The Challenge of Teen Scoliosis Patients: “I’ve got your back” may take on a whole new meaning …

If you think it’s difficult to get a teen to wear his pricey orthodontic appliance, try dealing with a teen being treated for scoliosis (curvature of the spine). How do you get adolescent spinal patients to wear their back braces for the prescribed number of hours each day? Sometimes an electronic “big brother” can help.

Last summer at the 124th meeting of the American Orthopaedic Association, a team of doctors and specialists from NYPresbyterian Hospital-Orthopaedic Center delivered a presentation focusing on that conundrum.

As in any medical treatment, patient compliance is a vital component to the treatment’s success and efficacy. When treating “independent,” often contrarian adolescents, it can be more of a challenge to get them to sign-on to their own treatment regimen.

Prior studies concluded that monitoring patients for medication compliance improves their behavior. However, such monitoring methods have not been used in determining adolescents’ adherence to using their orthotic devices.

Michael G. Vitale, M.D., chief, Pediatric Spine and Scoliosis Surgery, Department of Orthopaedic Surgery, headed a study to determine if electronic monitoring would improve teens’ compliance with their treatment schedules. Twenty-one adolescents with idiopathic scoliosis received custom-fit spinal braces to treat their conditions. At the beginning of the study, their physicians, using a uniform script, told their adolescent patients to wear it at least 18 hours a day. Unknown to the teens, a temperature probe was hidden in each of their braces to measure the length of time the orthotic was worn.

After institutional review board (ethics board) approval, 10 of the patients were chosen at random and informed of the monitoring device. Eleven were not informed. At the patients’ four-month follow-up visits, data from the devices was collected to create a profile of each patient’s brace-wearing pattern during the 14-week observation period.
Michael G. Vitale, M.D., chief, Pediatric Spine and Scoliosis Surgery examines a teen with scoliosis. The results revealed that 30 percent of the informed patients were compliant with their treatment schedule (wearing the brace daily for 18 or more hours); whereas none of the uninformed patients were adhering to their regimens. However, when the uninformed patients were apprised of the device, their compliance improved.

On average, the informed patients wore their braces for more than 15 hours a day; uninformed patients wore theirs a little more than 10 hours a day.

Overall, the study’s results indicate that such electronic monitoring may be a highly useful tool to get teens to get with the program.

Other members of the study team were Daniel J. Miller, Jeanne M. Franzone, Hiroko Matsumoto, Joshua E. Hyman, M.D., and David P. Roye, M.D.

[See the original abstract at here & go to page 20.]