Scoliosis is a three dimensional deformity in which the spine deviates from the normal sagittal and coronal position in upright posture and becomes fixed in an unbalanced posture. The aetiology is poorly understood, however the spinal deformity is a problematic developmental process, the outcome of which can be altered with appropriate intervention. There is some evidence in the literature that scoliosis is reversible. Asymmetric loading is the driving force for development and progression of curvatures. Progression of curvatures is related to growth potential, magnitude of the curve and bone age. Curves that are not managed result in signs and symptoms of pain, deformity, pulmonary dysfunction and psychological distress. For many cases that end up in surgery, spinal fusion fails to address the significant clinical symptoms of spinal deformity. The complications of surgery are high. There is controversy as to whether conservative management of wearing a brace and exercises are effective in stabilising the curve. Past studies have shown that exercises alone do not improve the curve. Studies have also shown that a brace only prevents progression of the curve and the efficiency of the brace is not clear. Guidelines for brace wearing have not been given in the literature. High correction bracing has however been shown to have favourable outcomes when patients are compliant. The aim of this study was therefore to determine the effect of compliance to the RSC brace and a specific exercise programme on idiopathic scoliosis curvature. Further objectives were to determine factors affecting compliance to the treatment protocol. The quality of life and psychological traits of compliant subjects and non compliant subjects during the study were established and compared. To achieve these objectives a pre test /post test study design was used with a post study comparison between subjects who complied with the management and those who did not comply. Fifty one subjects, girls aged 12-16 years were drawn from a private physiotherapy practice in Randburg, South Africa referred by different orthopaedic surgeons. Cobb angles were between 20-50 degrees and subjects had no prior treatment. Subjects were divided into two groups after the brace and exercise interventions were complete and when weaning out of the brace had begun. Subjects were allocated to the two groups according to their compliance. The compliant group was defined as those subjects who wore the brace 20 or more hours a day and exercised three or more times per week. The non-compliant group were those subjects who wore the brace less than 20 hours a day and exercised less than three times per week. The study was terminated the day the subjects started weaning out of the brace. The two study groups were compared with respect to the Cobb angle, kyphotic and lordotic angle, apical vertebral rotation, scoliometer measures, peak flow, quality of life and personality traits. The subjects in both groups were well matched at baseline. The compliant group, who wore the brace 21.5 hours per day and exercised four times a week, significantly improved in all measures compared to non compliant subjects, who wore the brace 12 hours per day, exercised 1.7 times a week and significantly deteriorated. The non compliant group followed the natural history of progression of IS curvatures. The major Cobb angles in the compliant group improved 10.19° (±5.5) and deteriorated 5.52°(±4.3) in the non compliant group. Compliant subjects had a significantly better quality of life than the non compliant subjects. Vitality, physical functioning, self esteem, bodily pain, school activity and general health perception, emotional function were significantly better in the compliant group compared to the non compliant group. The compliant group were significantly more emotionally mature, stable and realistic than the non compliant group. In conclusion good compliance to a conservative treatment programme of the RSC brace and a specific regime of exercises resulted in a significant improvement in curvatures, poor compliance resulted in progression/deterioration. A poorer quality of life in the non compliant group possibly was caused by personality traits of the group, being more emotionally immature and unstable. Possibly different personality traits have different psychosocial coping mechanisms and when put in a stressful situation, result in different levels of compliance. A personality trait questionnaire is recommended on subjects initially, to predict compliance and then to include psychological support if required. This conservative treatment programme can be offered to patients all over South Africa and Africa. The patients only have to visit the physiotherapist and brace technician once a month and in some cases every three months. Further studies are required on the long term effects of this conservative treatment programme. Scoliosis is a complex condition of the developing child, and their psychosocial coping mechanisms need further research to improve compliance.

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