Gender-related differences in brace adherence among adolescents with idiopathic scoliosis

Adolescent idiopathic scoliosis (AIS) is commonly treated with bracing, but the effectiveness of this approach depends on adherence to prescribed wear time. While previous studies suggest higher compliance among females, the influence of psychosocial and behavioral factors remains underexplored and the extent to which gender-based differences affect brace adherence over the course of treatment remains uncertain. Therefore, the aim of this study was to examine whether males and females differ in their adherence to Chêneau brace treatment.

This retrospective observational study included patients with AIS treated with a Chêneau brace and followed for a standardized 24-month period, with analyses restricted to the first 24 months after brace prescription. Adherence to prescribed brace wear was assessed at routine follow-up visits, and clinical, radiographic, and behavioral variables were collected. Adherence trajectories over time were analyzed using longitudinal mixed-effects models to account for repeated measurements, and exploratory analyses evaluated the association between curve magnitude during follow-up and adherence.

62 patients were included (45 females and 17 males). The mean age at brace prescription was 13.9 ± 0.8 years in females and 14.9 ± 0.7 years in males. Adherence was significantly higher in males at all evaluated timepoints. Patients engaging in both organized sports and postural gymnastics showed the highest adherence levels (77.8%), whereas inactive patients demonstrated the lowest adherence (55.0%). Curve progression occurred in 66.7% of patients with low adherence, 21.4% with moderate adherence, and 11.8% with high adherence. Adherence decreased over time in the overall cohort (78.2% at 6 months to 70.3% at 24 months), with a progressive decline observed in females and relatively stable adherence in males (time × gender interaction p < 0.001). Mean Cobb angle increased slightly during follow-up (23.9° at 6 months to 25.5° at 24 months). In exploratory longitudinal analysis, higher Cobb angles were concurrently associated with lower adherence (- 1.3% per + 1° Cobb, p < 0.001).

Males showed significantly higher adherence to brace treatment than females, differing from some previous findings reported in the literature. However, adherence varied markedly across levels of physical engagement. Adolescents who participated in organized sports had the highest adherence rates, followed by those involved in general physical activity, while inactive patients showed the lowest compliance.