{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T05:46:08Z","timestamp":1788414368976,"version":"build-2803163510"},"reference-count":38,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,2,8]],"date-time":"2026-02-08T00:00:00Z","timestamp":1770508800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JFMK"],"abstract":"<jats:p>Background: Brace adherence is a key determinant of treatment success in adolescents with idiopathic scoliosis. However, adherence is influenced by multiple clinical, psychological, and social factors, and reported wear times vary widely across studies. This systematic review and meta-analysis aimed to identify determinants of brace adherence and assess their quantitative impact on real wear. Methods: A comprehensive search was conducted in PubMed\/MEDLINE, Scopus, Web of Science, Embase, and Google Scholar from database inception to November 2025. A total of 1040 records were identified, 620 were screened, and 45 full-text articles were assessed for eligibility. In total, 17 studies met the inclusion criteria and were included in the qualitative synthesis, and 10 provided extractable quantitative data and were included in the meta-analysis. A random-effects model was used to calculate pooled mean differences for identified determinants, including sex, age, early adherence, and sensor-based monitoring. Results: In total, 17 studies involving 1716 adolescents were included, and 10 provided extractable quantitative data for meta-analysis. Objective sensor-based monitoring was consistently associated with higher adherence, with a pooled mean difference of 25.6 percent compared with non-sensor methods. Early adherence significantly predicted long-term compliance, with a mean difference of 9.6 percent. Younger adolescents demonstrated greater adherence than older patients, with a mean difference of 19.1 percent, while sex differences favored females but did not reach statistical significance. Psychosocial determinants such as body image perception, stress, family dynamics, and religious environment played an important role in modulating adherence. Higher body mass index (BMI) and reduced quality of life were associated with poorer compliance. Overall, studies evaluating positive determinants reported a pooled mean adherence of 89.6 percent compared with 67.7 percent in studies characterized by negative determinants. Conclusions: Brace adherence is determined by a combination of clinical and psychosocial factors. Sensor-based monitoring, strong early adherence, and supportive environments consistently enhance compliance, whereas stress, poor body image, and higher BMI hinder wear. Targeted interventions, early counseling, and standardized adherence metrics are needed to improve outcomes in brace-treated scoliosis.<\/jats:p>","DOI":"10.3390\/jfmk11010068","type":"journal-article","created":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T14:05:15Z","timestamp":1770645915000},"page":"68","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Clinical, Psychological, and Social Determinants of Brace Compliance in Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8311-9132","authenticated-orcid":false,"given":"Marco","family":"Sapienza","sequence":"first","affiliation":[{"name":"Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3058-062X","authenticated-orcid":false,"given":"Marco Simone","family":"Vaccalluzzo","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuele","family":"Perricone","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmelo","family":"Giannone","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessia","family":"Caldaci","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8260-8890","authenticated-orcid":false,"given":"Giuseppe","family":"Musumeci","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia No.97, 95123 Catania, Italy"},{"name":"Research Center on Motor Activities (CRAM), University of Catania, Via S. Sofia No.97, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1677-927X","authenticated-orcid":false,"given":"Andrea","family":"Vescio","sequence":"additional","affiliation":[{"name":"Department of Life Science, Health, and Health Professions, Link Campus University, 00165 Rome, Italy"},{"name":"Department of Orthopaedic and Trauma Surgery, \u201cMater Domini\u201d University Hospital, \u201cMagna Gr\u00e6cia\u201d University, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5246-9714","authenticated-orcid":false,"given":"Gianluca","family":"Testa","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5664-8066","authenticated-orcid":false,"given":"Vito","family":"Pavone","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1007\/s00586-011-1695-8","article-title":"Idiopathic scoliosis in Korean schoolchildren: A prospective screening study of over 1 million children","volume":"20","author":"Suh","year":"2011","journal-title":"Eur. Spine J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1302\/0301-620X.67B2.3980521","article-title":"Idiopathic scoliosis. Prevalence and ethnic distribution in Singapore schoolchildren","volume":"67-B","author":"Daruwalla","year":"1985","journal-title":"J. Bone Jt. Surgery. Br. Vol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"15030","DOI":"10.1038\/nrdp.2015.30","article-title":"Adolescent idiopathic scoliosis","volume":"1","author":"Cheng","year":"2015","journal-title":"Nat. Rev. Dis. Prim."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1512","DOI":"10.1056\/NEJMoa1307337","article-title":"Effects of Bracing in Adolescents with Idiopathic Scoliosis","volume":"369","author":"Weinstein","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1007\/s43390-020-00060-1","article-title":"Establishing consensus on the best practice guidelines for the use of bracing in adolescent idiopathic scoliosis","volume":"8","author":"Roye","year":"2020","journal-title":"Spine Deform."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2070","DOI":"10.1097\/01.brs.0000138280.43663.7b","article-title":"Compliance Monitoring of Brace Treatment for Patients with Idiopathic Scoliosis","volume":"29","author":"Takemitsu","year":"2004","journal-title":"Spine"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1097\/BRS.0b013e31822f4306","article-title":"Electronic Monitoring Improves Brace-Wearing Compliance in Patients with Adolescent Idiopathic Scoliosis: A Randomized Clinical Trial","volume":"37","author":"Miller","year":"2012","journal-title":"Spine"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/1748-7161-7-12","article-title":"In defense of adolescents: They really do use braces for the hours prescribed, if good help is provided. Results from a prospective everyday clinic cohort using thermobrace","volume":"7","author":"Donzelli","year":"2012","journal-title":"Scoliosis"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1097\/BRS.0000000000004446","article-title":"Early Adherence to Prescribed Brace Wear for Adolescent Idiopathic Scoliosis Is Associated With Future Brace Wear","volume":"48","author":"Linden","year":"2023","journal-title":"Spine"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Zhu, C., Wu, Q., Xiao, B., Wang, J., Luo, C., Yu, Q., Liu, L., and Song, Y. (2021). A compliance real-time monitoring system for the management of the brace usage in adolescent idiopathic scoliosis patients: A pilot study. BMC Musculoskelet. Disord., 22.","DOI":"10.1186\/s12891-021-03976-5"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"E1026","DOI":"10.1097\/BRS.0000000000000426","article-title":"A longitudinal study of alexithymia in relation to physical activity in adolescent females with scoliosis subjected to cheneau brace treatment: Preliminary report","volume":"39","author":"Misterska","year":"2014","journal-title":"Spine"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"101","DOI":"10.3233\/BMR-181121","article-title":"Does rigid spinal orthosis carry more psychosocial implications than the flexible brace in AIS patients? A cross-sectional study","volume":"32","author":"Misterska","year":"2019","journal-title":"J. Back Musculoskelet. Rehabil."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.2106\/JBJS.15.01313","article-title":"The Effect of the Risser Stage on Bracing Outcome in Adolescent Idiopathic Scoliosis","volume":"98","author":"Karol","year":"2016","journal-title":"J. Bone Jt. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1097\/BPO.0000000000002272","article-title":"Why Don\u2019t Adolescents Wear Their Brace? A Prospective Study Investigating Psychosocial Characteristics That Predict Scoliosis Brace Wear","volume":"43","author":"Gornitzky","year":"2023","journal-title":"J. Pediatr. Orthop."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1097\/01241398-198803000-00004","article-title":"Brace-wear compliance in patients with adolescent idiopathic scoliosis","volume":"8","author":"DiRaimondo","year":"1988","journal-title":"J. Pediatr. Orthop."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1007\/s11832-010-0249-7","article-title":"Objective compliance of adolescent girls with idiopathic scoliosis in a dynamic SpineCor brace","volume":"4","author":"Hasler","year":"2010","journal-title":"J. Child. Orthop."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Fregna, G., Rossi Raccagni, S., Negrini, A., Zaina, F., and Negrini, S. (2023). Personal and Clinical Determinants of Brace-Wearing Time in Adolescents with Idiopathic Scoliosis. Sensors, 24.","DOI":"10.3390\/s24010116"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1097\/BRS.0000000000004997","article-title":"Factors Influencing Optimal Bracing Compliance in Adolescent Idiopathic Scoliosis: A Single-center Prospective Cohort Study","volume":"49","author":"Asada","year":"2024","journal-title":"Spine"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1007\/s12671-022-02021-3","article-title":"Effects of Mindfulness-Based Intervention to Improve Bracing Compliance in Adolescent Idiopathic Scoliosis Patients: A Randomized Controlled Trial","volume":"14","author":"Li","year":"2023","journal-title":"Mindfulness"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"377","DOI":"10.22603\/ssrr.2022-0246","article-title":"Impact of Brace-Related Stress on Brace Compliance in Adolescent Idiopathic Scoliosis: A Single-Center Comparative Study Using Objective Compliance Measurement and Brace-Related Stress","volume":"7","author":"Asada","year":"2023","journal-title":"Spine Surg. Relat. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e519","DOI":"10.1097\/BPO.0000000000000734","article-title":"Body Image and Quality of Life and Brace Wear Adherence in Females with Adolescent Idiopathic Scoliosis","volume":"37","author":"Schwieger","year":"2017","journal-title":"J. Pediatr. Orthop."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s13013-017-0145-8","article-title":"2016 SOSORT guidelines: Orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth","volume":"13","author":"Negrini","year":"2018","journal-title":"Scoliosis Spinal Disord."},{"key":"ref_23","first-page":"111","article-title":"Physiotherapeutic scoliosis-specific exercises for adolescents with idiopathic scoliosis","volume":"50","author":"Parent","year":"2014","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.2106\/JBJS.I.01142","article-title":"Brace Wear Control of Curve Progression in Adolescent Idiopathic Scoliosis","volume":"92","author":"Katz","year":"2010","journal-title":"J. Bone Jt. Surg."},{"key":"ref_25","first-page":"218","article-title":"Brace monitoring system for the treatment of scoliosis","volume":"88","author":"Lou","year":"2002","journal-title":"Stud. Health Technol. Inform."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1007\/s11999-009-0884-9","article-title":"Brace Management in Adolescent Idiopathic Scoliosis","volume":"468","author":"Schiller","year":"2010","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_27","unstructured":"Alyafei, A., and Easton-Carr, R. (2025). The Health Belief Model of Behavior Change. StatPearls, StatPearls Publishing."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/1479-5868-9-18","article-title":"Self-determination theory: Its application to health behavior and complementarity with motivational interviewing","volume":"9","author":"Patrick","year":"2012","journal-title":"Int. J. Behav. Nutr. Phys. Act."},{"key":"ref_29","first-page":"118","article-title":"Scoliosis Research Society (SRS) Criteria and Society of Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) 2008 Guidelines in Non-Operative Treatment of Idiopathic Scoliosis","volume":"79","author":"Korbel","year":"2014","journal-title":"Pol. Orthop. Traumatol."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Kaspiris, A., Spyrou, I., Panagopoulos, F., Marougklianis, V., Pelantis, P., Vavourakis, M., Sakellariou, E., Lianou, I., Ntourantonis, D., and Repantis, T. (2025). Surgical Strategies and Challenges in Scheuermann\u2019s Kyphosis: A Comprehensive Review. J. Clin. Med., 14.","DOI":"10.3390\/jcm14124276"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1080\/13638490310001644593","article-title":"Developmental psychological aspects of scoliosis treatment","volume":"6","author":"Reichel","year":"2003","journal-title":"Pediatr. Rehabil."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"O79","DOI":"10.1186\/1748-7161-9-S1-O79","article-title":"A cognitive behavioral approach allows improving brace wearing compliance: An observational controlled retrospective study with thermobrace","volume":"9","author":"Negrini","year":"2014","journal-title":"Scoliosis"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e473","DOI":"10.1542\/peds.2011-1635","article-title":"Pediatric Self-management: A Framework for Research, Practice, and Policy","volume":"129","author":"Modi","year":"2012","journal-title":"Pediatrics"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1097\/01241398-198905000-00001","article-title":"Stress and coping with scoliosis: Psychological effects on adolescents and their families","volume":"9","author":"MacLean","year":"1989","journal-title":"J. Pediatr. Orthop."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1007\/s11517-011-0737-z","article-title":"Biomechanical modeling of brace treatment of scoliosis: Effects of gravitational loads","volume":"49","author":"Clin","year":"2011","journal-title":"Med. Biol. Eng. Comput."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1007\/s11832-010-0266-6","article-title":"Electronic monitoring of scoliosis brace wear compliance","volume":"4","author":"Rahman","year":"2010","journal-title":"J. Child. Orthop."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"100930","DOI":"10.1016\/j.bas.2022.100930","article-title":"Reflections on the future of telemedicine and virtual spinal clinics in the post COVID-19 era","volume":"2","author":"Mazarakis","year":"2022","journal-title":"Brain Spine"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"}],"container-title":["Journal of Functional Morphology and Kinesiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2411-5142\/11\/1\/68\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T14:47:03Z","timestamp":1770648423000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2411-5142\/11\/1\/68"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,8]]},"references-count":38,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["jfmk11010068"],"URL":"https:\/\/doi.org\/10.3390\/jfmk11010068","relation":{},"ISSN":["2411-5142"],"issn-type":[{"value":"2411-5142","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,8]]}}}