Adolescent idiopathic scoliosis (AIS) is a common disease that, in many cases, can be conservatively treated through bracing. High adherence to brace prescription is fundamental to gaining the maximum benefit from this treatment approach. Wearable sensors are available that objectively monitor the brace-wearing time, but their use, combined with other interventions, is poorly investigated. The aims of the current review are as follows: (i) to summarize the real compliance with bracing reported by studies using sensors; (ii) to find out the real brace wearing rate through objective electronic monitoring; (iii) to verify if interventions made to increase adherence to bracing can be effective according to the published literature. We conducted a systematic review of the literature published on Medline, EMBASE, CINAHL, Scopus, CENTRAL, and Web of Science. We identified 466 articles and included examples articles, which had a low to good methodological quality. We found that compliance a greatly varied between 21.8 and 93.9% (weighted average: 58.8%), real brace wearing time varied between 5.7 and 21 h per day (weighted average 13.3), and specific interventions seemed to improve both outcomes, with compliance increasing from 58.5 to 66% and brace wearing increasing from 11.9 to 15.1 h per day. Two comparative studies showed positive effects of stand-alone counseling and information on the sensors’ presence when added to counseling. Sensors proved to be useful tools for objectively and continuously monitoring adherence to therapy in everyday clinical practice. Specific interventions, like the use of sensors, counseling, education, and exercises, could increase compliance. However, further studies using high-quality designs should be conducted in this field.

Purpose: The Brace Adolescent Idiopathic Scoliosis Trial (BrAIST) reported a bracing dose–response curve in AIS for brace-wearing time (BWT) up to 18 h/day (h/d) on the outcome end-of-treatment < 50°. We aimed to examine the dose–response curve for this and other relevant outcomes in cases of BWT > 18 h/d. Methods: Design: Retrospective secondary analysis of consecutively collected data. Participants: braced AIS patients with curves < 45° and a subgroup with BrAIST inclusion criteria. Treatment: different braces, prescribed 18 to 24 h/d, according to curve topography, Cobb angle and a shared decision-making approach. We divided patients into BWT quartiles and developed dose–response curves using the BrAIST methodology for the end-of-growth outcomes END < 50°, END < 30°, avoidance of progression, and improvement. Results: We included 884 patients (85% female), with a mean age of 13.0 ± 1.3 years and a mean Cobb angle of 28 ± 7°. In the higher BWT quartiles, we found larger scoliosis curves but also better final Cobb angle results. The dose–response curves showed statistically significant improvements for the outcomes END < 30° and improvement (outcomes improvements ranging 45–60% and 25–35%, respectively). The outcomes END < 50° and avoiding progression showed a ceiling effect due to a very high success rate (range 97–98% and 85–87%, respectively). Conclusion: BWT > 18 h/d is associated with avoiding surgery (END < 50°), reduced progression, and increased improvement rates, and achieving END < 30°, which is particularly relevant because it reduces the risk of problems in adulthood. Decisions on daily BWT should be based on the desired outcomes and an honest conversation with the patients and parents.

Purpose: Effective communication with patients regarding long-term conservative treatment for idiopathic scoliosis necessitates an understanding of its natural history. Existing predictive models have limitations in this regard. Our study aimed to develop and evaluate the reliability and utility of the Idiopathic Scoliosis Graphical Representation Of Worsening Trend of Natural History (IS-GROWTH) communication tool. Methods: IS-GROWTH development and validation involved consecutive untreated patients with radiographs taken at and prior to the first consultation. To construct the model, we calculated the minimum and maximum progression of patients grouped by 10° Cobb angle range and growth phases. IS-GROWTH is developed for each patient, incorporating the expected progression of each growth phase into the preceding one. For temporal validation, we included patients whose data were obtained after the development of IS-GROWTH, comparing IS-GROWTH predictions with natural history. We calculated the percentage of correct predictions and applied the chi-square test. We also examined the distribution of natural history within IS-GROWTH. Finally, we piloted the tool's usefulness for communication with patients among a group of physicians using it for several years. Results: To develop IS-GROWTH, we analysed 3,184 radiographs from 1,818 participants, spanning from infancy to adolescence. For validation, we included 552 patients and found an accuracy of 95% (95% Confidence Interval, 93-97%) after adjusting for the 5° radiographic measurement error. Nineteen physicians (7.3±5.8 years’ experience) reported using IS-GROWTH in 30% of their patients (range 5-95%) and found it most useful during follow-up (84%) to motivate patients (79%). Conclusion: IS-GROWTH is reliable and useful. We now regularly use it to deepen our understanding of individual natural history and enhance communication with patients.

Background: The Sforzesco brace is a very rigid push-up brace effective in adolescent idiopathic scoliosis (AIS). We recently developed a new Sforzesco brace based on modularity (the Modular Italian brace—MI brace) that could allow standardization, facilitating global expertise diffusion, increased modifiability and adaptability, and cost savings due to longer brace life. We aimed to compare the short-term results of the two braces. Methods: The retrospective study included 231 consecutive AIS treated with a MI brace (N = 53) or Sforzesco brace (N = 178). The main outcome was the first 6-month follow-up out-of-brace radiograph Cobb angle change. Secondary outcomes included the in-brace Cobb degrees and aesthetics (TRACE), prominence (angle of trunk rotation and mm), kyphosis, and lordosis changes. Results: The two groups were similar at baseline, apart from more immature patients in MI brace. Both braces reduced the Cobb angle (−6° out-of-brace; −16° in-brace) without differences between groups. All secondary outcomes improved, apart from a statistically and clinically insignificant 3° kyphosis reduction. The MI brace participants were 4.9 times more likely to improve the Cobb angle than the Sforzesco brace (OR = 4.92; 95%CI 1.91–12.64; p = 0.001). Conclusions: These findings suggest that the MI-brace can be safely used instead of the classical Sforzesco brace. However, further studies of different designs and longer follow-ups are needed to confirm these findings.