Bone Mineral Density and Bracing Compliance in Adolescent Idiopathic Scoliosis

Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity with a Cobb angle of at least 10° that affecting about 1- 4% of adolescents. If the curve progress, future adverse health outcomes may increase in AIS patients, including increased risk of deformity, psychosocial disturbances, and surgery. Up to date, bracing is the primary evidence-based non-invasive treatment to prevent curve progression. Vitamin D and calcium supplements are suggested as a complementary treatment option in addition to bracing since poor bone health (e.g., low bone mineral density [BMD]) is associated with an increased risk of curve progression. In Study I, I found that low BMD is persistent till skeletal maturity in AIS patients, which suggested that early bone health-specific treatment has great potential.Without a wide-accepted evidence-based alternative treatment option, bracing or compliance to bracing is of utmost importance in AIS care management. However, poor bracing compliance has been reported as a worldwide issue in clinical practice, and few interventions have been proposed to improve bracing compliance. In the systematic review, I identified a few potential interventions, including sensor monitoring, more intense or collaborated medical care, psychosocial intervention, and auto-adjusted brace (Study II). The evidence is, however, not conclusive due to various limitations.In this thesis, we proposed a mindfulness-based program (MBrace), an adapted shorter version of the Mindfulness-based stress reduction (MBSR) program specifically designed for AIS patients who were prescribed with the brace, to increase their bracing compliance (Study III). Mindfulness-based training, as a mind-body psychosocial intervention, has been used in various clinical settings and populations with a range of chronic conditions We hypothesized that mindfulness may benefit braced AIS patients because it had been suggested that mindfulness training of focusing and redirecting attention may facilitate self-regulation and strengthens the ability of the individual to avoid absorption in maladaptive and habitual mental patterns, behaviors, and emotional reactions which may lead to a better level of compliance to therapy. Besides, there is plenty of evidence demonstrating the role of mindfulness in improving quality of life and well-being not only in adults but also in adolescents.A two-arms randomized clinical trial was conducted in Study III, with 83 AIS patients who were randomized into MBrace group and PE group and followed up till six months post-intervention. A short-term benefit of MBrace was found to increase bracing compliance in AIS patients. It also indicates that MBrace had a potentially positive effect on the quality of life, emotional regulation strategy, and prevention of curve progression.In summary, given the importance of brace treatment in AIS care management, more RCTs are needed to explore interventions that can improve bracing compliance. We demonstrated that MBrace has a great potential to fill the current knowledge and service gaps and early interventions to improve bone health among AIS patients might be needed to prevent curve progression. Considering MBrace is non-invasive and harmless, it could be considered as an add-on option in bracing management programs.青少年特發性脊柱側彎（Adolescent idiopathic scoliosis, AIS)是一種Cobb角大於10度的三維脊柱畸形，大約1-4%的青少年受其影響。若脊柱曲線進展，患者的不良健康結局可能增加，包括早期死亡、畸形的增加及心理社會功能障礙。迄今為止，支架治療是已知可有效預防曲線進展的主要治療方式。由於低骨質量是曲線進展的危險因素，維生素D和鈣補充劑亦被建議為支架治療的補充措施。在研究I中，我發現AIS病人中的低骨密度或可持續至骨骼成熟，這表明早期對AIS病人骨質量的干預具有較大療效潛力。由於沒有廣為認可的替代療法，支架治療的依從性在AIS治療中至關重要，然而帶架之低依從性普遍存在。目前，旨在改善帶架依從性的干預措施尚屬少見。在系統綜述中，我發現目前四種相關干預措施已被提出，包括傳感器監測、更加密集協作的醫療團隊、心理社會幹預、及智能支架(研究II)。然而，由于種種限制，这些证据并不具結論性。本論文提出了一項旨在提高AIS 病人帶架依從性的正念靜觀干預方案（MBrace），該方案為靜觀減壓療法(MBSR)簡化版本。作为一种身心干预，正念靜觀训练已被廣泛應用於多種臨床場景和慢性病人群。我們假設正念靜觀可使帶架治療的AIS病人受益，因為研究表明正念靜觀中集中和轉移注意力的訓練可促進自我調節能力提升並避免陷入慣常之心理、行為和情緒反應模式，從而促進治療依從性提高。此外，證據顯示，與成年人類似，正念靜觀同樣可有效改善青少年的生活質量。在研究III中，我們進行了一項雙臂隨機臨床對照試驗。83位AIS病人被隨機分入MBrace組和物理治療組，並隨訪至干預後六個月。研究发现，正念靜觀干預可在短期內提高AIS病人帶架依從性，且對其生活質量、情緒調節和預防曲線進展具有潛在積極影響。本文結果顯示，鑒於支架治療在AIS治療中之重要性，未來需要更多RCT探索可能提高帶架依從性的干預措施，MBrace有望填補此項空白。對AIS病人骨質量的早期干預可能是預防曲線進展的必要舉措。考慮到正念干預的非侵入性和無害性，正念靜觀可作為AIS支架治療中的一項附加干預措施。LI, Xue.Ph.D. Chinese University of Hong Kong 2021.Includes bibliographical references (leaves )Abstracts in English and Chinese.Title from PDF title page (viewed on ...