Scoliosis surgeons have always known that adolescent females do not like wearing braces to prevent progression of scoliosis, though the level of this stress has generally not been well quantified. In the June 15 issue, Dr. Misterska and her colleagues from Poland report on brace and deformity related stress in both female adolescent idiopathic scoliosis (AIS) patients and their parents. Using the Bad Sobberheim Stress Questionnaries for brace and deformity, they found that both patients and their parents had reported a moderate degree of stress or perceived stress related to the brace. However, while patients reported only a low level of stress related to their deformity, parents perceived their daughters to have a greater degree of deformity related stress than they actually experienced. In this case, it appears as though patients find the treatment to be worse than the disease. Interestingly, there were no or only relatively weak correlations between radiographic or anthropometric measurements and deformity related stress among patients (the only significant correlation was between apical translation and deformity related stress, r=-0.38). This supports the findings of prior studies indicating a weak relationship between actual deformity and stress related to the deformity. This paper clearly demonstrates that bracing causes a substantial amount of stress among female AIS patients.
This study is a good first step in quantifying the degree of brace related stress experienced by patients in a demographic very concerned about appearance and the perceptions of others. It would be very interesting to see if the degree of brace related stress was related to compliance with brace wear. Additionally, future studies should determine if there are any interventions that can reduce brace related stress (i.e. education, discussion with patients who had been successfully treated with a brace, etc.), and the questionnaires used in this study would be effective instruments to measure the effect of such interventions. This study was conducted in Poland, and it would be interesting to see if similar findings were found in other nations. Given that bracing does generate a moderate amount of stress in patients, the larger question that remains largely unanswered is “for whom is bracing indicated?” Many surgeons perceive nonoperative treatment for scoliosis as having no adverse side-effects, though this paper shows this clearly is not true. As long as bracing continues to be a wide-spread treatment, those taking care of scoliosis patients need to continue to be aware of the stress that this treatment creates. Hopefully future work will address reducing the level of stress associated with brace treatment, though, given the patient population involved, this will likely be a challenge.
Please read Dr. Misterska’s paper and accompanying commentary. Does this paper change how you perceive the brace and deformity related stress of your AIS patients? Let us know by leaving a comment on The Spine Blog.
Adam Pearson, MD,MS
Associate Web Editor