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Brace adherence Influenced by geographic and personal factors: ISICO study published in children

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The ISICO study entitled “Geographic, Personal and Clinical Factors Influencing Brace Adherence in Adolescents with Idiopathic Scoliosis” has just been published in the journal Children (MDPI). The research also competed for the SOSORT Award 2025.
Brace therapy is an effective treatment for adolescents with idiopathic scoliosis (AIS), provided that adherence is high. While previous studies have objectively measured compliance using thermal sensors, the influence of geographic and socioeconomic variables—such as living in mountain versus seaside areas, in large cities versus small towns, or differences in income level—had not previously been investigated.

The study, led by Alessandra Negrini, physiotherapist at ISICO and author of the research, analyzed 1,904 adolescents(mean age 13 years; mean curve 35° Cobb). Adherence was measured using a thermal sensor (iButton) applied to the brace. The variables examined included age, prescribed brace-wearing hours, geographic area (Northern, Central, Southern Italy), gender, skeletal maturity (Risser), curve type, presence of back pain, income level, altitude above sea level, and distance from the sea.

Key Findings

  • 90% of patients demonstrated good adherence (wearing the brace for more than 75% of the prescribed hours).
  • Higher adherence was associated with:
    • Younger age
    • Female gender
    • A prescription of more than 20 hours per day
    • Residence in Northern Italy

The results suggest that climatic and social factors may influence treatment adherence.

As Alessandra Negrini comments:

“Through this study, we aimed to verify the influence of geographic, personal, and clinical variables — routinely recorded by doctors — on adherence to brace treatment. Understanding that certain factors can reduce adherence allows us to identify patients who may benefit from targeted strategies to improve compliance. Thanks to this type of research, we can enhance the personalization of therapeutic interventions, adapting them to patient characteristics to maximize treatment effectiveness.”

📖 The full article is available here

Active self correction and stabilization: an Isico letter to the editor

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It has just been published a letter to the editor  “The active self-correction component of scoliosis-specific exercises has results in the long term, while the stabilization component is sufficient in the short term” in the scientific journal Prosthetics and Orthotics International. 

“This is a comment to the study “Core stabilization exercises versus scoliosis-specific exercises in moderate idiopathic scoliosis treatment” –explains dr. Alessandra Negrini, Isico physiotherapist and author of the letter – the authors of the research compared two groups included Scientific Exercises Approach to Scoliosis (SEAS) and core stabilization. Scoliosis-specific exercise schools like SEAS include two main components: active self-correction (ASC) and stabilization. Consequently, a common intervention was provided to the two groups (stabilization) in this study, while the SEAS group also received ASC”.

Follow-up X-rays were taken after only 4 months. According to the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT)/Scoliosis Research Society (SRS) criteria, these results should be classified as a very short-term assessment. No significant difference was found between the two interventions. The patients were more adherent to the brace than to the exercise therapy. “Unfortunately, the authors did not mention if there was a difference in the adherence to bracing between the groups: this variable is expected to impact the results more than the type of exercises -adds dr. Negrini – Experts agree that stabilization exercises are more important during the first treatment phase (when the brace maintains for many hours every day the alignment of the spine and exercises are aimed to counteract muscle impairment). Exercises in ASC are more important in maintaining the obtained results when the brace weaning phase starts, when the patients should live sustaining in correction their spine without the brace support”. 

It is important for the future to determine when to start ASC: immediately (even if it could add nothing to stabilization) or when weaning starts (when it could be too late)?

The full letter: https://pubmed.ncbi.nlm.nih.gov/32524898/