Does Longer Brace Wear Harm Quality of Life in Patients with Adolescent Idiopathic Scoliosis?

Abstract

Rigid bracing is a key treatment in patients with adolescent idiopathic scoliosis (AIS) but requires long duration wearing. Although the impact of the brace wear and its psychological stress raises concerns in adolescents, its contributions to health-related quality of life (HRQOL) during brace treatment remain unclear. To compare the associations of objectively recorded brace wear time and early brace-related stress with HRQOL at 1 year after brace initiation, and to test whether stress mediates the association between wear time and HRQOL. Retrospective single-center cohort study. Two hundred four patients with AIS (10-15 years; Cobb angle 20°-40°; apical vertebra below T7) treated with a Boston brace and followed for at least 1 year. Scoliosis Research Society-22r (SRS-22r) total score at 1 year. Mean brace wear time from initiation to 1 month visit was objectively monitored using an in-brace temperature data logger, and brace-related psychological stress was assessed at 1 month visit using the Japanese Bad Sobernheim Stress Questionnaire-Brace (JBSSQ-brace). Hierarchical multiple regression assessed independent associations between brace wear time, brace-related stress, and SRS-22r score, adjusting for baseline SRS-22r and clinical covariates. Causal mediation analysis examined path a, representing the association between brace wear and stress; path b, representing the association between stress and HRQOL after accounting for brace wear; and path c', representing the direct association between brace wear and HRQOL after accounting for stress. In hierarchical multiple regression models, objective brace wear time was not associated with the 1-year SRS-22r total score (β = -0.029, p = 0.670), whereas JBSSQ-brace score was independently associated with this outcome (β = 0.217, p = 0.003). Mediation analysis showed no significant indirect association between wear time and HRQOL through brace-related stress (path a: β = 0.041, p = 0.491; direct path c': β = -0.002, p = 0.541), while brace-related stress remained associated with HRQOL (path b: β = 0.015, p = 0.002). Contrary to common clinical assumptions, objective brace wear time was not associated with 1-year HRQOL. Early brace-related psychological stress was an independent factor associated with 1-year HRQOL during AIS bracing. Mediation analysis showed no clear evidence of an indirect association between longer brace wear time and lower HRQOL through brace-related stress. These findings suggest that longer brace wear is not inherently detrimental from a HRQOL perspective and highlight the importance of early psychological assessment and targeted interventions to reduce brace-related stress.