The validity of compliance monitors to assess wearing time of thoracic-lumbar-sacral orthoses in children with spinal cord injury.
METHODS
Prospective multicenter observation.


OBJECTIVE
To determine the validity of 3 commercially available at recording thoracic-lumbar-sacral orthosis (TLSO) wearing time of children with spinal cord injury (SCI) and to assess each monitor's function during daily activities.


BACKGROUND
A major limitation to studies assessing the effectiveness of spinal prophylactic bracing is the patient's compliance with the prescribed wearing time. Although some studies have begun to use objective compliance monitors, there is little documentation of the validity of the monitors during activities of daily life and no comparisons of available monitors.


METHODS
Fifteen children with SCI who wore a TLSO for paralytic scoliosis were observed for 4 days during their rehabilitation stay. Three compliance monitors (2 temperature and 1 pressure sensitive) were mounted onto each TLSO. Time of brace wear from the monitors was compared with the wear time per day recorded in diaries.


RESULTS
Observed versus monitored duration of brace wear found the HOBO (temperature sensitive) to be the most valid compliance monitor. The HOBO had the lowest average of difference and variance of difference scores. The correlation between the recorded daily entries and monitored brace wear time was also highest for the HOBO in analysis of dependent and independent scores. Bland-Altman plots showed that the pressure sensitive monitor underestimated wear time whereas the temperature monitors overestimated wear time.


CONCLUSIONS
Compliance to prescribed wearing schedule has been a barrier to studying TLSO efficacy. All 3 monitors were found to measure TLSO compliance, but the 2 temperature monitors were more in agreement with the daily diaries. Based on its functional advantages compared with the HOBO, the StowAway TidbiT will be used to further investigate the long-term compliance of TLSO bracing in children with SCI.
Shriners Hospitals for Children Hospitals, Philadelphia, PA, USA. lhunter@shrinenet.org
Louis N
LN
Hunter
Mitell
M
Sison-Williamson
Melissa M
MM
Mendoza
Craig M
CM
McDonald
Fred
F
Molitor
M J
MJ
Mulcahey
Randal R
RR
Betz
Lawrence C
LC
Vogel
Anita
A
Bagley
D000203:Activities of Daily Living; D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D018670:Monitoring, Ambulatory / Q000295:instrumentation* / Q000379:methods*; D009989:Orthotic Devices / Q000706:statistics & numerical data*; D010349:Patient Compliance; D011446:Prospective Studies; D015203:Reproducibility of Results; D012600:Scoliosis / Q000628:therapy; D013119:Spinal Cord Injuries / Q000628:therapy*; D013696:Temperature