Adherence and Radiological Outcomes in Braced Adolescents with Idiopathic Scoliosis: A Real-World Study Using Thermal Sensors

<b>Background</b>: Bracing is an effective treatment for idiopathic scoliosis (IS), and Adherence is one of the most important factors influencing outcomes. However, evidence on the effectiveness of objective monitoring using thermal sensors in everyday clinical settings remains limited. Objective: To evaluate the impact of Adherence and brace-wearing consistency on short-term outcomes in IS patients during growth in a real clinical setting. <b>Methods</b>: This retrospective cohort study included 114 patients (100 with adolescent idiopathic scoliosis (AIS) and 14 with juvenile idiopathic scoliosis (JIS)) treated with a three-dimensional (3D) rigid brace equipped with a thermal sensor. Adherence was calculated as the ratio of actual to prescribed wear time; consistency was defined using the interquartile range (IQR) of daily wear time (IQR ≤ 1 h = consistent). Cobb angle was measured at baseline, in-brace, and after 6 months. Logistic regression, receiver-operating characteristic (ROC) analysis, and general linear model (GLM) analyses were performed, supported by sensitivity analyses, to assess model robustness. <b>Results</b>: Mean Adherence was 85.3 ± 18.9%; high Adherence was observed in 71.4% of JIS and 57.0% of AIS patients, while 19.3% showed high consistency. In-brace correction averaged 52.5 ± 23.2% (68.1% JIS vs. 50.3% AIS; <i>p</i> = 0.007). At 6 months, 55% improved, 42% were stable, and 3% worsened. Adherence was the only significant predictor of consistency (OR = 1.511; 95% CI 1.181-1.933; <i>p</i> = 0.001). The ROC analysis showed excellent discriminative ability (Area Under the Curve (AUC) = 0.908). Adherence category (<i>p</i> = 0.041) and Risser stage (<i>p</i> = 0.041) were significant predictors of short-term outcome. Conclusions: Adherence and brace-wearing consistency are key predictors of short-term bracing outcomes in IS. Objective monitoring with thermal sensors enables precise tracking, improves patient engagement, and supports individualised treatment.