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Outcomes for nighttime bracing in adolescent idiopathic scoliosis based on brace wear adherence

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Abstract

Background

This study determined brace wear adherence for patients treated with nighttime braces and evaluated the effect of brace adherence on curve progression.

Methods

One hundred twenty-two patients with AIS ages 10–16 years, Risser stages 0–2, major curves 20°–40° treated with Providence nighttime braces prescribed to be worn at least 8 h per night were prospectively enrolled and followed until skeletal maturity or surgery. Brace adherence was measured using iButton temperature sensors after 3 months of brace initiation and at brace discharge.

Results

Curve types were single thoracolumbar/lumbar (62%, n = 76), double (36%, n = 44), and single thoracic (2%, n = 2). Brace adherence averaged 7.8 ± 2.3 h after 3 months (98% adherence) and 6.7 ± 2.6 h at brace discharge (84% adherence). Curves that progressed ≥ 6° had decreased brace adherence than non-progressive curves after 3 months (7.0 h vs. 8.1 h, p = 0.010) and at brace discharge (5.9 h vs. 7.1 h, p = 0.017). Multivariate logistic regression analysis showed that increased hours of brace wear [odds ratio (OR) 1.23, 95% confidence interval (CI) 1.06–1.46], single curves (OR 3.11, 95% CI 1.35–7.53), and curves < 25° (OR 2.61, 95% CI 1.12–6.44) were associated with non-progression at brace discharge.

Conclusions

Patients treated with nighttime bracing have a high rate of brace adherence. Lack of curve progression is associated with increased brace wear. Nighttime bracing is effective at limiting curve progression in AIS single thoracolumbar/lumbar and double curves.

Level of evidence

Prognostic Level 2.

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Data availability

Data can be made available in a de-identified manner upon request.

References

  1. Katz DE, Herring JA, Browne RH et al (2010) Brace wear control of curve progression in adolescent idiopathic scoliosis. J Bone Joint Surg Am 92(6):1343–1352. https://doi.org/10.2106/jbjs.i.01142

    Article  PubMed  Google Scholar 

  2. Weinstein SL, Dolan LA, Wright JG et al (2013) Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med 369(16):1512–1521. https://doi.org/10.1056/nejmoa1307337

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. D’Amato CR, Griggs S, McCoy B (2001) Nighttime bracing with the Providence brace in adolescent girls with idiopathic scoliosis. Spine (Phila Pa 1976) 26(18):2006–2012. https://doi.org/10.1097/00007632-200109150-00014

    Article  CAS  PubMed  Google Scholar 

  4. Yrjönen T, Ylikoski M, Schlenzka D et al (2006) Effectiveness of the Providence nighttime bracing in adolescent idiopathic scoliosis: a comparative study of 36 female patients. Eur Spine J 15(7):1139–1143. https://doi.org/10.1007/s00586-005-0049-9

    Article  PubMed  PubMed Central  Google Scholar 

  5. Climent JM, Sánchez J (1999) Impact of the type of brace on the quality of life of adolescents with spine deformities. Spine (Phila Pa 1976) 24(18):1903–1908. https://doi.org/10.1097/00007632-199909150-00007

    Article  CAS  PubMed  Google Scholar 

  6. Moradi V, Babaee T, Shariat A et al (2022) Predictive factors for outcomes of overcorrection nighttime bracing in adolescent idiopathic scoliosis: a systematic review. Asian Spine J 16(4):598–610. https://doi.org/10.31616/asj.2021.0037

    Article  PubMed  Google Scholar 

  7. Katz DE, Richards BA, Browne RH et al (1997) A comparison between the Boston brace and the Charleston bending brace in adolescent idiopathic scoliosis. Spine 22(12):1302–1312. https://doi.org/10.1097/00007632-199706150-00005

    Article  CAS  PubMed  Google Scholar 

  8. Price CT, Scott DS, Reed FE Jr et al (1997) Nighttime bracing for adolescent idiopathic scoliosis with the Charleston bending brace: long-term follow-up. J Ped Orthop 17(6):703–707

    Article  CAS  Google Scholar 

  9. Buyuk AF, Truong WH, Morgan SJ et al (2022) Is nighttime bracing effective in the treatment of adolescent idiopathic scoliosis? A meta-analysis and systematic review based on scoliosis research society guidelines. Spine Deform 10(2):247–256. https://doi.org/10.1007/s43390-021-00426-z

    Article  PubMed  Google Scholar 

  10. Ohrt-Nissen S, Lastikka M, Andersen TB et al (2019) Conservative treatment of main thoracic adolescent idiopathic scoliosis: Full-time or nighttime bracing? J Orthop Surg (Hong Kong) 27(2):2309499019860017. https://doi.org/10.1177/2309499019860017

    Article  PubMed  Google Scholar 

  11. Ohrt-Nissen S, Hallager DW, Gehrchen M et al (2016) Flexibility predicts curve progression in Providence nighttime bracing of patients with adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 41(22):1724–1730. https://doi.org/10.1097/brs.0000000000001634

    Article  PubMed  Google Scholar 

  12. Lee CS, Hwang CJ, Kim DJ et al (2012) Effectiveness of the Charleston night-time bending brace in the treatment of adolescent idiopathic scoliosis. J Pediatr Orthop 32(4):368–372. https://doi.org/10.1097/bpo.0b013e3182561193

    Article  PubMed  Google Scholar 

  13. Wiemann JM, Shah SA, Price CT (2014) Nighttime bracing versus observation for early adolescent idiopathic scoliosis. J Pediatr Orthop 34(6):603–606. https://doi.org/10.1097/bpo.0000000000000221

    Article  PubMed  PubMed Central  Google Scholar 

  14. Janicki JA, Poe-Kochert C, Armstrong DG et al (2007) A comparison of the thoracolumbosacral orthoses and Providence orthosis in the treatment of adolescent idiopathic scoliosis: results using the new SRS inclusion and assessment criteria for bracing studies. J Pediatr Orthop 27(4):369–374. https://doi.org/10.1097/01.bpb.0000271331.71857.9a

    Article  PubMed  Google Scholar 

  15. Trivedi JM, Thomson JD (2001) Results of Charleston bracing in skeletally immature patients with idiopathic scoliosis. J Pediatr Orthop 21(3):277–280

    Article  CAS  PubMed  Google Scholar 

  16. Davis L, Murphy JS, Shaw KA et al (2019) Nighttime bracing with the Providence thoracolumbosacral orthosis for treatment of adolescent idiopathic scoliosis: a retrospective consecutive clinical series. Prosthet Orthot Int 43(2):158–162. https://doi.org/10.1177/0309364618792727

    Article  PubMed  Google Scholar 

  17. Simony A, Beuschau I, Quisth L et al (2019) Providence nighttime bracing is effective in treatment for adolescent idiopathic scoliosis even in curves larger than 35°. Eur Spine J 28(9):2020–2024. https://doi.org/10.1007/s00586-019-06077-z

    Article  PubMed  Google Scholar 

  18. Bohl DD, Telles CJ, Golinvaux NS et al (2014) Effectiveness of Providence nighttime bracing in patients with adolescent idiopathic scoliosis. Orthopedics 37(12):e1085–e1090. https://doi.org/10.3928/01477447-20141124-56

    Article  PubMed  Google Scholar 

  19. Benish BM, Smith KJ, Schwartz MH (2012) Validation of a miniature thermochron for monitoring thoracolumbosacral orthosis wear time. Spine (Phila Pa 1976) 37(4):309–315. https://doi.org/10.1097/brs.0b013e31821e1488

    Article  PubMed  Google Scholar 

  20. Karol LA, Virostek D, Felton K et al (2016) The effect of the Risser stage on bracing outcome in adolescent idiopathic scoliosis. J Bone Joint Surg Am 98(15):1253–1259. https://doi.org/10.2106/jbjs.15.01313

    Article  PubMed  Google Scholar 

  21. Karol LA, Virostek D, Felton K et al (2016) Effect of adherence counseling on brace use and success in patients with adolescent idiopathic scoliosis. J Bone Joint Surg Am 98(1):9–14. https://doi.org/10.2106/jbjs.o.00359

    Article  PubMed  Google Scholar 

  22. Richards BS, Bernstein RM, D’Amato CR et al (2005) Standardization of criteria for adolescent idiopathic scoliosis brace studies: SRS committee on bracing and nonoperative management. Spine (Phila Pa 1976) 30(18):2068–2075. https://doi.org/10.1097/01.brs.0000178819.90239.d0. (Discussion 2076–7)

    Article  PubMed  Google Scholar 

  23. Zapata KA, McIntosh AL, Jo CH et al (2023) The addition of daytime physiotherapeutic scoliosis-specific exercises to adolescent idiopathic scoliosis nighttime bracing reduces curve progression. J Pediatr Orthop 43(6):368–372. https://doi.org/10.1097/bpo.0000000000002391

    Article  PubMed  Google Scholar 

  24. Chopra S, Larson AN, Milbrandt TA, Kaufman KR (2023) Outcome of bracing vs. surgical treatment in adolescents with idiopathic scoliosis based on device measured daily physical activity: a prospective pilot study. J Pediatr Orthop B 32(6):517–523. https://doi.org/10.1097/BPB.0000000000001016

    Article  PubMed  Google Scholar 

  25. Zapata KA, Virostek D, Davis K et al (2023) Early brace treatment for idiopathic scoliosis may change the paradigm to improve curves. Spine Deform 11(6):1381–1388. https://doi.org/10.1007/s43390-023-00726-6

    Article  PubMed  Google Scholar 

  26. Lonstein JE, Carlson JM (1984) The prediction of curve progression in untreated idiopathic scoliosis during growth. J Bone Joint Surg Am 66(7):1061–1071

    Article  CAS  PubMed  Google Scholar 

  27. Grivas TB, Vasiliadis ES, Rodopoulos G et al (2008) The role of the intervertebral disc in correction of scoliotic curves. A theoretical model of idiopathic scoliosis pathogenesis. Stud Health Technol Inform 140:33–36

    CAS  PubMed  Google Scholar 

  28. Noonan KJ, Farnum CE, Leiferman EM et al (2004) Growing pains: are they due to increased growth during recumbency as documented in a lamb model? J Pediatr Orthop 24(6):726–731. https://doi.org/10.1097/00004694-200411000-00024

    Article  PubMed  Google Scholar 

  29. Linden GS, Emans JB, Karlin LI et al (2023) Early adherence to prescribed brace wear for adolescent idiopathic scoliosis is associated with future brace wear. Spine (Phila Pa 1976) 48(1):8–14. https://doi.org/10.1097/brs.0000000000004446

    Article  PubMed  Google Scholar 

  30. Ruffilli A, Fiore M, Barile F et al (2021) Evaluation of night-time bracing efficacy in the treatment of adolescent idiopathic scoliosis: a systematic review. Spine Deform 9(3):671–678. https://doi.org/10.1007/s43390-020-00248-5

    Article  PubMed  Google Scholar 

  31. Roye BD, Simhon ME, Matsumoto H et al (2020) Establishing consensus on the best practice guidelines for the use of bracing in adolescent idiopathic scoliosis. Spine Deform 8(4):597–604. https://doi.org/10.1007/s43390-020-00060-1

    Article  PubMed  Google Scholar 

  32. Khoshbin A, Caspi L, Law PW et al (2015) Outcomes of bracing in juvenile idiopathic scoliosis until skeletal maturity or surgery. Spine (Phila Pa 1976) 40(1):50–55. https://doi.org/10.1097/BRS.0000000000000669

    Article  PubMed  Google Scholar 

  33. Zapata KA, Sucato DJ, Lee MC et al (2019) Skeletally immature patients with adolescent idiopathic scoliosis curves 15°–24° are at high risk for progression. Spine Deform 7(6):870–874. https://doi.org/10.1016/j.jspd.2019.02.012

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors would like to acknowledge Kevin Felton for assisting with retrieving the brace adherence data and Becca Dieckmann for assisting with data collection.

Funding

No funding was received for this work.

Author information

Authors and Affiliations

  1. Scottish Rite for Children, 2222 Welborn Street, Dallas, TX, 75219, USA

    Karina Amani Zapata, Donald Virostek, Yuhan Ma, Anne-Marie Datcu, John A. Herring & Megan E. Johnson

  2. Shriners Children’s Spokane, Spokane, WA, USA

    McKenzie R. Gunselman

Authors
  1. Karina Amani Zapata
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  2. Donald Virostek
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  3. Yuhan Ma
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  6. John A. Herring
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  7. Megan E. Johnson
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Contributions

Conception/Design or Data Acquisition/Analysis/Interpretation: KZ made substantial contributions to the conception, design, data acquisition and interpretation. DV made substantial contributions to the conception and data interpretation. YM made substantial contributions to data analysis and interpretation. AD made substantial contributions to data acquisition. MG made substantial contributions to data acquisition. JH made substantial contributions to the conception. MJ made substantial contributions to the study design and interpretation of the data. Drafted/Revised Work: KZ drafted the work and revised the work. DV revised the work critically for important intellectual content. YM revised the work critically for important intellectual content. AD revised the work critically for important intellectual content. MG revised the work critically for important intellectual content. JH revised the work critically for important intellectual content. MJ drafted and revised the work critically for important intellectual content. Approved the Version to be Published: Yes. Agree to be Accountable for all aspects of the work: Yes.

Corresponding author

Correspondence to Karina Amani Zapata.

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IRB approval was received from Scottish Rite for Children and from University of Texas Southwestern.

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Zapata, K.A., Virostek, D., Ma, Y. et al. Outcomes for nighttime bracing in adolescent idiopathic scoliosis based on brace wear adherence. Spine Deform (2024). https://doi.org/10.1007/s43390-024-00835-w

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