title: Correlation between compliance and brace treatment in juvenile and adolescent idiopathic scoliosis: SOSORT 2014 award winner.
abstract: BACKGROUND
  Over the last years, evidence has accumulated in support of bracing as an effective treatment option in patients with idiopathic scoliosis. Yet, little information is available on the impact of compliance on the outcome of conservative treatment in scoliotic subjects. The aim of the present study was to prospectively evaluate the association between compliance to brace treatment and the progression of scoliotic curve in patients with idiopathic adolescent (AIS) or juvenile scoliosis (JIS).
  
  
  METHODS
  Among 1.424 patients treated for idiopathic scoliosis, 645 were eligible for inclusion criteria. Three outcomes were distinguished in agreement with the SRS criteria: curve correction, curve stabilization and curve progression. Brace wearing was assessed by one orthopaedic surgeon (LA) and scored on a standardized form. Compliance to treatment was categorized as complete (brace worn as prescribed), incomplete A (brace removed for 1 month), incomplete B (brace removed for 2 months), incomplete C (brace removed during school hours), and incomplete D (brace worn overnight only). Chi square test, T test or ANOVA and ANOVA for repeated measures tests were used as statistical tests.
  
  
  RESULTS
  The results from our study showed that at follow-up the compliance was: Complete 61.1%; Incomplete A 5.2%; Incomplete B 10.7%; Incomplete C 14.2%; Incomplete D 8.8%. Curve correction was accomplished in 301/319 of Complete, 19/27 Incomplete A, 25/56 Incomplete B, 52/74 Incomplete C, 27/46 Incomplete D. Cobb mean value was 29.8 ± 7.5 SD at beginning and 17.1 ± 10.9 SD at follow-up. Both Cobb and Perdriolle degree amelioration was significantly higher in patients with complete compliance over all other groups, both in juvenile, both in adolescent scoliosis. In the intention-to-treat analysis, the rate of surgical treatment was 2.1% among patients with definite outcome and 12.1% among those with drop-out. Treatment compliance showed significant interactions with time.
  
  
  CONCLUSIONS
  Curve progression and referral to surgery are lower in patients with high brace compliance. Bracing discontinuation up to 1 month does not impact on the treatment outcome. Conversely, wearing the brace only overnight is associated with a high rate of curve progression.
authors.affiliation: U.O.C. of Orthopedics and Traumatology, Children's Hospital Bambino Gesù, Institute of Scientific Research, P.zza S. Onofrio, Rome 4-00165, Italy.
authors.forename: Angelo G
authors.initials: AG
authors.lastname: Aulisa
authors.affiliation: U.O.C. of Orthopedics and Traumatology, Children's Hospital Bambino Gesù, Institute of Scientific Research, P.zza S. Onofrio, Rome 4-00165, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Giordano
authors.affiliation: U.O.C. of Orthopedics and Traumatology, Children's Hospital Bambino Gesù, Institute of Scientific Research, P.zza S. Onofrio, Rome 4-00165, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Falciglia
authors.affiliation: Department of Orthopedics, University Hospital "Agostino Gemelli", Catholic University of the Sacred Heart School of Medicine, Rome 00168, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Marzetti
authors.affiliation: Institute of public health, University Hospital "Agostino Gemelli", Catholic University of the Sacred Heart School of Medicine, Rome 00168, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Poscia
authors.affiliation: U.O.C. of Orthopedics and Traumatology, Children's Hospital Bambino Gesù, Institute of Scientific Research, P.zza S. Onofrio, Rome 4-00165, Italy ; University of Cassino, Cassino, FR 03043, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Guzzanti
keywords: Adolescent idiopathic scoliosis; Compliance; Conservative treatment; Juvenile idiopathic scoliosis; PASB brace