O2123: The Grit Factor: A Prospective Study to Predict Brace Compliance in Adolescent Idiopathic Scoliosis

Background: Bracing for adolescent idiopathic scoliosis (AIS) can effectively decrease curve progression and risk for future surgery, yet a discrepancy exists between prescribed hours and actual brace wear. While recent studies have developed preliminary models to predict bracing compliance, incorporation of psychosocial factors may further build upon this work. “Grit”, defined as passion and perseverance for long-term goals, is associated with success and achievement in various fields. The purpose of this study was to evaluate whether "grit" and its subdomains can predict brace compliance.

Methods: A prospective single-center observational study was performed on a consecutive series of AIS patients who were prescribed a new, first-time brace. “Grit” was measured at a single time point via an administered survey with scales specific to assessing the following subdomains: grit, self-control, compliance perception, and student thriving. Objective brace compliance was collected from temperature-sensitive monitors. Descriptive statistics and bivariate analyses were completed using SPSS (v28.0).

Results: 84 patients (82% female) were included with a mean age at bracing initiation of 12.2 years. Median bracing compliance as a percentage of prescribed wear was 84% (IQR: 69-98%). Patients who possessed higher compliance perceptions with scores of ≥18 (n=36/84) had a greater average brace compliance than those with a score < 18 (n=48/84), with average compliances of 91.9% vs. 67.4%, respectively (p < 0.001). Questionnaire scores relating to thoughts about brace compliance were positively correlated with improved brace wear (p=0.036). The other subdomains were not significant: there was no correlation between overall percent brace wear and scores on grit (p=0.99), self-control (p=0.34), and the student-thriving index (p=0.81).

Conclusion: A patient’s own perception about the importance of bracing compliance is strongly associated with true compliance. Patients who value bracing demonstrated higher levels of overall compliance. Grit, self-control, and student thriving scores were not significantly correlated with bracing compliance. Screening tools to identify subgroups at high risk for poor bracing compliance can help guide clinical and shared decision making between the physician and patients.