Research Award Details

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The Role of Health Mindset in Adolescents’ Compliance With Brace Wear for Adolescent Idiopathic Scoliosis

Grant Recipient: Kali Tileston, MD

Stanford University School of Medicine
Presentations & Publications:
Presentations: None, but planning to submit to POSNA 2022.

Publications: None, but planning to submit for publication once dataset is complete.
Further Funding:
Further grant obtained as result of POSNA funding:
We used preliminary data to secure an additional grant through the Scoliosis Research Society to examine Health Mindset and postoperative patient mobilization after posterior spinal fusion surgery.
Additional Information:
Study aims:
The purpose of this study was to utilize a previously validated psychological assessment tool to evaluate Health Mindset (fixed versus growth) among patients with adolescent idiopathic scoliosis undergoing treatment with a brace. Patients with a growth mindset believe that personal traits be developed and changed over time whereas a fixed mindset means that you believe these personal traits are fixed and cannot be altered.

We planned to investigate how health mindset relates to an adolescent’s brace wear compliance. We hypothesized that children with a fixed mindset will have decreased compliance with bracing protocols as compared to those with a growth mindset. Prior studies have demonstrated that mindset is malleable and can be altered. Therefore, this correlation would create an avenue for intervention and in turn increased compliance.

Patients in the prospective study were given an iButton thermosensor in their brace to measure body temperature every 30 minutes for 6 months at a time. The iButton software gave patients and their physicians exact brace wear hours based on the body temperature readings. Patients were asked to complete the SRS-30, PROMIS, and Health Mindset questionnaires before their appointment. They also self-reported their brace wear hours at their appointment prior to reviewing their actual brace wear times as reported by the iButton software with the physician.

In addition to the specific aims of the study, we also evaluated health mindset as it relates to patient reported outcome measurements in the adolescent idiopathic scoliosis population undergoing brace treatment.

Research findings:
Before data collection started, a power analysis was done and determined that 75 patients were needed to reach statistical significance for the research questions. While we have enrolled 75 patients in the research study, only 61 patients could be included in the analysis since we do not have full data for the 75 patients. Mixed-effects linear regression models were used to evaluate relationships between health mindset, SRS-30, and PROMIS scores with brace wear times. These models were also used to analyze the relationships between health mindset and patient reported outcomes. A paired t-test was used to analyze actual vs. patient reported brace wear times. All analyses were completed in RStudio version 1.1.456 using a two-sided level of significance of 0.05.

With the preliminary data, we analyzed (1) Actual Brace wear Times versus Health Mindset, SRS-30 and PROMIS; (2) Health Mindset versus SRS-30 and PROMIS; and (3) Actual Brace wear Times versus Reported Brace wear Times. We found that worse pain symptoms measured by the SRS-30 questionnaire were associated with lower actual brace wear times (p=0.023) (Figure 1). Better peer relationship scores on the PROMIS questionnaire were associated with a growth health mindset (p<0.001) (Figure 2). Worse depression symptom scores and worse physical stress scores on the PROMIS questionnaire were associated with a fixed health mindset (p=0.028; p=0.013) (Figure 3, Figure 4). Patients overestimated their brace wear times by an average of 1.3 hours (p<0.001). We did not find a significant correlation between health mindset and brace wear compliance with the preliminary analysis. Health Mindset versus SRS-30 Appearance, SRS-30 Satisfaction, and PROMIS Pain Interference dimensions were approaching significance (p=0.056; p=0.067; p=0.085). We plan to re-analyze the data once the full data set is obtained to see if there are any further correlations in this patient population as this will increase our power.

Figure 1: Average Bracewear Time vs. SRS-30 Pain

Figure 2: Health Mindset Score vs. PROMIS Peer Relations

Figure 3: Health Mindset Score vs. PROMIS Depression

Figure 4: Health Mindset Score vs. PROMIS Physical Stress

The project is still ongoing as we continue to collect more follow-up data for the 75 patients enrolled in the study. We plan to follow these patients through the entirety of their treatment and have expanded upon this study to evaluate our patients postoperatively as well.