Abstract
INTRODUCTION: Brace treatment is an essential nonoperative strategy to prevent curve progression in adolescent idiopathic scoliosis (AIS), yet it can cause substantial psychological stress. However, few studies have investigated factors associated with brace-related psychological stress. This study aimed to evaluate the association between pre-bracing health-related quality of life (HRQOL) and brace-related psychological stress during treatment. METHODS: This study retrospectively analyzed female patients with AIS aged 10-15 years who initiated brace treatment at a single center. Inclusion criteria were a baseline Cobb angle of 20-40°, initiation of full-time bracing, and completion of standardized questionnaires. Baseline assessments included demographic and radiographic data, as well as patient-reported outcomes: the Scoliosis Research Society-22r and the Scoliosis Japanese Questionnaire-27 (SJ-27). Brace-related psychological stress was assessed at multiple time points during the first year using the Japanese version of the Bad Sobernheim Stress Questionnaire-Brace (JBSSQ-brace). A linear mixed-effects model was used to identify baseline factors associated with higher stress levels over time. RESULTS: A total of 151 patients (mean age 12.4±1.1 years) were included. At one month, 32.5% of patients reported moderate to severe stress (JBSSQ-brace ≤16), and 11.8% of the total cohort experienced worsening stress during the first six months. In multivariable analysis, a higher baseline SJ-27 score was significantly associated with increased brace-related psychological stress over time (β=-0.15±0.04, p<0.001). Other factors, including age, skeletal maturity, pre-bracing Cobb angle, and in-brace correction rate, were not significant. CONCLUSIONS: Lower pre-bracing HRQOL, as measured by the SJ-27, was independently associated with increased psychological stress during brace treatment. Early psychological screening using AIS-specific HRQOL tools may help identify high-risk patients and provide timely support to improve compliance and treatment outcomes.