Psychological Factors in Failure to Wear the Milwaukee Brace for Treatment of Idiopathic Scoliosis

Comparative multifactorial analysis of the effects of idiopathic adolescent scoliosis and Scheuermann kyphosis on the self-perceived health status of adolescents treated with brace

“…However, objective measurement with actual monitoring of brace wear showed that actual brace compliance is much less than claimed by patients or parents [16] so that some authors thought that <15% of their patients with scoliosis were fully compliant with a 23-h/day schedule [9]. The reported poor compliance during brace therapy for idiopathic scoliosis seems to be directly linked with psychological reactions that have been reported by several authors [14,34,40].…”

“…However, bracing has a quantifiable impact on several aspects on adolescent and family functioning [13,30]. The stressor effects of bracing, applied for multiple reasons, in relation to different psychological reactions (panic, negative mood, depression, anger, or feelings of responsibility for illness during the initial adjustment period, emotional disturbances of body image, self-esteem and sexual attitudes) have been reported [1,7,12,18,19,32,34,40]. Factors contributing negatively to copying with orthoses include length of time that the brace must be worn, failure of the brace [34], or previous poor adjustment behaviour [14,37].…”

Outcome in adolescent idiopathic scoliosis after brace treatment and surgery assessed by means of the Scoliosis Research Society Instrument 24

“…The instrument comprises seven domains: pain (questions 1, 2, 3,6,8,11,18), general self-image (questions 5, 14, 15), function from back condition (questions 7, 12, 13), general level of activity (questions 4, 9, 10), post-treatment self-image (questions 19,20,21), posttreatment function (questions 16,17), and satisfaction with the treatment (questions 22,23,24); each of these domains can be evaluated independently and/or by summarizing all questions in a total outcome score.…”

“…Eleven questions (3-8, 14, 20, 22-24) have five answer categories which are quantified by 1-5: 1 was the most negative response and 5 the most positive; seven questions (12,13,(16)(17)(18)(19)21) have three answer categories quantified by 1, 3, and 5: decrease counts one point, no change or the same three points, and increase five points; three questions have two answer categories quantified by 1 and 5: no counts as one point and yes as five points; two questions (1, 2) have scales with a range from 1 to 9, rating the sensation of pain; 1 is no pain and 9 severe pain: 1 and 2=5 points, 3 and 4=4 points, 5=3 points, 6 and 7=2 points, and 8 and 9=1 point. One question (15) has a scale with a range from 1 to 9 rating the feeling of selfimage; 1 is very low and 9 is extremely high self-image; 1 and 2=1 point, 3 and 4=2 points, 5=3 points, 6 and 7=4 points, and 8 and 9=5 points.…”

“…Measurement of quality of life or treatment outcome by subjective data has become an important tool in evidence-based medicine [8][9][10][11][12][13][14][15][16][17][18]. The Scoliosis Research Society instrument for outcome assessment (SRS 24) was designed to measure outcome after surgery, particularly in adolescent idiopathic scoliosis (AIS) patients [19][20][21].…”