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Exploring Predictors of Brace-Wearing Adherence in Non-Surgical Treatment of Acute Knee Medial Collateral Ligament
Dana J Hunter1,2, Amanda M Black3,4,5,6, S Nicole Culos-Reed2,5,7,6,8,9,10
1Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.
Objectives:
(1) To estimate adherence to brace wearing for medial collateral ligament (MCL) injuries across 3 phases of conventional treatment and (2) to explore predictors of adherence for each phase.
Design:
Exploratory cohort study.
Setting:
Primary care center.
Patients:
Fifty-nine patients aged 18 to 65 (27 men, 32 women) from a randomized clinical trial examined the effectiveness of 2 bracing techniques (0-90 degrees or 30-90 degrees) for acute isolated MCL or combined anterior cruciate ligament injuries. Patients were prescribed a 6-week bracing protocol and were followed for 12 weeks.
Interventions:
Patients were prescribed constant brace wearing for 4 weeks (∼23 h/d), then daytime wear only (∼15 h/d) until brace discontinuation at 6 weeks. Rehabilitation exercises were prescribed from 2 weeks onward. Adherence to the protocol was assessed through daily self-reported logs. Clinical and patient-reported outcomes were collected throughout the randomized clinical trial (baseline, 2, 4, and 6 weeks). This study interpreted them as predictor variables of treatment adherence alongside patient and treatment characteristics.
Main Outcome Measures:
Adherence to each 2-week phase, interpreted dichotomously (adherer or nonadherer). Adherers were identified as those who wore their brace according to the protocol.
Results:
Adherence and pain decreased, while overall knee ratings improved throughout the treatment. Pain, affected knee, and brace range-of-motion settings were significant predictors of adherence in the exploratory logistic regressions.
Conclusions:
Pain, affected knee, and brace range-of-motion settings were the primary predictors of brace wearing in the first 4 weeks of treatment. This study is the first to provide insight into MCL bracing adherence, potentially aiding clinicians in treatment management.
