NDLI: Accuracy in the prediction and estimation of adherence to bracewear before and during treatment of adolescent idiopathic scoliosis.

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Year: 2008 Volume: 28 Issue: 2

Year: 2007 Volume: 27

Accuracy in the prediction and estimation of adherence to bracewear before and during treatment of adolescent idiopathic scoliosis.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Morton, Anne Riddle, Russ Buchanan, Renee Katz, Don Birch, John
Description	Author Affiliation: Morton A ( Department of Psychology, Texas Scottish Rite Hospital for Children, Dallas, TX 75219 USA.)
Abstract	BACKGROUND: Because bracing for scoliosis may prevent curve progression, it is important to recognize nonadherence. We used temperature sensors to determine actual bracewear and examined: (1) the ability of a new pretreatment questionnaire to predict bracewear; (2) the ability of the physician and orthotist to predict bracewear before treatment and (3) the ability of physicians, orthotists, patients, and parents to accurately estimate bracewear during the first year of treatment. METHODS: Sixteen males and 108 females with adolescent idiopathic scoliosis were fitted with a Boston brace equipped with a temperature sensor and told that investigators were examining comfort. Before treatment, each patients completed an 18-item Brace-Beliefs Questionnaire (BBQ), and physicians/orthotists rated the likelihood that their patient would be adherent. During treatment, physicians, orthotists, patients, and parents provided estimates of daily bracewear. Data obtained at 1 to 3, 4 to 7, and 9 to 12 months into treatment were analyzed. RESULTS: Scores from the BBQ were related to actual adherence (r = 0.46, P < 0.001). No patient scoring more than 1 SD below the BBQ sample mean had an adherence level more than 40%. Correlations of physician/orthotist pretreatment predictions with actual adherence were minimal. Overall, patients wore the brace 47% of the prescribed time, although they were estimated to have worn it 64%, 66%, 72%, and 75% by physicians, orthotists, parents, and patients, respectively. Physicians/orthotists incorrectly identified at least 1 of every 4 nonadherers. CONCLUSIONS: Predicting a patient's adherence before treatment is difficult, but a pretreatment questionnaire may be helpful. During treatment, all respondents overestimated adherence. Health care providers should be mindful of overreports of bracewear and skeptical of their own assessments of adherence. CLINICAL RELEVANCE: Potential nonadherence may be predicted by a brief treatment-specific questionnaire. Treatment teams should not assume that patients follow their instructions or that family members are accurate sources of adherence information during treatment. Health care providers also should not assume that they can accurately predict adherence based on subjective expectations.
File Format	HTM / HTML
ISSN	02716798
Issue Number	3
Volume Number	28
e-ISSN	15392570
Journal	Journal of Pediatric Orthopaedics
Language	English
Publisher	Lippincott Williams & Wilkins
Publisher Date	2008-04-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Orthopedics Patient Compliance Statistics & Numerical Data Scoliosis Therapy Adolescent Braces Child Female Humans Male Physician-patient Relations Temperature Treatment Refusal Journal Article
Content Type	Text
Resource Type	Article
Subject	Orthopedics and Sports Medicine Pediatrics, Perinatology and Child Health

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