Development and application of an adherence assessment scale before brace treatment for patients with adolescent idiopathic scoliosis(AIS)

English Keywords:Adolescent idiopathic scoliosis  Adherence  Scale development  Treatment efficacy  Quality of life

English Abstract:

  【Abstract】 Objectives: To explore the factors influencing brace treatment adherence in adolescent idiopathic scoliosis(AIS) patients, develop a pre-treatment adherence assessment scale, test its reliability and validity, and further apply the scale to examine the predictive effect of its scores on actual treatment adherence, therapeutic outcomes, patient quality of life, and the related mediating mechanisms. Methods: From September 2020 to December 2022, 239 AIS patients were enrolled in this study, 71 of whom ultimately received and completed brace treatment with follow-up. Based on open-ended questionnaires and references to internationally recognized scales, a preliminary scale was initially constructed. It was then tested and revised through steps including item analysis, exploratory factor analysis, and confirmatory factor analysis, resulting in a finalized version with good reliability and validity. In the application stage, partial correlation analysis was further employed to identify key items that significantly predicted actual adherence, forming a concise version of the scale. Finally, correlation analysis and mediation analysis were used to evaluate the relationships between the scores of the concise scale, actual adherence(wear time ratio), therapeutic outcome(change in Cobb angle), and quality of life(Chinese version of the BrQ score). Results: A formal adherence assessment scale consisting of eight dimensions and 27 questions was formed, and a concise version of 9 questions was developed during application. The score of the concise scale showed a significant negative correlation with actual adherence(r= -0.364, P=0.003). Furthermore, the total score of this scale had a significant indirect effect on quality of life mediated by actual adherence(β=-0.09, P=0.049); However, its indirect effect on therapeutic outcome was at a borderline significance level(β=0.063, P=0.064). Conclusions: The findings suggest that the score of the concise scale shows potential for predicting patients′ actual brace-wearing adherence and may indirectly influence quality of life through actual adherence. Nevertheless, given the exploratory scope of the mediation analysis, these results should be interpreted with caution and validated by future research employing adequately large sample sizes.