A compliance real-time monitoring system for the management of the brace usage in adolescent idiopathic scoliosis patients: a pilot study

Abstract

Background Patient compliance is essential to the effectiveness of brace treatment for adolescent idiopathic scoliosis (AIS) patients. Subjective measurements like questionnaires and inquiries proved to be arguably inaccurate. Although some scholars have applied temperature/force monitors to measuring patient compliance objectively, few studies to date could monitor patient compliance in real time. The objective of this study is to describe and evaluate a compliance real-time monitoring system of the brace usage in AIS patients. Methods A compliance real-time monitoring system (specifically consisting of a compliance monitor, a WeChat Mini Program, a cloud-based storage system and a website backstage management system) was designed to manage the brace treatment. Thirty patients receiving brace treatment were enrolled. They were told to upload the data at least once a day. Clinicians downloaded the compliance data and communicated with the patients online based on their analysis of data at least once every 3 months. The measured force, quality compliance (measured force / baseline force), measured time, and quantity compliance (measured time/ prescribed time) were used to evaluate patient compliance. Patients were also asked to rate their satisfaction at the final follow-up. Results Twenty-eight patients were included in the final analysis. The mean baseline force was 1.23 ± 0.28 N. The mean measured force was 0.79 ± 0.29 N. The mean quality compliance was 64.8 ± 22.2%. The prescribed time of all patients was 23 h. The mean measured time was 14.1 ± 2.9 h. The mean quantity compliance was 61.3 ± 12.6%. Both the quality and quantity compliance during the first 3 months of treatment was significantly lower than the latter 3 months. In this study, 96.4% (27/28) patients were satisfied with the use of the monitoring system, among whom 21.4% (6/28) are very satisfied and 75.0% (21/28) are somewhat satisfied. Conclusions The compliance real-time monitoring system, without evaluating the clinical and radiographic outcomes for now, has already shown some feasibility and effectiveness for the management of the brace usage in AIS patients. This system, as a useful tool for online patient management and patient-clinician communication, would be potentially employed on a large scale in future for clinicians to improve the compliance and satisfaction of AIS patients who have received brace treatment.

mHealth for the Monitoring of Brace Compliance and Wellbeing in Adolescents with Idiopathic Scoliosis: Study Protocol for a Feasibility Study

“…Due to the widespread use of web and app-based devices in our daily activities, it seems feasible to integrate these devices into the daily monitoring of IS in adolescent populations. Some web and mobile applications have been used previously in detection of AIS and the assessment of adherence to the brace [25,26]. However, the assessment of the psychological and physical state of the patient, which could explain individual differences in adherence and provides important information for the safety and effectiveness of the treatment, has been never included in the daily monitoring of adolescents with IS.…”

“…For example, mobile applications have been used as screening tools for AIS to measure the Cobb's degrees of curvature, even more accurately than traditional hand-held scoliometers [25]. Another alternative to sensors has been a web-based system for assessing brace compliance, which was well accepted by the participants [26]. Some limitations of the literature on alternatives to sensors for IS assessment should be considered.…”

Sensor based braces: Challenges ahead

“…Even their predecessor, sensor based spinal orthosis, run an experimental course till date and lack widespread acceptance despite their introduction more than 2 decades ago. 13 None of the clubfoot studies demonstrate effectiveness of patient interventions/changes in practice based on the research data. 7e9 In fact, a later follow up prognostic study on the same subjects who used sensor based braces in initial months demonstrated that in long term, adherence as reported by caretaker or measured by sensor did not figure out as a factor in clubfoot relapse.…”

Effectiveness of psychosocial interventions for pediatric patients with scoliosis: a systematic review

“…Ten studies Open access (described in 13 papers) met the selection criteria, all of which focused on AIS (figure 1). [23][24][25][26][27][28][29][30][31][32][33][34][35] We included six clinical trials, 23 28-34 three cohort studies, [24][25][26][27] and one cross-sectional study. 35 The included studies analyzed relatively small sample sizes (mean (range) of analyzed sample sizes: 101 (28-237)).…”

“…23 25 26 Both studies found evidence that this intervention significantly improved outcomes. 23 25 26 Karol et al 23 conducted an RCT and found that adolescents who received brace compliance reports and whose providers similarly received these reports and offered compliance counseling wore their TSLO braces significantly longer than those who did not. Zhu et al 25 26 incorporated a mobile phone application for providers to offer real-time compliance monitoring and counseling.…”