Patients, Parents Perceive Different Stress Levels With Adolescent Idiopathic Scoliosis

Patients who undergo conservative treatment for adolescent idiopathic
scoliosis and their parents perceive emotional stress similarly when related to
orthotic treatment. However, parents overestimate the assessment of stress
related to body deformity, according to recent study results.

“Many authors emphasize that the necessity of conservative
treatment in patients with adolescent idiopathic scoliosis may cause emotional
distress,” the researchers wrote. “Until now, the majority of
researchers investigated parents’ and patients’ perceptions of the
postoperative appearance or assessment of deformity in patients with adolescent
scoliosis…To our knowledge, no group has ever reported patient and
parental estimation of emotional stress related with the necessity of wearing a
brace and trunk deformity in patients with adolescent idiopathic scoliosis
treated conservatively.”

Similarities, differences in stress levels

Sixty-three females aged 10 years to 17 years with adolescent idiopathic
scoliosis (AIS) treated with a Cheneau brace and their parents completed the
Bad Sobberheim Stress Questionnaire-Deformity (BSSQ-Deformity) and the Bad
Sobberheim Stress Questionnaire-Brace (BSSQ-Brace). Parents completed the
questionnaires based on their own perspective of their child’s situation.
Researchers assessed whether differences in stress levels existed between the
patients and their parents.

Overall, parents and patients reported similar stress levels regarding
orthosis wear, the researchers found; however, perceptions of stress levels
regarding scoliosis were different. Patients reported a moderate level of
stress regarding conservative treatment, but a low level of stress related to
scoliosis. Parents also reported perceiving a moderate level of stress
regarding conservative treatment, but they reported a perception of moderate
stress related to scoliosis as well.

“Psychological stress is a cause of special concern for health
professionals, as it can correlate with a lack of compliance from scoliosis
patients to brace treatment regimen,” Ewa Misterska, PhD, MSc, of
the department of pediatric orthopaedics and traumatology at Poznan University
of Medical Science, Poland, told O&P Business News.

Misterska and colleagues found that the ability for parents to
understand the perspective of an adolescent scoliosis patient and the
psychological burden related to orthosis wearing and spinal disfigurement was
an important point that may cause family conflicts.

“It should be emphasized that conservative treatment may bring an
escalation of family conflicts regarding the necessity of brace-wearing, as
well as great dependency of patients on their parents who have to assist in
maintaining the treatment, such as putting on the brace of monitoring wearing
times,” Misterska said.

Clinical implications

According to Misterska and colleagues, the lack of discrepancies in the
assessment of emotional burden related to orthosis wear may have useful
clinical implications. If patients and parents grasp the importance of wearing
an orthosis, they may be more apt to talk about it, resulting in better
scoliosis treatment cooperation and compliance.

However, there are negative consequences to parents’ overestimation
of stress levels related to body deformity, such as psychological disturbances
in females with AIS, because the development of body image is a process
influenced by direct and indirect feedback provided by peers or family members.
Health professionals can help clear up any miscommunications.

“If parents receive sufficient information from health
professionals, it would be possible for them to provide strong social support
for their children through decreasing the emphasis on the importance of spinal
appearance thus helping to minimize the psychosocial impairment of AIS
patients,” Misterska said. “Therefore, we believe complex assessment
of brace treatment should include, in addition to objective, radiographic and
clinical parameters, such as Cobb angle or angle of trunk rotation, the
evaluation of emotional stress from the perspective of both patients and
parents.” — by Casey Murphy

For more information:

Misterka E, Glowacki M, Latuszewska J et al. Female patients’ and
parents’ assessment of deformity- and brace-related stress in the
conservative treatment of adolescent idiopathic scoliosis. Spine. 2012;

Disclosure: Misterska has no relevant financial disclosures.

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