Author: Chan, Siu Ling
Title: A correlation study among the orthotic treatment effectiveness, compliance to spinal orthosis and health-related quality of life of the patients with adolescent idiopathic scoliosis (AIS) in the initial treatment period
Degree: DHSc
Year: 2014
Subject: Scoliosis -- Patients -- Treatment.
Scoliosis -- Patients -- Psychological aspects.
Hong Kong Polytechnic University -- Dissertations
Department: Faculty of Health and Social Sciences
Pages: xiii, 169 leaves : illustrations ; 30 cm
Language: English
Abstract: From the latest literature, the effectiveness of orthotic treatment for patients with adolescent idiopathic scoliosis (AIS) was confirmed and it can significantly decrease the progression of high-risk curves to the threshold for surgery. To better understand the effectiveness of orthotic treatment, in-brace correction should be considered, as some researchers have highlighted that the best guideline for prediction of the results of brace treatment is the response of the spinal curve to the brace, especially during the first year of treatment. However, bracing may be a stressful experience for the patient, and compliance with an orthotic treatment protocol is very much dependent upon the patient's physical, emotional and social well-being. Non-compliance with orthotic treatment could be psychologically related. It is thus necessary to explore whether there are relationships among in-brace correlation, patients' compliance with orthotic treatment and patients' quality of life (QoL). The results of such research should inform the future management of AIS. This study was conducted in three parts. The first part aimed to validate the Chinese translated Brace Questionnaire (BrQ) and the Chinese translated Trunk Appearance Perception Scale (TAPS). The second part explored correlation between the effectiveness of orthosis (in-brace correction), patients' compliance with orthotic treatment and health-related QoL of patients with AIS. The third part compared the QoL between a 'brace group' and an 'observation group'. For the validation study, Chinese translations of the BrQ and TAPS were assessed according to published guidelines for the cross-cultural adaptation process. This validation method is currently used by the American Association of Orthopedic Surgeons (AAOS) Outcomes Committee. After translation of the two instruments, 52 subjects were recruited at the Department of Prosthetics and Orthotics of the Duchess of Kent Children's Hospital, and they were asked to fill out the Chinese BrQ, TAPS and a reference questionnaire SRS-22r. One week later, the subjects again filled out the BrQ and TAPS, and they returned their questionnaires in pre-addressed envelopes. According to the data analysis, both the BrQ and TAPS showed good internal consistency and test-retest reliability. The two questionnaires were also shown to have concurrent validity against the SRS-22r and discriminant validity against such parameters as the angle of trunk rotation and the in-brace Cobb angle.
For the correlation study, 55 patients with a diagnosis of AIS were recruited. All were female, all were aged 10 years or above when a brace was prescribed, none had undergone prior treatment, and all had a Risser sign of 0 - 2 and a Cobb angle of 25-40{493}. The study patients were examined in three consecutive visits with 4 to 6 months between each visit. During the first visit, each subject filled out the TAPS, and the pre-brace Cobb angle, vertebral rotation and trunk list were measured. During the second and third visits, the subjects filled out the TAPS, BrQ and SRS-22r, and the in-brace Cobb angle, vertebral rotation and trunk list were measured. All subjects reported their brace-wear compliance by submitting a log sheet that they had maintained daily throughout the study period. In addition, each subject's compliance was checked by means of an orthosis monitoring system that was installed into their brace for 2 to 4 months. The data extracted from the monitoring system were compared against the information reported on the log sheet. The results of this correlation study showed a positive relationship between patients' brace-wear compliance and patients' QoL. Poor compliance (0-8 hours of brace wearing) was predictive of a low QoL. Otherwise, there was no relationship between patients' brace-wear compliance and in-brace correction or between in-brace correction and QoL. In addition, a positive correlation was found between the subjective information (from the log sheet) and objective data (from the orthosis monitoring system) in terms of patient compliance to brace wear. For the comparative study, the QoL of the brace group and that of the observation group was analysed in a cross-sectional manner. The observation group comprised 55 patients with a diagnosis of AIS; all were females aged 10 years or above, and none had undergone prior treatment, nor were they undergoing treatment at the time of the study. The SRS-22r and the Chinese TAPS were used. From the results of this study, it was found that the brace group would have a poorer QoL than that of the observation group. Bracing can have a negative effect on the QoL as well as the trunk appearance perception of patients with AIS. Some studies have suggested that QoL should be carefully monitored over the course of treatment, highlighting the difficulties patients experience when subjected to conservative treatment. In the present study, patients' compliance patterns were identified and the effect of compliance on patients' QoL was thus clarified. The results of the study will allow us to make adjustments to patients' care regimens, adjustments that are based upon factors that affect outcomes. Such factors include patient compliance, which is as important to QoL as it is to brace success. The ultimate treatment effect (in both physical and psychological aspects) can then be enhanced.

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