{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T02:45:49Z","timestamp":1785725149505,"version":"3.56.0"},"reference-count":18,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Johannes Kepler Open Access Publishing Fund"},{"name":"federal state Upper Austria"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Brace treatment is a key component of conservative management in adolescent idiopathic scoliosis (AIS), with treatment success strongly depending on patient adherence. While recommended wearing times are well defined, real-life adherence patterns remain insufficiently characterized. In particular, temporal and seasonal variations in brace-wearing behavior under real-world conditions have not yet been comprehensively characterized. Materials and Methods: This retrospective observational study analyzed objectively measured brace-usage data from scoliosis patients treated with temperature sensor-equipped braces. The study focused exclusively on objectively measured brace-wearing behavior; no clinical or radiographic outcome measures were included. Daily adherence time was recorded and aggregated across 6892 monitoring days from 43 patients. Brace wear was defined using a predefined temperature threshold (\u226529 \u00b0C). Temporal patterns were assessed by analyzing weekday versus weekend differences, seasonal variation, and hourly wear probability. A linear mixed-effects model with patient as a random effect was applied to evaluate the influence of season, day type, and time since treatment initiation. Results: The mean objectively measured daily brace-wearing time was 9.22 h (median 8.67 h), demonstrating substantial variability. Wear time was slightly lower on weekends compared to weekdays (\u22120.34 h\/day, p = 0.026). Seasonal differences in objectively measured brace-wearing time were observed (p &lt; 0.001), with the highest values occurring during summer and the lowest during winter. Mixed-effects modeling confirmed increased wear time in summer (+2.05 h\/day, p &lt; 0.001) and reduced wear in winter (\u22121.27 h\/day, p &lt; 0.001) compared to spring. Heatmap analysis revealed pronounced diurnal patterns, with peak usage during nighttime hours (approximately 21:00\u201306:00) and reduced daytime adherence. A small but significant decline in wear time over the observation period was noted. Conclusions: Objective monitoring demonstrated temporal and seasonal variation in brace-wearing behavior under real-world conditions. Although environmental influences on temperature-based monitoring cannot be excluded, these findings provide valuable insights into adherence patterns and may support individualized patient counseling and future optimization of conservative scoliosis management.<\/jats:p>","DOI":"10.3390\/medicina62081484","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T01:43:27Z","timestamp":1785721407000},"page":"1484","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Seasonal and Temporal Patterns of Brace-Wearing Behavior in Adolescent Idiopathic Scoliosis Assessed Using Objective Sensor Data"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7568-6233","authenticated-orcid":false,"given":"Manuel","family":"Gahleitner","sequence":"first","affiliation":[{"name":"Department for Orthopedics and Traumatology, Johannes Kepler University Linz, Krankenhausstra\u00dfe 9, 4020 Linz, Austria"},{"name":"Kepler University Hospital GmbH, Johannes Kepler University Linz, Altenberger Strasse 96, 4040 Linz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michaela","family":"Winkler","sequence":"additional","affiliation":[{"name":"Orthovida Plus GmbH, Rohrbacherstra\u00dfe 2, 4111 Walding, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Leitner","sequence":"additional","affiliation":[{"name":"Orthovida Plus GmbH, Rohrbacherstra\u00dfe 2, 4111 Walding, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Regina","family":"Strassl","sequence":"additional","affiliation":[{"name":"Department for Orthopedics and Traumatology, Johannes Kepler University Linz, Krankenhausstra\u00dfe 9, 4020 Linz, Austria"},{"name":"Kepler University Hospital GmbH, Johannes Kepler University Linz, Altenberger Strasse 96, 4040 Linz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Holzbauer","sequence":"additional","affiliation":[{"name":"Department for Orthopedics and Traumatology, Johannes Kepler University Linz, Krankenhausstra\u00dfe 9, 4020 Linz, Austria"},{"name":"Kepler University Hospital GmbH, Johannes Kepler University Linz, Altenberger Strasse 96, 4040 Linz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Gotterbarm","sequence":"additional","affiliation":[{"name":"Department for Orthopedics and Traumatology, Johannes Kepler University Linz, Krankenhausstra\u00dfe 9, 4020 Linz, Austria"},{"name":"Kepler University Hospital GmbH, Johannes Kepler University Linz, Altenberger Strasse 96, 4040 Linz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenz","family":"Pisecky","sequence":"additional","affiliation":[{"name":"Department for Orthopedics and Traumatology, Johannes Kepler University Linz, Krankenhausstra\u00dfe 9, 4020 Linz, Austria"},{"name":"Kepler University Hospital GmbH, Johannes Kepler University Linz, Altenberger Strasse 96, 4040 Linz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,1]]},"reference":[{"key":"ref_1","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_2","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. 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