Enhancing Scoliosis Brace Comfort: The Key Role of Orthotists

Introduction: While scoliosis bracing is an effective method for controlling curve progression, adherence is often challenging and multifactorial, with both physical and psychosocial components. Since braces must be worn for many hours each day, brace comfort is crucial, yet it is infrequently explored in the literature. Therefore, the purpose of this study was to identify factors associated with brace comfort. Methods: This study consisted of a cross-sectional survey, which included the Bad Sobernheim Stress Questionnaire (BSSQ)-Brace and questions about demographics, bracing appointments, comfort, and overall experience. It was distributed via the Scolios-us website, social media, and newsletter from January to August 2023. Participants were eligible if they had a scoliosis diagnosis and were currently bracing. Data were analyzed using descriptive statistics, Mann–Whitney U tests, and Kendall’s tau-b correlations. Results: Fifty-one participants with a median age of 13.5 (IQR: 3) participated in the study. Brace comfort/discomfort emerged as the biggest barrier to brace adherence (41%). Orthotist gender emerged as a key factor, with significant positive associations between women orthotists and brace comfort at the fitting appointment ( U = 159.5, P = 0.002), ease of adjusting to the brace ( U = 192.5, P = 0.015), and skin integrity ( U = 190.0, P = 0.013). Brace pain at the fitting ( U = 91.5, P = 0.014) and current brace pain ( U = 81.0, P = 0.046) were negatively associated with BSSQ-Brace scores. The orthotists’ understanding of participants’ needs emerged as another key factor, demonstrated by strong correlations with perceived brace fit ( τ b = 0.515, P < 0.001), perceived orthotist skill level ( τ b = 0.660, P < 0.001), and desire to choose the same orthotist again ( τ b = 0.571, P < 0.001). Brace type was not found to be associated with brace comfort, ease of adjusting, or BSSQ-Brace scores. Conclusions: Brace comfort is a significant barrier to adherence and appears to be linked to the orthotist, not the brace design. Since brace pain and poor brace appearance were associated with increased brace-related stress, orthotists should focus on these details during fitting and follow-up appointments. Finally, orthotists should actively listen to and understand their patients’ needs to improve their bracing experience. Clinical Relevance: Brace discomfort transcends physical discomfort and can impact our patients’ emotional well-being. Optimizing comfort should be a central focus of scoliosis orthotic care.