Brace Dose in Scoliosis: Measurement, Monitoring, and Clinical Decision-Making—A Narrative Review

Saied Besharaty,1 Shahab Sheikhalishahi,2 Hesameddin Jafarinasab2 1Department of Orthopedic Surgery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; 2Student Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd, IranCorrespondence: Shahab Sheikhalishahi, Email [email protected]: Adolescent idiopathic scoliosis bracing is best conceptualized as a dose-dependent therapy in which clinical benefit depends on the delivered, rather than prescribed, corrective exposure. This narrative review synthesizes post-2015 evidence to present a clinically oriented framework for “precision bracing” that links brace prescription to objectively measured delivered dose and subsequent clinical response. We summarize evidence that bracing reduces progression risk in skeletally immature patients, while highlighting the efficacy–effectiveness gap driven by incomplete adherence. We review objective adherence monitoring technologies, focusing on temperature-based data loggers and emerging force or pressure sensing approaches, and explain how objective dosing data refine outcome interpretation by distinguishing undertreatment from true treatment failure. We conceptualize brace dose as a multidimensional construct that includes quantity (objectively measured wear time), pattern (regularity), and correction-related indicators (including in-brace and early out-of-brace radiographic metrics and, when available, interface force surrogates). We synthesize key effect modifiers, including skeletal maturity, curve magnitude and phenotype, early radiographic response, and contextual determinants of achieved wear time. We translate this evidence into a practical clinical framework for risk stratification, brace schedule selection, objective monitoring, early reassessment, and escalation when delivered dose is inadequate or response is unacceptable We conclude by outlining research priorities for standardized reporting of delivered dose, pragmatic trials embedded in routine care, and core outcome sets that integrate radiographic and patient-reported outcomes.Plain Language Summary: Many teenagers develop a sideways curve of the spine called adolescent idiopathic scoliosis. For some, wearing a brace can slow down curve progression and reduce the chance of needing surgery. In everyday practice, brace treatment works best when it fits well into daily life and when clinicians, patients, and families can understand how much treatment is actually being delivered.This review looks at bracing as a “dose-dependent” treatment. This means the benefit depends on the dose that is actually delivered, not just the number of hours written on a prescription. We reviewed research published since 2015 on how to measure brace wear objectively (for example, using small temperature sensors), how brace design is becoming more personalised (including computer-designed braces), how full-time and night-time schedules compare, what is known about younger children with scoliosis, and how bracing affects quality of life.Across studies, objective monitoring often showed that real-world brace use differed from self-report. Early wear patterns in the first weeks helped predict later wear. More time in the brace was generally linked to better curve control, and for some outcomes benefits continued above 18 hours per day. At the same time, “hours worn” is not the whole story; how well the brace corrects the spine and how consistently it is worn also matter.These findings support a practical “precision bracing” approach: set clear targets, measure real-world brace use, check early response, address comfort and psychosocial concerns, and adjust the plan promptly to achieve an effective, tolerable dose.Keywords: orthotic devices, treatment adherence and compliance, wearable electronic devices, quality of life, risk assessment