Barriers and facilitators of brace compliance in adolescents with spinal deformities: a qualitative study

Adolescent idiopathic scoliosis (AIS) and Scheuermann's kyphosis (SK) are common spinal deformities affecting different aspects of teenagers' lives. Conservative treatments such as bracing and exercise are key for managing these spinal deviations before skeletal maturity. This qualitative descriptive study explored factors influencing adolescents' adherence to brace treatment for spinal deformities, with the goal of identifying barriers and facilitators to compliance.

Seventy-four participants, including 32 adolescents, their parents (27 mothers and 5 fathers), and healthcare professionals (6 orthotists, 2 physiotherapists, and 2 spine surgeons), were interviewed between September 2020 and May 2021. The participants were invited from related spinal centers. For data analysis in this qualitative study, content analysis was used.

Data analysis revealed four main categories, 14 categories, and 94 subcategories across 1521 codes. The findings indicate that while adolescents generally experience a similar path toward brace adherence, each individual's journey is unique, and influenced by personal circumstances. For each stage of the brace compliance process, some codes were extracted as facilitating and inhibiting factors.

Various factors affect adolescents' compliance with wearing a brace for spinal deformities, with each factor impacting individuals differently. Personalized solutions are essential to overcome barriers and enhance compliance, as each adolescent experiences unique conditions during treatment. Although the path to brace compliance shares patterns, minor differences exist, necessitating customized approaches. Barriers and facilitators identified in the study can be managed through structured follow-up programs, therapeutic incentives, educational videos, and workshops that highlight others' progress, fostering a positive attitude towards treatment's health and appearance benefits.