A cognitive behavioral approach allows improving brace wearing compliance: an observational controlled retrospective study with thermobrace

Abstract

Background: Results of brace treatment of Idiopathic Scoliosis are related to brace wearing. Aim(s): To verify if Cognitive Behavioural Approach (CBA) dispensed during Physiotherapic Scoliosis Specific Exercises (PSSE) sessions increases brace wearing. Design(s): Retrospective controlled cohort study nested into a clinical database. Method(s): Setting. Outpatient tertiary referral clinic. Population. Out of 778 patients, 246 fulfilled the inclusion criteria: Idiopathic Scoliosis; first brace prescription; regular use of Thermobrace heat sensor; two evaluations after bracing; age 36; European Risser 0-3. Evaluations. T0 (start of bracing), T1 (4 months), T2 (10 months). Measurements. Brace wearing compliance (BWC) T0 to T1 (T0-T1) and T1 to T2 (T1-T2). Treatment. CBA adjunctive sessions dispensed during PSSE (CBA-PSSE), after the standard CBA provided to all patients including: at prescription, 20' by Medical Doctor (MD) and 30-45' by Physiotherapist; at brace check, 10-15' by MD and Orthopaedic Technician; at T1, 10-15' by MD. Groups. According to CBA-PSSE in T0-T1 period: CBA1 (143 patients) 32 sessions; Poor-Adherence (PA1, 52) 1 session; Control (CON1, 51) 0 sessions . Similarly, according to CBA-PSSE in T1-T2 period: CBA2 (97),PA2 (78), CON2 (71). Combinations among the 6 groups in the two periods were checked. Statistics. ANOVA for group comparisons. Result(s): Patients were 13.03+/-1.11 years old. Brace hours prescription: 21.93+/-1.77 (T0-T1), 21.03+/-1.79 (T1-T2). BWC: 91.06+/-12.63% (T0-T1), 91.64 +/-14.3% (T1-T2). We found no differences among groups in brace prescription and BWC in T0-T1. In T1-T2: CBA1 had more brace prescription than CON1 (P<0.01); CBA1 and CON1 improved BWC more than PA1 (P<0.005);CBA2 and CON2 improved BWC more than PA2; patients who were both in CBA1 and in CBA2, had more hours of brace prescription than PA2 and CON2, and improved brace compliance more than PA2 (P<0.05). Overall, BWC differences among groups reached a maximum of 7%. Conclusion(s): CBA improves BWC: specifically, patients with high CBA-PSSE in both observed periods (CBA1+CBA2) had both the highest brace hours prescription and the highest BWC. Poor adherence to CBA-PSSE matched with poor adherence to brace wearing.