Bracing Compliance and Personality Traits: A Compliance Assessment Program for Scoliosis and Clubfeet
Condition: Clubfeet; Adolescent Idiopathic Scoliosis
MeSH terms: Scoliosis; Clubfoot; Talipes; Equinus Deformity
Study type: Observational

Summary: 
      While studies have shown that better outcomes are associated with brace wear compliance in
      the scoliosis and clubfoot populations, compliance rates are still poor. Reasons identified
      by patients, parents and research for not complying with prescribed brace wear include the
      inconvenience or irritability of the child when in the brace in the case of clubfeet, and
      fear of looking different from peers, clothes not fitting properly, or discomfort in the case
      of scoliosis. While reasons for noncompliance are many and can be complex, there has been
      some research to indicate that personality traits may play a role in brace wear compliance.

      The primary purpose of the proposed study is to determine if personality traits are related
      to compliance patterns for individuals undergoing brace treatment for AIS or Clubfeet.
    

Detailed description: 
      Bracing compliance, or the ability of patients to tolerate prescribed bracing regimens, has
      been shown to be related to the success of treatment. In pediatric orthopedics, bracing is
      used as one treatment option for a number of diagnoses and reasons. Two populations that are
      commonly prescribed bracing as part of the treatment paradigm are infants with clubfeet
      following Ponseti casting and adolescents with scoliosis.

      For adolescents with idiopathic scoliosis, bracing is used to stop or slow progression of
      curves with the hope to delay or prevent the need for surgical intervention. Research has
      shown that bracing significantly decreased curve progression in patients with adolescent
      idiopathic scoliosis, and that the benefits of bracing increased with longer hours of brace
      wear.

      Likewise, bracing is common practice for treating infants with clubfeet. All infants with
      clubfeet at SHC-Lexington are prescribed a bracing regimen following the completion of their
      Ponseti casting protocol. Previous research has shown that noncompliance with brace wear is
      strongly associated with recurrence of clubfeet in this population. Recurrence often leads to
      surgical intervention for these infants. Previous Kosair funded research conducted at
      SHC-Lexington investigated actual brace wear rates compared to the prescribed wear time in a
      sample of infants with clubfeet. In that study, brace wear rate significantly declined in the
      first three months of wear. That study did not look at factors related to the compliance with
      brace wear.

      While studies have shown that better outcomes are associated with brace wear compliance in
      the scoliosis and clubfoot populations, compliance rates are still poor. Reasons identified
      by patients, parents and research for not complying with prescribed brace wear include the
      inconvenience or irritability of the child when in the brace in the case of clubfeet, and
      fear of looking different from peers, clothes not fitting properly, or discomfort in the case
      of scoliosis. While reasons for noncompliance are many and can be complex, there has been
      some research to indicate that personality traits may play a role in brace wear compliance.
      Work done by Rivett looked at personality traits of scoliotic girls who wore a Cheneau brace
      (a brace not commonly prescribed in North America and the United Kingdom) and found that
      those who were compliant with their bracing prescription tended to be more emotionally
      mature, stable and realistic than the noncompliant group. Although not well studied,
      personality traits of infants with clubfoot and their caregiver might similarly affect their
      compliance with brace wear.

      Past work has shown that when braces are worn as prescribed, treatment outcomes are improved
      in those with scoliosis and clubfoot, yet bracing compliance is a consistent problem in both
      populations. With adolescent idiopathic scoliosis and clubfoot being the largest and third
      largest populations seen at SHC-Lexington, 3700 active patients and 2500 active patients,
      respectively, it is imperative that we address brace wear compliance in order to offer the
      best treatment outcome possible. At SHC-Lexington, during 2013 approximately 30 AIS patients
      and 50 infants with clubfoot were prescribed braces for the first time.

      The primary purpose of the proposed study is to determine if personality traits are related
      to compliance patterns for individuals undergoing brace treatment for AIS or Clubfeet. This
      pilot project will examine different measures used to assess personality traits of
      adolescents with AIS, babies with clubfeet and their parent/guardian/caregiver. Using these
      identified measures, the association between traits and degree of compliance with the bracing
      prescriptions will be evaluated. If certain personality traits are identified as indicators
      for noncompliance, then additional support should be offered to those patients.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        A total of 105 participants will be enrolled in the study. Of those 105, 35 will be
        clubfoot patients, 35 clubfoot patients' guardians, and 35 AIS patients.