
[1] Pham VM, Houlliez A, Caprentier A, et al. Determination of the influence of the Cheneau brace on quality-of-life for adolescent with idiopathic scoliosis. Ann Readapt Med Phys. 2007;51:3–8.
[2] Rivett L, Rothberg A, Stewart A, et al. The relationship between quality of life and compliance to a brace protocol in adolescents with idiopathic scoliosis: a comparative study. BMC Musculoskeletal Disorders. 2009;10:5.
Chan SL, Cheung KM, Luk KD, et al. A correlation study between in-brace correction, compliance to spinal orthosis and health-related quality of life of patients with adolescent idiopathic scoliosis. Scoliosis. 2014;9:1.
Donnelly MJ, Dolan LA, Grande L, et al. Patient and parent perspectives on treatment for adolescent idiopathic scoliosis. The Iowa Orthopaedic Journal. 2004;24:76–83.
[3] Donnelly MJ, Dolan LA, Grande L, et al. Patient and parent perspectives on treatment for adolescent idiopathic scoliosis. The Iowa Orthopaedic Journal. 2004;24:76–83.
Matsunaga S, Hayashi K, Naruo T, et al. Psychologic management of brace therapy for patients with idiopathic scoliosis. Spine (Phila Pa 1976). 2005;30:547–550.
[4] Hasler CC, Wietlisbach S, Buchler P. Objective compliance of adolescent girls with idiopathic scoliosis in a dynamic SpineCor brace. J of Children’s Orthop. 2010;4:211–218.
Schwieger T, Campo S, Weinstein SL, et al. Body Image and Quality-of-Life in Untreated Versus Brace-Treated Females with Adolscent Idiopathic Scoliosis. Spine (Phila Pa 1976). 2016;41.
Danielsson AJ, Wiklund I, Pehrsson K, et al. Health-related quality of life in patients with adolescent idiopathic scoliosis: A matched follow-up at least 20 years after treatment with brace or surgery. Eur Spine J. 2001;10:278–288.
Merenda L, Costello K, Santangelo AM, et al. Perceptions of self-image and physical appearance: Conversations with typically developing youth and youth with idiopathic scoliosis. Orthop Nurs. 2011;30:383–390.
Olafsson Y, Saraste H, Ahlgren R. Does bracing affect self-image? A prospective study on 54 patients with adolescent idiopathic scoliosis. Eur Spine J. 1999;8:401–405.
[5] Traci Schwieger, PhD,corresponding author* Shelly Campo, PhD,* Stuart L. Weinstein, MD,* Lori A. Dolan, PhD,* Sato Ashida, PhD,* and Keli R. Steuber, PhD Body Image and Quality of Life and Brace Wear Adherence in Females With Adolescent Idiopathic Scoliosis J Pediatr Orthop. 2017 Dec; 37(8): e519–e523.
