Using a heat sensor Thermobrace consecutively in a clinical setting
showed high compliance with wearing the orthosis among adolescents, according
to a study.
Clinical use of a heat sensor Thermobrace (TB) was followed in 68
adolescent patients with idiopathic scoliosis or hyperkyphosis and a mean age
of 14 years. Forty-eight of the patients were at their first evaluation and 20
patients were already in treatment. Study treatment included bracing,
physiotherapic specific exercises and a multidisciplinary team approach to
care, according to the Society On Scoliosis Orthopedic and Rehabilitation
Treatment (SOSORT) Bracing Management Guidelines. Researchers calculated
compliances measured by the Thermobrace (real) and reported by the patient
“We wanted to test the use of a temperature sensor in clinical
everyday activity to verify if this device could be complementary to the
treatment [of adolescent idiopathic scoliosis] or not, because in previous
studies some authors argued that the use of a compliance monitor could affect
the physician, patients and family mutual trust relationship,” Sabrina
Donzelli, MD, of the Italian Scientific Spine Institute, told O&P
Results of TB use
Average use of the Thermobrace was 5 months. Patients with an orthosis
prescription of 23 hours wear per day reported 100% compliance wearing the
orthosis. However, the real compliance was 91.7%, which corresponded to 20
hours per day. Study results showed that patients were more compliant the
longer the orthosis was prescribed. Patients directed to wearing the orthosis
23 hours per day had a compliance of 94.8% vs. 73.2% in patients who were
prescribed 18 hours per day. Reported compliance increased among patients who
already wore an orthosis before the study.
Overall, researchers found 90% compliance among 60% of patients.
Moreover, 45% of patients remained within 1 hour of their prescription and
56.2% remained within 2 hours of their prescription. The median of no wearing
days was zero, involving 29% of patients. Sometimes patients could not wear the
orthosis for a few days, for example, because they were sick.
During the night, 92% of patients reached the maximum orthosis wear.
Sixty-four percent of patients reached the minimum orthosis wear in the
afternoon and evening. Researchers found no difference between orthosis wear on
weekdays and weekends.
“This was a preliminary study, and the results emphasize the
importance of further research with greater and homogenous samples of
consecutive patients,” the researchers concluded. “Longer monitoring
periods are needed to better understand the efficacy of brace treatment and to
point out all factors involved in the adolescent idiopathic scoliosis
treatment. The opportunity to measure real compliance by monitoring all
patients until the end of therapy will allow a deeper analysis about the real
efficacy of brace treatment.”
How the TB can help
“It is difficult for patients and families to be accurate in the
use of the brace and so they are not aware not to overestimate these
data,” Donzelli said. “Various factors can influence declaration
about the use of the brace by parents and patients, not least the relationship
with the physician and therapist. Some of these factors, but not all, can be
overcome by using the TB.”
Donzelli said making the best decisions to improve patient treatment and
discussing problems and discomfort would not work without the use of the TB.
“Sometimes it is difficult for parents and patients to admit that
they didn’t do what was prescribed,” she said. “But we have the
TB and we can openly discuss and try to understand all critical points. We
always regret when patients don’t accept the use of the TB.” —
by Casey Murphy
Donzelli S. In defense of adolescents: They really do use braces for the
hours prescribed, if good help is provided. Results from a prospective everyday
clinical cohort using Thermobrace.Scoliosis. 2012;7:13.
Disclosure: The researchers have no relevant financial