STUDY DESIGN: In this prospective study, we measured the pad pressures of the Milwaukee brace in adolescent hyperkyphosis treatment. PURPOSE: We evaluated the skin-brace interface forces exerted by the main pads of the Milwaukee brace. OVERVIEW OF LITERATURE: A fundamental factor associated with brace effectiveness in spinal deformity is pad force adjustment. However, few studies have evaluated the in-brace force magnitude and its effect on curve correction. METHODS: Interface forces at four pads of the Milwaukee brace were measured in 73 patients withround back deformity (mean age, 14.04±1.97 years [range, 10–18]; mean initial Cobb angle,67.70°±9.23° [range, 50°–86°]). We used a modified aneroid sphygmomanometer to measure the shoulder and kyphosis pad pressures. Each patient underwent measurement in the standing and sitting positions during inhalation/exhalation. RESULTS: The mean pad pressures were significantly higher in the standing than in thesitting position, and significantly higher pressures were observed during inhalation compared toexhalation (p=0.001).There were no statistically significant differences between right and left shoulder pad pressures (p>0.05); however, the pressure differences between the right and left kyphosis pads were statistically significant (p<0.05). In a comparison of corrective forces with bracing for less or more than 6 months, corrective force was larger with bracing for less than 6 months (p=0.02). In the standing position, there were no statistically significant correlations between pad pressures and kyphosis curve correction. CONCLUSIONS: In the sitting position, there was a trend toward lower forces at the skin-brace interface; therefore, brace adjustment in the standing position may be useful and more effective. There was no significant correlation between the magnitude of the pad pressures and the degree of in-brace curve correction.
Adolescent* ; Braces* ; Congenital Abnormalities* ; Humans ; Inhalation ; Kyphosis ; Posture ; Prospective Studies ; Scheuermann Disease ; Shoulder ; Sphygmomanometers

STUDY DESIGN: This was a prospective cohort study.PURPOSE: This study aimed to evaluate the potential differences between the objective and subjective bracing compliances of adolescents with Scheuermann’s kyphosis.OVERVIEW OF LITERATURE: Bracing is a well-documented intervention for managing adolescents with progressive thoracic Scheuermann’s kyphosis, and the brace should be worn 23 hours every day. Most research studies that have investigated the efficacy of bracing have assumed that the patients wore the braces as advised or that the bracing time was measured subjectively. This may be one of the reasons for the conflicting reports regarding the efficacy of bracing.METHODS: Nineteen volunteers (11 girls and 7 boys, 12.89±1.77 years) who were prescribed Milwaukee braces for Scheuermann’s kyphosis were enrolled. Each brace was equipped with a miniature temperature logger to record the actual brace wearing time over a period of 3 weeks. The patients and their families were unaware of the mounted sensor. Each participants and/or parent was provided with a questionnaire to record the number of hours for which the brace was worn each day. In addition, the therapist asked each patient and/or his/her parent about the average number of hours that the brace was worn.RESULTS: The compliance rates measured using the temperature logger (16.00±4.90 hours daily) were significantly lower than those reported in the questionnaires (19.52±6.04 hours daily, p<0.001) and the verbal responses (20.21±6.05 hours daily, p<0.001). Moreover, there was no correlation of age, sex, and body mass index with brace compliance.CONCLUSIONS: The braces were worn less often than reported by the patients and/or their parents. Therefore, objective compliance assessments of adolescents with Scheuermann’s kyphosis in a brace are recommended for future studies.
Adolescent ; Body Mass Index ; Braces ; Cohort Studies ; Compliance ; Female ; Humans ; Kyphosis ; Parents ; Prospective Studies ; Scoliosis ; Volunteers