Investigating a Potentially Effective Minimum Brace Wear Time for Clinically Meaningful Outcomes in Adolescent Idiopathic Scoliosis: A Literature Review

Abstract

Background: Orthotic spinal brace treatment is an established intervention for adolescents with idiopathic scoliosis at risk of curve progression. Although longer wear is associated with better outcomes, uncertainty remains about whether a potentially effective minimum wear time can be identified.

Objective: This critical literature review investigated whether evidence supported a potentially effective minimum brace wear time associated with clinically meaningful outcomes in adolescent idiopathic scoliosis.

Study design: Critical literature review.

Methods: Searches covered seven electronic databases and information sources. After screening, targeted verification and reference-list checking, 20 studies were retained for the main synthesis. Data were extracted using a 37-field framework, and the main-synthesis studies were appraised using the Joanna Briggs Institute (JBI) Critical Appraisal Checklists. Narrative synthesis was used because studies differed in brace protocol, wear-time measurement, outcome definition and analytical approach.

Results: Evidence supported a dose-related association between brace wear and clinically meaningful outcomes more strongly than a universal minimum daily value. Greater wear, better adherence and more regular use were associated with reduced Cobb angle progression, curve stabilisation or improvement, treatment success, non-progression or lower risk of reaching a surgical threshold. Findings differed across full-time, reduced-hour, high-hour and night-time protocols. Interpretation was influenced by skeletal maturity, baseline Cobb angle, curve pattern, in-brace correction, brace type, outcome definition and measurement method. Objective monitoring provided stronger evidence than self-report or documentation. Review-level quality judgements informed by JBI classified 12 studies as moderate quality and eight as low quality.

Conclusion: Brace wear time is clinically important, but the evidence did not support one universal minimum daily value. Reported numerical values should be used as protocol-specific reference points to guide prescription review, patient counselling and adherence monitoring rather than as directly transferable prescriptions. Interpretation should also consider patient progression risk, brace design, actual adherence, corrective response and confidence in the evidence.