Patient Adherence to Wide Abduction Brace Treatment for Legg-Calvé-Perthes Disease

Abstract

Background: A wide abduction brace called the A-frame brace is used to contain the deformed femoral head and improve femoral head remodeling in patients with Legg-Calvé-Perthes disease (LCPD). While there is some data showing the efficacy of brace treatment, little is known about patient adherence. The purpose of this study was to measure A-frame brace adherence using temperature sensors and to identify factors that influence adherence. Methods: This is an IRB-approved retrospective study of 61 patients with LCPD treated with an A-frame brace between ages 5 and 11. Brace wear was measured using built-in temperature sensors. Pearson correlation coefficient and multiple regression were used to determine relationships between patient characteristics and brace adherence. Results: Of 61 patients, 80% were male. Mean age at LCPD onset was 5.9±1.8 years and the mean age at initiation of brace treatment was 7.1±1.5 years. Fifty-eight patients (95%) were in the fragmentation or reossification stage at the start of bracing, with 23 patients (38%) having lateral pillar B, 7 (11%) lateral pillar B/C, and 31 (51%) lateral pillar C. Forty-two (69%) patients were treated with a Petrie cast for 6 weeks before the A-frame brace. Mean adherence, defined as the ratio of measured over prescribed brace wear, was 0.69±0.32. Mean adherence improved with age (P<0.05), increasing from 0.57 in patients less than 6 to 0.84 in patients aged 8 to 11. Patients first treated with a Petrie cast had significantly better adherence than those without (0.77 vs. 0.50; P<0.005). Adherence was negatively associated with the amount of prescribed brace wear per day (P<0.005). Adherence did not change significantly between the start and end of treatment and was not significantly associated with sex or attention deficit hyperactivity disorder. Conclusions: A-frame brace adherence was significantly associated with age at treatment, prior Petrie casting, and the amount of daily prescribed brace wear. These findings provide new insight into A-frame brace treatment, which will lead to better patient selection and counseling to optimize adherence. Level of Evidence: III Therapeutic Study.

Global trends in the research on Legg–Calve–Perthes disease in Web of Science

“…It is worth noting that Kim HKW 's latest study aimed at measuring the brace adherence of the A-frame, an equipment used to contain the deformed femoral head and improve femoral head remodeling in patients with LCPD using temperature sensors, and to identify factors that influence adherence. The study found that the compliance of A-frame braces was significantly associated with age at the time of treatment, previous Petrie casting, and daily prescribed brace wear ( 23 ). This latest study provides new insights and suggestions for the treatment and prevention of LCPD.…”