title: Pectus Carinatum Evaluation Questionnaire (PCEQ): a novel tool to improve the follow-up in patients treated with brace compression.
abstract: OBJECTIVE
  A questionnaire (Pectus Carinatum Evaluation Questionnaire, PCEQ) was developed to be applied in follow-up of patients with Pectus Carinatum (PC). After validation of the PCEQ, we aimed to quantify the compliance to brace compression and to assess factors that could influence this treatment in patients with PC.
  
  
  METHODS
  From July 2008 to July 2014, 56 patients with PC were treated with the Calgary Protocol of compressive bracing at Paediatric Surgery Department of Hospital São João. Forty patients (71%) completed the questionnaire. The PCEQ was divided into four sections: (i) compliance; (ii) symptoms; (iii) social influence; (iv) activities. For the validation process of the PCEQ, principal components analysis (PCA), orthogonal varimax or oblimin rotation and Cronbach's α coefficient were used. To evaluate the association between compliance and other sections of the questionnaire, we estimated the Pearson's correlation between compliance factor scores ('Compliance Days' and 'Compliance Hours') and the final score of each new questionnaire component identified by PCA ('Chest Pain', 'Dyspnoea', 'Back Pain', 'Parents' Influence', 'Friends' Influence', 'Activities', 'Time To Compliance'). For the sections 'Symptoms', 'Social Influence' and 'Activities', we estimated final scores as the sum of the questions that constitute each component. For the section 'Compliance', the factor scores were estimated by the regression method.
  
  
  RESULTS
  After PCA analysis, the PCEQ found nine different components with high reliability. When analysing the compliance of our study group, the final score for 'Activities' revealed a significant correlation with the factor score for 'Compliance Hours' (r = 0.382, P = 0.015). The final score for 'Time To Compliance' showed a significant correlation with both factor scores for 'Compliance Hours' (r = -0.765, P < 0.001) and 'Compliance Days' (r = -0.345, P < 0.029).
  
  
  CONCLUSIONS
  The PCEQ seems to be an important tool to follow up patients with PC treated by brace compression. Practical steps, such as developing a tight schedule in the early follow-up period or applying the PCEQ in first visits after initiating brace therapy, can be taken in order to increase compliance with brace therapy and improve the quality of life.
authors.affiliation: Department of Paediatric Surgery, Faculty of Medicine and Hospital S. João, Porto, Portugal.
authors.forename: Inês
authors.initials: I
authors.lastname: Pessanha
authors.affiliation: Department of Medical Education and Simulation, Faculty of Medicine, Porto, Portugal.
authors.forename: Milton
authors.initials: M
authors.lastname: Severo
authors.affiliation: Surgical Sciences, Life and Health Sciences Research Institute, University of Minho, Braga, Portugal.
authors.forename: Jorge
authors.initials: J
authors.lastname: Correia-Pinto
authors.affiliation: Department of Paediatric Surgery, Faculty of Medicine and Hospital S. João, Porto, Portugal.
authors.forename: José
authors.initials: J
authors.lastname: Estevão-Costa
authors.affiliation: Department of Paediatric Surgery, Faculty of Medicine and Hospital S. João, Porto, Portugal thc@med.up.pt.
authors.forename: Tiago
authors.initials: T
authors.lastname: Henriques-Coelho
mesh_terms: D000293:Adolescent; D001915:Braces / Q000706:statistics & numerical data*; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance / Q000706:statistics & numerical data*; D066166:Pectus Carinatum / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy*; D015203:Reproducibility of Results; D012919:Social Behavior; D011795:Surveys and Questionnaires / Q000592:standards
keywords: Bracing; Chest wall deformity; Chondrogladiolar type; Pectus; Sternal protrusion