OBJECTIVE: The objective of this study is to determine the different biological, psychological, and social factors that affect patient adherence in bracing treatment for adolescent idiopathic scoliosis. By comparing adherent and non-adherent bracing patients, we hope to gain insight into how to improve patient adherence in bracing as a means of primary treatment and to avoid secondary and tertiary treatments such as surgery. METHODS: Of the 19 patients (15 adherent, 4 non-adherent) who were examined for this study, the majority of them completed all psychosocial surveys at one time point in their bracing treatment. Patients answered surveys for multidimensional anxiety, generalized anxiety, pain-related fear and avoidance, pain catastrophizing, and quality of life. Quantitative sensory testing was performed on only 5 of the 19 patients at the time of writing. Sensory testing was conducted to gather information on thermal sensitivities and thresholds. Statistical t-test significance was determined for all surveys distributed to adherent and non-adherent bracing groups, and scaled T-scores were calculated for each survey measure to determine clinical significance. RESULTS: There were no statistically significant differences in any measures examined between adherent and non-adherent bracing patients. The only statistically significant difference was the number of hours of brace wearing, with the adherent group wearing their brace over 11 hours more than the non-adherent group (p < 0.0004). CONCLUSIONS: Because of the underpowered nature of this study, measures for multidimensional anxiety, generalized anxiety, pain-related fear and avoidance, pain catastrophizing, and quality of life should be reexamined for potential differences between adherent and non-adherent bracing patients. Quantitative sensory testing should be included as a measure of possible sensory differences between the two groups. A future study with a larger sample size may provide greater understanding into the motivations for bracing adherence in an effort to help patients avoid more invasive means of intervention in treating adolescent idiopathic scoliosis.

Le port d’un corset orthopédique de 20 à 23 heures par jour est reconnu comme efficace pour prévenir la progression de la courbe chez les adolescents atteints de scoliose idiopathique, mais il engendre des conséquences biopsychosociales importantes qui perturbent leur quotidien et qui contribuent à un problème de non-adhésion au corset généralisé. En effet, le temps de port réel observé est d’environ 12 heures par jour. Il n’existe aucune intervention dans la littérature qui vise à améliorer l’adhésion au corset pour cette population spécifique. Le but de ce mémoire était de concevoir un modèle interprofessionnel d’interventions de soutien à l’adhésion au traitement par corset chez les patients atteints de scoliose idiopathique. Pour répondre à ce but, nous avons effectué des entrevues individuelles auprès de neuf professionnels d’expertises variées afin de comprendre leurs perspectives et leurs stratégies potentielles pour soutenir les patients vers une meilleure adhésion au corset. Les entrevues ont été enregistrées, transcrites et codées. Nous avons procédé à l’analyse thématique des verbatim et conçu le modèle d’intervention résultant. Lors des entrevues, les participants ont relevé des barrières à l’adhésion au corset et au soutien professionnel ainsi que des stratégies fonctionnelles, éducatives, motivationnelles, psychologiques et interprofessionnelles pour répondre à ces barrières. Le modèle a été validé par un panel d’experts cliniques. Le modèle d’intervention Interprofessionnel en Soutien à l’Adhésion (IPSA) au traitement par corset est structuré en trois paliers (préparation au corset, ateliers de groupe et consultation individuelle) et nous estimons qu’il a un grand potentiel d’implantation en clinique de scoliose. / Wearing a spinal brace between 20 to 23 hours a day is recognized as effective to prevent curve progression in adolescents with idiopathic scoliosis, but it generates important biopsychosocial consequences that disturb patients’ daily activities and that contribute to the generalized problem of brace nonadherence. Indeed, the observed time spent in-brace is approximately 12 hours a day. A thorough review of the literature could not yield any intervention to enhance brace adherence for this specific population. The purpose of this master’s thesis is to develop an interprofessional support intervention model to enhance brace adherence in adolescents with idiopathic scoliosis. To fulfill this purpose, we have conducted individual interviews with 9 professionals of various expertise in order to understand their perspectives and their potential strategies to support patients towards better brace adherence. The interviews were audiotaped, transcribed and coded. We proceeded to a thematic analysis of the interview transcripts, which resulted in the intervention model. During the interviews, participants mentioned adherence barriers to brace treatment and professional support barriers as well as functional, educational, motivational, psychological and interprofessional teamwork strategies for answering these issues. The model was reviewed by an expert panel of clinicians. The Interprofessional Adherence Support intervention model (IPAS) to brace treatment is three-tiered to provide different levels of intensity of support to patients (brace preparation, group workshops and one-on-one consultations) and has great potential for implementation in clinical practice.