A study comparing two groups of patients with scoliosis showed patients and their families do adhere to practitioner instructions for weaning into a new orthosis. The findings are part of an ongoing multi-year study of orthosis wear at Texas Scottish Rite Hospital for Children and make use of existing patient data to draw comparisons between two types of weaning instructions.
Comparing slow and fast weaning periods
The idea for the study originated in a clinical discussion between residency director Kevin M. Felton, MLA, CO, CO, FAAOP, and his colleague, Scott Savage, BS, CPO, LPO, an orthotist in the Orthotics Department of Texas Scottish Rite. Felton believed scoliosis patients needed a weaning period of 2 weeks to 3 weeks to adjust to an orthosis, whereas Savage believed the weaning period could happen in just a week.
“[The study] came from a clinical discussion, but the data existed so we … analyzed data we were already collecting,” Felton told O&P News.
The data from two groups of patients was used for the analysis: the “slow” weaning group comprised 13 of Felton’s patients, all of whom were advised to wean into wear time over a period of 2 weeks to 3 weeks, and the “fast” weaning group was made up of 28 of Savage’s patients, all of whom were advised a rapid adjustment of 1 week. All patients were between the ages of 10 years and 14 years and had been prescribed thoraco-lumbar-sacral orthoses with the goal of 22 hours of wear each day. Felton and colleagues calculated wear time based on temperature loggers mounted in spinal orthoses.
Savage believed the fast adjustment period would be more beneficial based on the idea that “it is easier to start new habits immediately” and that patients would not learn “strategies to rationalize leaving the orthosis off,” according to the published findings. Felton, however, used the longer adjustment period to allow time for patients to adjust to the pressure on their skin. School wear was delayed for the patients in the slow group until they could wear the orthosis for a full day without problems.
The analysis results noted that “each hypothesis makes the assumption that the [orthosis wear] instructions given influence families’ behavior, which has not previously been determined.”
Adjustment, instruction results
Felton and colleagues found the fast group was significantly quicker in reaching the goal of 22 hours of wear. Patients in the fast group reached this goal, on average, in 10.6 days, whereas patients in the slow group reached the goal, on average, in 18.9 days.
“I was surprised by how many [patients] really do wean into wearing a brace in 1 week when they are instructed to do so,” Felton said. “I did not think that was possible.”
The data also confirmed that differences in instructions to patients and their families resulted in changes in behavior.
“I think we all had hoped that families would follow our instructions … That was the hoped-for result,” Felton said.
Because Texas Scottish Rite’s Orthotics Department has eight different orthotists, Felton and colleagues hope the results of the analysis will aid them in creating a weaning protocol for orthoses.
“The discussion is still ongoing on [whether] we as a department [should] come up with some kind of unified voice to decide [the protocol] with weaning into a scoliosis brace,” Felton said. “We still have not reached an agreement. The thing that has not been answered is [whether] one protocol or another makes a difference to the outcomes … That may be influenced by any changes we might see, based on long-term follow-up.”
The analysis focused only on the initial adjustment period, Felton said, rather than long-term results.
“We are only talking the first couple of weeks here, and this is a long-term, [multi-year] outcomes process for most of these [patients].”
For now, Felton said, the results should signal practitioners to take great care when instructing patients.
“It is good to know that what we are really instructing families to do is going to affect their behavior, which makes us more cognizant of [the need to] make sure that we instruct families appropriately and correctly.” – by Amanda Alexander
- Felton K, et al. J Prosthet Orthot. 2015;doi:10.1097/JPO.0000000000000046.
Disclosure: Felton reports no relevant financial disclosures.