Shriners Children's Enhances Scoliosis Care with Brace Compliance: Tracking Technology Boosts Patient Outcomes

The Brace Compliance Program was designed by Shriners Children's to improve patient care and health outcomes of individuals diagnosed with idiopathic scoliosis through the objective measurement of TLSO (thoracic lumbar sacral orthosis) brace wear times.

Idiopathic scoliosis is a type of scoliosis that causes the spine to develop an abnormal curve. Idiopathic means the cause is unknown, and typically appears after age 10. In many cases, idiopathic scoliosis is a small curve and doesn't require treatment, but will be closely monitored as the patient grows.

"The use of a well-fitted TLSO is a mainstay in the treatment we provide to prevent progression," said Keith Gettys, M.D., Shriners Children's Greenville. "It is important that our patients understand what is at stake. Without proper use, more aggressive treatment may become necessary."

A TLSO brace is used to limit motion in the thoracic, lumbar and sacral regions of the spine, and to treat stable fractures or after surgery to the thoracic (middle) and/or lumbar (lower) parts of the spine.

Initial Research

Under the leadership of then Chief of Staff Henry Iwinski, M.D., who now serves as the chief medical quality officer for the Shriners Children's Physicians Group, Shriners Children's Lexington launched the system's first brace compliance program in 2018 as a research project.

Positive results and overwhelming support by the physicians led to the program being adopted clinically a few years later and growing to 736 total patients who have participated. Currently, more than 400 active patients are part of the Brace Compliance Program in Lexington.

"Compliance monitors allow us to quantify how much a child is actually wearing the brace and determine if our treatment is being effective," said Vincent Prusick, M.D. "It provides useful reports for families to have better insight into how well their child is doing or identify areas where they can improve. Additionally, it is a helpful data set for research to analyze the effects of bracing compliance on outcomes."

Compliance System Wide

In accordance with the recommendations of the Scoliosis Research Society and the Shriners Hospitals for Children Spine Study Group, objective measurement of brace wear time using temperature monitors will be a part of the standard of care provided by Shriners Children's.

"There is a current challenge with kiddos who have been prescribed TLSO braces," said Madeleine O'Brien, Shriners Children's Northern California outcomes coordinator. "We do not have any knowledge of if the patients are wearing their braces as prescribed at home - providers are hoping for 100% compliance. However, without the iButtons we do not have an accurate representation of compliance from the patient."

The iButton is a small, dime-sized thermal sensor that has the ability to track length of wear time within the brace per day. The iButton is very accurate, able to determine the difference between room temperature and body temperature to ensure accuracy in the data provided. There is no age restriction with the prescription of a TLSO brace to have an iButton included.

"The iButton can be used to provide a 'report card' for parents and guardians to get an accurate idea whether their child is wearing the brace as much as prescribed," said Dr. Gettys. "It also gives clinicians the opportunity to praise those who are wearing their brace as they should, and a chance to ask what the barriers are for those who are not."

Tracking patients' compliance with their braces is vital: The idea is that if the patient is compliant in wearing their brace as prescribed, the further progression in their spine curvature can be avoided.

"We know that patient compliance is essential to the effectiveness of brace treatment for patients with scoliosis," said René Mackechnie, RN, BSN, at Shriners Children's New England."With ongoing patient-clinician communication coupled with this individual study information, we have witnessed some dedicated and compliant brace wear. The study report we are now able to generate allows us to concretely celebrate one's compliance, which in turn contributes to the positives of therapy and becomes an integral part of the treatment plan."

Plans to Expand

Rolando Roberto, M.D.'s scoliosis clinic, with 50 patients currently enrolled in the Brace Compliance Program, is live within Shriners Children's Northern California. Northern California will slowly be rolling out additional clinics towards the end of 2024.

"What is also incredible about this program is the collaboration of the patient's care team - including the physicians/APPs, nursing, POPS[Pediatric Orthotic and Prosthetic Services] department, outcomes coordinators," said Noah Smith, healthcare quality and outcomes project analyst for Shriners Children's. "Each team member works together to find the best way to bring the Brace Compliance Program forward at their site and makes sure that their patients are well-supported during their scoliosis care."

Currently, Shriners Children's Lexington, Greenville, Shreveport, New England, Northern California and Spokane are live with the Brace Compliance Program. Noah's team is currently engaged in the process of going live at Shriners Children's Chicago.