Brace Dose in Scoliosis: Measurement, Monitoring, and Clinical Decision-Making-A Narrative Review

Adolescent idiopathic scoliosis bracing is best conceptualized as a dose-dependent therapy in which clinical benefit depends on the delivered, rather than prescribed, corrective exposure. This narrative review synthesizes post-2015 evidence to present a clinically oriented framework for "precision bracing" that links brace prescription to objectively measured delivered dose and subsequent clinical response. We summarize evidence that bracing reduces progression risk in skeletally immature patients, while highlighting the efficacy-effectiveness gap driven by incomplete adherence. We review objective adherence monitoring technologies, focusing on temperature-based data loggers and emerging force or pressure sensing approaches, and explain how objective dosing data refine outcome interpretation by distinguishing undertreatment from true treatment failure. We conceptualize brace dose as a multidimensional construct that includes quantity (objectively measured wear time), pattern (regularity), and correction-related indicators (including in-brace and early out-of-brace radiographic metrics and, when available, interface force surrogates). We synthesize key effect modifiers, including skeletal maturity, curve magnitude and phenotype, early radiographic response, and contextual determinants of achieved wear time. We translate this evidence into a practical clinical framework for risk stratification, brace schedule selection, objective monitoring, early reassessment, and escalation when delivered dose is inadequate or response is unacceptable We conclude by outlining research priorities for standardized reporting of delivered dose, pragmatic trials embedded in routine care, and core outcome sets that integrate radiographic and patient-reported outcomes.