Effects of mindfulness-based intervention to improve bracing compliance in adolescent idiopathic scoliosis patients: A randomized controlled trial

Objectives: Bracing is the primary treatment for preventing spine curve progression and the subsequent need for surgery among patients with adolescent idiopathic scoliosis (AIS), and poor bracing compliance is a major factor limiting its treatment benefits. We compared the effectiveness of a mindfulness-based intervention program called MBrace, which is a shorter version of the Mindfulness-Based Stress Reduction program, versus that of a supervised physiotherapy exercise (PE) program in enhancing bracing compliance among AIS patients followed for eight months. 

Method: Eighty-three AIS patients with unsatisfactory bracing compliance (< 18 hr/day) were randomly allocated to MBrace (n = 45) or PE (n = 38) program. The primary outcome was bracing compliance at Month 8 (six months post-intervention). Secondary outcomes included validated inventory of quality-of-life measures, self-compassion, emotion regulation, self-efficacy, stress, and mindfulness level at Month 2 (end of intervention) and Month 8. 

Results: Although bracing compliance was considerably improved in the MBrace program group compared with control at Month 8 (difference in changes between-group (DD), 1.64 hr/day; 95% confidence interval (CI), − 0.25 to 3.53 hr/day; p = 0.09), statistical significance was achieved only after the exclusion of outliers (DD, 2.27 hr/day; 95% CI, 0.49–4.05 hr/day; p = 0.01). At Month 2, a significant treatment effect was estimated both with and without the exclusion of outliers. No significant between-group differences were observed in other secondary outcomes. 

Conclusions: Mindfulness-based interventions may be effective to improve bracing compliance among AIS patients in the short term. Larger randomized controlled trials with longer follow-up durations are needed to confirm the long-term effects of mindfulness-based interventions. 

Trial Registration: Chinese Clinical Trial Register (ChiCTR), ChiCTR-IOR-16010299. Copyright © 2023 The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.