Association of Brace-Wearing Time With Changes in Health-Related Quality of Life Assessed by the Scoliosis Japanese Questionnaire-27 in Braced Female Adolescents With Idiopathic Scoliosis: A Multicenter Cohort Study

Association of Brace-Wearing Time With Changes in Health-Related Quality of Life Assessed by the Scoliosis Japanese Questionnaire-27 in Braced Female Adolescents With Idiopathic Scoliosis: A Multicenter Cohort Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Association of Brace-Wearing Time With Changes in Health-Related Quality of Life Assessed by the Scoliosis Japanese Questionnaire-27 in Braced Female Adolescents With Idiopathic Scoliosis: A Multicenter Cohort Study Toru Doi, Yuki Taniguchi, So Kato, Ken Okazaki, Satoru Demura, and 20 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9102080/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Brace treatment is the only evidence-based effective conservative therapy for adolescent idiopathic scoliosis (AIS). However, the relationship between brace treatment and health-related quality of life (HRQOL), and the extent to which brace-wearing time is associated with HRQOL, remain unclear. This study investigated longitudinal changes in HRQOL, assessed using the Scoliosis Japanese Questionnaire-27 (SJ-27) and their association with daily brace-wearing time. Methods This multicenter observational cohort study included 179 female patients with AIS undergoing brace treatment. Daily brace-wearing time at follow-up (> 1-year after brace initiation) was assessed by questionnaire and categorized using a 12 h/day cutoff (< 12 vs. ≥ 12 h/day). In the overall cohort and in each brace-wearing time group, the major Cobb angle and SJ-27 scores (Pain, Discomfort when wearing clothes, Cognition/psychological distress, Appearance/self-consciousness, Participation/physical activity, and total score) were compared between baseline and follow-up. Multivariate regression analyses were performed to examine the association between brace-wearing time and changes (Δ) in HRQOL as assessed by the SJ-27. Results The mean follow-up duration was 24.7 months. In the overall cohort, the SJ-27 Pain and Discomfort when wearing clothes domain scores worsened, whereas the Cognition/psychological distress and Participation/physical activity domain scores improved; the total SJ-27 score showed no significant change. In analyses stratified by brace-wearing time (< 12 vs. ≥ 12 h/day), neither group showed a significant change in the major Cobb angle from baseline to follow-up. Pain and clothing-related discomfort worsened regardless of wear time, whereas the ≥ 12 h/day group additionally showed deterioration in the Appearance/self-consciousness domain and the total score. In multivariate analysis, ≥ 12 h/day bracing was independently associated with worsening in ΔAppearance (p = 0.017), ΔParticipation (p = 0.036), and ΔTotal score (p = 0.033). Conclusion During brace treatment, pain and clothing-related discomfort worsened, whereas overall HRQOL was largely preserved. Longer daily brace wear (≥ 12 h/day) was independently associated with deterioration in appearance-related self-consciousness, physical activity, and overall HRQOL. These findings suggest that, in braced female patients with AIS, changes in HRQOL should be considered when discussing wear-time targets during follow-up. adolescent idiopathic scoliosis bracing brace-wearing time health-related quality of life patient-reported outcome measure Scoliosis Japanese Questionnaire (SJ-27) Figures Figure 1 Introduction Adolescent idiopathic scoliosis (AIS) is the most common spinal deformity in adolescents, with an estimated prevalence of 1%–4% worldwide. [ 1 , 2 ] Brace treatment is commonly indicated for moderate scoliosis, typically defined as a major Cobb angle of approximately 20°–40°, in patients considered to be at risk of progression during growth. [ 2 ] Bracing is the only evidence-based effective conservative therapy for AIS to reduce progression to the surgical threshold, as established by the Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST). [ 3 ] BrAIST also demonstrated a dose–response relationship, with greater daily brace-wearing time associated with a higher likelihood of treatment success. [ 3 ] Although bracing is effective for curve control, it can impose a substantial treatment burden and may affect multiple aspects of health-related quality of life (HRQOL) in adolescents. [ 4 ] In BrAIST, HRQOL assessed using the Pediatric Quality of Life Inventory (PedsQL) showed no significant changes associated with brace treatment. [ 3 , 5 ] In contrast, a literature review reported that studies using the revised version of the Scoliosis Research Society-22 (SRS-22r) and brace-specific patient-reported outcome (PRO) measures, such as the Bad Sobernheim Stress Questionnaire (BSSQ) and the Brace Questionnaire (BrQ), have suggested potential negative effects of bracing on HRQOL, including self-image, mental health, and vitality. [ 4 ] These findings highlight the clinical need to balance the benefits of curve-control with preservation of HRQOL during brace treatment. To achieve this balance, it is important to better understand how bracing, particularly brace-wearing time, relates to longitudinal changes in HRQOL. Although a recent study comparing full-time and night-time bracing suggested that shorter wear schedules may be associated with less adverse impact on HRQOL domains such as self-image and pain despite comparable curve-control effects [ 6 ], evidence regarding the relationship between brace-wearing time and HRQOL trajectories remains limited. Moreover, previous studies have indicated that poorer brace-related quality of life may be associated with lower compliance with prescribed brace-wearing protocols, suggesting that HRQOL during bracing is closely linked to adherence. [ 7 – 12 ] Accordingly, a better understanding of HRQOL changes during brace treatment—and how these changes relate to brace-wearing time—may help optimize patient counseling and shared decision-making, and ultimately support adherence in routine clinical practice. The SRS-22r questionnaire is widely used as a gold-standard PRO measure for AIS; however, cultural and healthcare-system differences across regions may limit the suitability of some SRS-22r items. [ 13 ] To address AIS-specific concerns relevant to Japanese adolescent girls, the Scoliosis Japanese Questionnaire-27 (SJ-27) was developed and has demonstrated acceptable reliability and validity. [ 14 ] SJ-27 comprises 27 items across five domains—Pain, Discomfort when wearing clothes, Appearance (self-consciousness about appearance), Cognition (anxiety/depressive feelings), and Participation (difficulties in physical activities)—with a total score ranging from 0 to 108, where higher scores indicate worse HRQOL. [ 14 ] The SJ-27 has also been cross-culturally adapted and validated in multiple languages, including Arabic, Korean, and Turkish, supporting its broader international applicability. [ 15 – 18 ] In addition, SJ-27 scores have been reported to be associated with curve severity and may be useful for identifying patients with moderate scoliosis who may require brace treatment. [ 19 ] Early HRQOL assessment using the SJ-27 during brace treatment may also help identify patients at higher risk of brace-related psychological distress. [ 20 ] However, no study has longitudinally evaluated HRQOL changes during brace treatment using the SJ-27 or examined how such changes relate to brace-wearing time. Therefore, the aim of this multicenter cohort study was to investigate longitudinal changes in HRQOL assessed by the SJ-27 among braced female patients with AIS and to determine whether brace-wearing time is associated with changes in SJ-27 domain scores and total score. Methods Study design This multicenter observational cohort study was conducted under the leadership of the Japanese Scoliosis Society Registry Outcome Committee and was design to longitudinally assess HRQOL in patients with AIS undergoing brace treatment. The study protocol was reviewed and approved by the institutional review board of the Japanese Scoliosis Society and by the ethics committees of all participating institutions, in accordance with local ethical standards. Written informed consent was obtained from all participants and/or their legal guardians before enrollment, and assent was obtained from the participants when appropriate. Patient recruitment A total of 303 patients with AIS who initiated brace treatment between January 2022 and October 2023 were recruited from 13 participating institutions. Because the SJ-27 is a female-specific PRO measure, male patients were excluded (n = 26). Eligible patients were females aged 10–15 years with a major Cobb angle of 20°–40°. Accordingly, two patients were excluded due to age and 11 because of major Cobb angle. Among the remaining 264 eligible patients, 85 were excluded because of incomplete major Cobb angle and/or SJ-27 data at baseline and/or follow-up (> 1-year after brace initiation). Because this study was designed to evaluate HRQOL changes during ongoing brace treatment, patients who had completed brace treatment before follow-up assessment, including those who may have transitioned to surgery, were not included in the analysis and were considered likely to be included among those with incomplete follow-up data. Consequently, 179 patients were included in the final analytic cohort (Fig. 1 ). Brace indication Brace treatment was prescribed in routine clinical practice at each participating institution, generally in accordance with contemporary recommendations and commonly used criteria for AIS bracing. [ 10 , 21 – 23 ] Because this study aimed to capture real-world practice and longitudinal PROs, brace treatment was not restricted to the most stringent research criteria. In selected patients who were relatively skeletally mature (e.g., Risser grade ≥ 3) but still considered at risk of curve progression, bracing could be offered at the treating physician’s discretion through shared decision-making with the patient and family after discussion of expected benefits and limitations. Data collection and radiographic assessment Baseline variables were assessed at each participating institution and included age, body mass index (BMI), Risser grade, and brace type. Skeletal maturity was dichotomized based on the Risser grade (0–2: skeletally immature; 3–5: skeletally mature). [ 24 , 25 ] Standing anteroposterior whole-spine radiographs were obtained at baseline and follow-up (> 1-year after brace initiation). The Cobb method was used to measure the major curve angle. Scoliosis progression was defined as an increase of ≥ 6° in the major Cobb angle from baseline to follow-up. [ 23 , 26 ] At follow-up, daily brace-wearing time was assessed using a patient-reported questionnaire with four response categories ( 18 h/day). Patients were divided into two groups using a 12 h/day cutoff, as commonly adopted in previous studies. [ 27 , 28 ] After excluding 10 patients with missing brace-wearing time data, 110 were classified into the 1-year follow-up. The SJ-27 was designed to cover a wide range of HRQOL issues among young female patients with AIS in Japan and comprises five domains: Pain (Q1–4), Discomfort when wearing clothes (Q5–10 and 27), Appearance/self-consciousness about scoliosis (Q12–14, 22, 25, and 26), Cognition/psychological distress (Q17, 18, 20, 21, 23, and 24), and Participation/physical activity (Q11, 15, 16, and 19). [ 14 ] Each of the 27 items is scored on a 5-point scale from no impairment (0 point) to severe impairment (4 points), yielding a total score ranging from 0 to 108, with higher scores indicating worse HRQOL. Statistical analysis Data are presented as mean (standard deviation) or frequency (percentage), as appropriate. Baseline demographic characteristics (age, BMI, skeletal maturity, and major Cobb angle), scoliosis progression, and follow-up period were compared between the < 12 h/day and ≥ 12 h/day groups using Fisher’s exact test for categorical variables and the Mann-Whitney U test for continuous variables. The major Cobb angle and SJ-27 scores (domain scores and total score) were compared between baseline and follow-up using the Wilcoxon signed-rank test in the overall cohort and within each brace-wearing time group. To explore factors potentially associated with HRQOL changes during bracing, multiple linear regression analyses were performed with the change (Δ) in each SJ-27 domain score and the total score from baseline to follow-up as dependent variables. Independent variables were prespecified as potential correlates of HRQOL change and included age, BMI, skeletal maturity, scoliosis progression, and ≥ 12 h/day brace-wearing time. A p value < 0.05 was considered statistically significant. All data were analyzed using IBM SPSS Statistics, version 29 (IBM Corp., Armonk, NY, USA). Results Patient characteristics Table 1 summarizes the demographic characteristics of the overall cohort and of each brace-wearing time group (< 12 h/day and ≥ 12 h/day). In the overall cohort, the mean age was 12.2 (1.1) years, mean BMI was 17.7 (2.4), and mean major Cobb angle was 29.0° (4.5°). Seventy patients (39.1%) were skeletally mature (Risser grade ≥ 3). The mean follow-up duration was 24.7 (2.5) months. The brace types used were the Boston brace (n = 104, 58.1%), High Boston brace (n = 23, 12.8%), Chêneau brace (n = 29, 16.2%), underarm brace (n = 11, 6.1%), OMC brace (n = 6, 3.4%), and Semoto–Nagano brace (n = 6, 3.4%). Compared with the < 12 h/day group, patients in the ≥ 12 h/day group were younger, had a lower BMI, and had a greater major Cobb angle at baseline. In contrast, the proportion of skeletally mature patients, the rate of scoliosis progression, and the follow-up period were comparable between the groups. Table 1 Baseline demographic characteristics, scoliosis progression, and mean follow-up period in the overall cohort and in the < 12 h/day and ≥ 12 h/day groups Age, years Overall (n = 179) < 12 h/day (n = 110) ≥ 12 h/day (n = 59) P value 12.2 (1.1) 12.4 (1.1) 11.9 (1.0) 0.002 BMI, kg/m 2 17.7 (2.4) 17.9 (2.3) 17.4 (2.6) 0.036 Skeletal maturity (Risser ≥ 3), n (%) 70 (39.1%) 44 (40.0%) 20 (33.9%) 0.507 Cobb angles, degree 29.0 (4.5) 28.1 (4.5) 30.3 (4.2) 0.002 Scoliosis progression, n (%) 41 (22.9%) 23 (20.9%) 16 (27.1%) 0.444 Follow-up period, months 24.7 (2.5) 24.8 (2.5) 24.3 (2.2) 0.224 Values are reported as mean (standard deviation). BMI , body mass index Comparison of major Cobb angle and SJ-27-assessed HRQOL between baseline and > 1-year follow-up in the overall cohort The major Cobb angle and SJ-27 scores (domain scores and total score) were compared between baseline and > 1-year follow-up in the overall cohort (Table 2 ). The mean major Cobb angle increased significantly from 29.0° (4.5°) at baseline to 30.5° (8.0°) at follow-up, and scoliosis progression (≥ 6° increase in the major Cobb angle) was observed in 41 patients (22.9%). At > 1-year follow-up, the SJ-27 Pain and Discomfort when wearing clothes domain scores were significantly worse than at baseline. In contrast, the Cognition/psychological distress and Participation/physical activity domain scores significantly improved, and the total SJ-27 score showed no significant change. Table 2 Comparison of Cobb angle and SJ-27-assessed HRQOL between baseline and > 1-year follow-up in the overall cohort Total (n = 179) Baseline > 1-year follow-up P value Cobb angles, degree 29.0 (4.5) 30.5 (8.0) 0.040 SJ-27 score Pain score 1.5 (2.1) 2.2 (2.8) < 0.001 Discomfort when wearing clothes score 2.3 (3.7) 4.5 (5.3) < 0.001 Appearance score 1.9 (2.7) 2.2 (3.1) 0.547 Cognition score 7.5 (4.9) 6.6 (5.0) 0.015 Participation score 3.9 (3.5) 2.7 (3.2) < 0.001 Total score 17.0 (13.0) 18.1 (14.8) 0.563 Values are reported as mean (standard deviation). HRQOL , health-related quality of life; SJ-27 , Scoliosis Japanese Questionnaire-27. In summary, over a mean follow-up of approximately 2 years, braced patients showed a significant increase in the major Cobb angle; however, the mean change was only 1.5°. Regarding HRQOL change assessed by the SJ-27, pain and discomfort when wearing clothes—both likely related to brace wear—worsened, whereas psychological distress and physical activity improved, resulting in largely preserved overall HRQOL as reflected by the unchanged total score. Comparison of major Cobb angle and SJ-27-assessed HRQOL between baseline and > 1-year follow-up in 1-year follow-up in the < 12 h/day group (n = 110) and the ≥ 12 h/day group (n = 59) (Table 3 ). No significant change in the mean major Cobb angle was observed over time in either group, and the proportion of patients with scoliosis progression did not differ significantly between groups (< 12 h/day: 20.9% vs. ≥ 12 h/day: 27.1%; p = 0.444). In the < 12 h/day group, the Pain and Discomfort when wearing clothes domain scores worsened significantly, whereas the Cognition and Participation domain scores improved significantly; the total SJ-27 score showed no significant change. In contrast, in the ≥ 12 h/day group, not only the Pain and Discomfort when wearing clothes domain scores but also the Appearance/self-consciousness domain score worsened significantly, resulting in a significant worsening of the total SJ-27 score. Table 3 Comparison of Cobb angle and SJ-27-assessed HRQOL between baseline and > 1-year follow-up in the < 12 h/day and ≥ 12 h/day groups 1-year follow-up P value Cobb angles, degree 28.1 (4.5) 29.6 (8.0) 0.081 SJ-27 score Pain score 1.8 (2.3) 2.4 (3.0) 0.026 Discomfort when wearing clothes score 2.5 (3.8) 3.9 (5.2) < 0.001 Appearance score 2.0 (2.8) 1.8 (2.9) 0.070 Cognition score 7.4 (4.9) 6.2 (4.7) 0.004 Participation score 4.4 (3.7) 2.6 (3.3) < 0.001 Total score 17.9 (13.1) 16.8 (14.5) 0.093 ≥ 12 h/day group (n = 59) Cobb angles, degree 30.3 (4.2) 31.6 (7.8) 0.478 SJ-27 score Pain score 1.0 (1.7) 1.8 (2.3) 0.007 Discomfort when wearing clothes score 2.3 (3.9) 5.4 (5.5) < 0.001 Appearance score 1.7 (2.8) 2.8 (3.1) 0.035 Cognition score 7.7 (4.9) 7.1 (5.2) 0.568 Participation score 3.2 (3.1) 2.7 (3.2) 0.131 Total score 15.9 (13.2) 19.8 (14.2) 0.023 Values are reported as mean (standard deviation). HRQOL , health-related quality of life; SJ-27 , Scoliosis Japanese Questionnaire-27. Thus, curve progression did not differ according to brace-wearing time, and pain and discomfort when wearing clothes worsened regardless of daily brace-wearing time. However, deterioration in appearance-related self-consciousness was more evident in patients with longer brace-wearing time, which may have contributed to an overall decline in HRQOL. Multivariate linear regression analysis of changes in SJ-27 domain scores and total score from baseline to > 1-year follow-up Because baseline age, BMI, and major Cobb angle differed between the < 12 h/day and ≥ 12 h/day groups, multivariate linear regression analyses were performed to identify factors associated with changes in SJ-27 scores (each domain score and the total score) from baseline to > 1-year follow-up (Table 4 ). Brace-wearing time of ≥ 12 h/day was significantly associated with worsening in the Appearance/self-consciousness domain (ΔAppearance; p = 0.017) and the Participation/physical activity domain (ΔParticipation; p = 0.036). BMI was also significantly associated with ΔParticipation ( p = 0.035). In addition, brace-wearing time ≥ 12 h/day was also independently associated with worsening in the total SJ-27 score (ΔTotal score; p = 0.033). Table 4 Multivariate linear regression analyses of changes (Δ) in SJ-27 domain scores and total score between baseline and > 1-year follow-up Variables B P value 95% CI B P value 95% CI Δ Pain score Δ Discomfort when wearing clothes score Age −0.297 0.146 −0.700 to 0.105 0.509 0.207 −0.284 to 1.302 BMI 0.101 0.213 −0.058 to 0.259 −0.181 0.255 −0.494 to 0.132 Skeletal Maturity 0.848 0.069 −0.066 to 1.763 −1.273 0.165 −3.075 to 0.530 Scoliosis progression −0.284 0.539 −1.198 to 0.629 0.232 0.799 −1.568 to 2.032 ≥ 12h/day bracing 0.083 0.841 −0.734 to 0.900 1.587 0.053 −0.024 to 3.198 Δ Appearance score Δ Cognition score Age 0.262 0.321 −0.258 to 0.783 0.101 0.797 −0.675 to 0.878 BMI 0.007 0.946 −0.198 to 0.213 −0.074 0.635 −0.381 to 0.233 Skeletal Maturity −0.732 0.224 −1.915 to 0.451 −1.222 0.173 −2.987 to 0.543 Scoliosis progression 1.125 0.062 −0.056 to 2.307 0.410 0.647 −1.353 to 2.172 ≥ 12 h/day bracing 1.286 0.017 0.228 to 2.343 0.427 0.594 −1.150 to 2.005 Δ Participation score Δ Total score Age 0.105 0.724 −0.478 to 0.688 0.680 0.524 −1.422 to 2.782 BMI 0.247 0.035 0.017 to 0.478 0.100 0.812 −0.730 to 0.930 Skeletal Maturity −0.636 0.344 −1.961 to 0.689 −3.014 0.215 −7.792 to 1.764 Scoliosis progression 1.242 0.066 −0.081 to 2.566 2.725 0.261 −2.048 to 7.497 ≥ 12 h/day bracing 1.272 0.036 0.087 to 2.456 4.655 0.033 0.383 to 8.926 B , unstandardized coefficients BMI , body mass index; SJ-27 , Scoliosis Japanese Questionnaire-27; 95% CI , 95% confidence interval. Taken together, these findings suggest that longer daily brace wear (≥ 12 h/day) may be associated with deterioration in overall HRQOL, particularly in appearance-related self-consciousness and physical activity, regardless of age, BMI, skeletal maturity, and scoliosis progression. Discussion To our knowledge, this is the first multicenter study to longitudinally evaluate changes in HRQOL during brace treatment using the SJ-27 and to examine how these changes relate to daily brace-wearing time. Our findings can be summarized as follows. First, among female patients with AIS undergoing bracing, pain and discomfort when wearing clothes worsened over a mean follow-up of approximately 2 years; however, overall HRQOL was largely preserved, as indicated by the unchanged SJ-27 total score. Second, in analyses stratified by brace-wearing time using a 12 h/day cutoff, pain and discomfort when wearing clothes worsened regardless of daily brace-wearing time, whereas patients wearing the brace for ≥ 12 h/day additionally showed deterioration in appearance-related self-consciousness and a significant worsening of overall HRQOL. Notably, multivariate regression analysis adjusting for age, BMI, scoliosis progression, and skeletal maturity further supported an independent association between ≥ 12 h/day bracing and deterioration in the SJ-27 Appearance/self-consciousness domain, Participation/physical activity domain, and total score. Collectively, these findings suggest that longer brace wear (> 12 h/day) may be associated with poorer HRQOL, particularly appearance-related self-consciousness and physical activity. Therefore, changes in HRQOL and patients’ preferences regarding physical activity may be important considerations when discussing recommended brace-wearing time, ideally with ongoing monitoring using disease-specific PRO measures such as the SJ-27. The SJ-27 was developed as an AIS-specific instrument for Japanese adolescent girls and has been reported to be useful for identifying patients with moderate scoliosis who may require brace treatment. [ 14 , 19 ] Previous work has also suggested that early HRQOL assessment using the SJ-27 may help identify patients at risk of brace-related psychological distress and facilitate timely support. [ 20 ] A distinctive strength of the SJ-27 for HRQOL assessment in braced patients is the “Discomfort when wearing clothes” domain, which may capture brace-specific burden in daily-life that can be underrepresented in more general instruments such as the SRS-22r. This clothing-related discomfort may be particularly important for adolescent girls, in whom interest in fashion and appearance typically increases during adolescence. As expected, female adolescents undergoing brace treatment in this study showed significant worsening in both pain and discomfort when wearing clothes at > 1-year follow-up after brace initiation. Notably, these deteriorations were observed regardless of daily brace-wearing time, suggesting that pain and clothing-related discomfort may represent common and, to some extent, unavoidable problems during bracing. Therefore, it may be important to proactively discuss potential issues that may arise during bracing with patients and their families before and during treatment to facilitate timely support. Because these symptoms were not dependent on daily wear duration, mitigation strategies may be needed for all braced patients, including optimization of brace fitting, management of skin irritation and pressure-related problems, guidance on underwear and clothing adaptations, appropriate pain management, and accommodations for school life. In contrast, the SJ-27 Cognition/psychological distress and Participation/physical activity domains improved over time in the overall cohort. Although the mechanisms remain unclear, one plausible explanation is that limited curve progression (mean change, 1.5°) and reassurance provided by active treatment may confer psychological and functional benefits for some patients. Communicating these potential positive aspects, while acknowledging brace-related discomfort, may be useful for patient education and could help support adherence to brace treatment. In analyses stratified by brace-wearing time using a 12 h/day cutoff, patients in the ≥ 12 h/day group showed significant deterioration in appearance-related self-consciousness and overall HRQOL as assessed by the SJ-27. Moreover, multivariate regression analyses demonstrated that brace wear of ≥ 12 h/day was significantly associated with worsening in the Appearance/self-consciousness domain, the Participation/physical activity domain, and the total SJ-27 score, independent of baseline patient characteristics and scoliosis progression. One possible explanation for the poorer HRQOL observed in the ≥ 12 h/day group is that longer daily brace wear may more often extend into school life and other daytime activities. In contrast to shorter wear schedules, such as night-time bracing, this may increase the day-to-day visibility of the brace and may therefore contribute to greater appearance-related self-consciousness and limitations in physical activity. If higher daily wear-time targets are recommended, strategies to minimize HRQOL burden may include providing counseling to address body image and appearance-related concerns, adjusting wear schedules around school life and other daytime activities where feasible, and setting realistic, lifestyle-compatible wear-time goals through shared decision-making with patients and their families. When comparing our results with previous studies on brace-wearing time and HRQOL, our findings are consistent with the report by Peiro-Garcia et al ., who compared full-time and night-time bracing and found comparable deformity-control outcomes, whereas HRQOL assessed by the SRS-22r was more favorable in the night-time group, which entails a shorter daily wear time. [ 6 ] In contrast, Asada et al . reported that objectively monitored brace-wearing time did not significantly affect brace-related psychological stress during the first year of treatment, as assessed by the Japanese version of the Bad Sobernheim Stress Questionnaire-brace (JBSSQ-brace), which differs from our findings. [ 20 ] One possible reason for this discrepancy is that Asada et al . focused on changes in brace-related psychological stress within 1 year, whereas we examined changes in disease-specific HRQOL assessed by the SJ-27 over a mean follow-up of approximately 2 years. Another possible reason is differences in the assessment and timing of wear-time measurement (objective thermal sensor monitoring early after brace initiation vs. patient-reported wear time at follow-up). Future studies incorporating objective wear-time monitoring, longer follow-up, and post-bracing HRQOL assessments may further clarify how wear-time prescriptions can be optimized to balance curve control with HRQOL. The present study has several limitations. First, brace-wearing time was assessed by patient self-report using categorical responses at follow-up rather than by continuous, objectively monitored wear-time data (e.g., thermal sensors); therefore, wear-time estimates may have been imprecise. Second, because this was an observational study and brace-wearing time was not randomly assigned, causal relationships between longer brace wear and HRQOL changes cannot be established. Although multivariate regression analyses were performed, residual confounding may remain, particularly because baseline characteristics differed between the < 12 h/day and ≥ 12 h/day groups and other potentially relevant factors, including individual psychological and behavioral characteristics that may influence both adherence to brace wear and perception of brace-related burden, were not assessed. Third, this registry-based cohort included only patients with available baseline and follow-up data during ongoing brace treatment; therefore, patients who discontinued bracing, completed brace treatment, transitioned to surgery, or were lost to follow-up may have been underrepresented, potentially leading to underestimation of HRQOL burden and curve progression in the broader braced population. Fourth, this study lacked a non-braced control group, and brace type was not standardized across institutions; therefore, changes in HRQOL cannot be attributed exclusively to bracing, and differences in brace design, fit, and clinical management may have influenced both HRQOL and radiographic outcomes. Fifth, follow-up was defined as > 1-year after brace initiation, with a mean duration of approximately 2 years, and longer-term outcomes, including HRQOL after brace discontinuation, were not assessed. Finally, the study did not include other commonly used outcome measures (e.g., SRS-22r or JBSSQ-brace), did not assess some potentially relevant clinical factors related to scoliosis progression, such as menarche timing, and, because the SJ-27 is a female-specific instrument, the findings may not be generalizable to male patients with AIS. Future prospective studies designed to address these limitations are warranted. Conclusion Our study showed that brace treatment was associated with worsening pain and discomfort when wearing clothes as assessed by the SJ-27; however, psychological distress and physical activity domains improved over time, resulting in largely preserved overall HRQOL. In contrast, longer daily brace wear (≥ 12 h/day) was associated with poorer overall HRQOL, including appearance-related self-consciousness. Moreover, ≥ 12 h/day bracing was significantly associated with worsening in appearance-related self-consciousness, participation/physical activity, and overall HRQOL, independent of scoliosis progression. These findings suggest that, in braced female patients with AIS, changes in HRQOL should be considered when discussing wear-time targets and patient education. Abbreviations AIS Adolescent idiopathic scoliosis BMI Body mass index BrAIST Bracing in Adolescent Idiopathic Scoliosis Trial BrQ Brace Questionnaire BSSQ Bad Sobernheim Stress Questionnaire HRQOL Health-related quality of life JBSSQ-brace Japanese version of the Bad Sobernheim Stress Questionnaire-Brace PedsQL Pediatric Quality of Life Inventory PRO Patient-reported outcome SRS-22r Revised version of the Scoliosis Research Society-22 SJ-27 Scoliosis Japanese Questionnaire-27. Declarations Ethics approval and consent to participate Written informed consent was obtained from all participants and/or their legal guardians before enrollment, and assent was obtained from the participants when appropriate. The study protocol was reviewed and approved by the institutional review board of the Japanese Scoliosis Society, and by the Ethics Committee of Jichi Medical University, the lead institution for this study (approval no. 21–123), and by the ethics committees of all participating institutions. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Author details ¹ Department of Orthopaedic Surgery, Tokyo Women’s Medical University, 8 − 1 Kawada-cho, Shinjuku-ku, Tokyo, Japan. ² Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan. ³ Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13 − 1 Takara-machi, Kanazawa, Ishikawa, Japan. ⁴ Niigata Spine Surgery Center, Kameda Daiichi Hospital, 2-5-22 Nishi-machi, Konan-ku, Niigata, Japan. ⁵ Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan. ⁶ Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan. ⁷ Department of Orthopaedic Surgery, Seirei Sakura Citizen Hospital, 2-36-2 Ebaradai, Sakura, Chiba, Japan. ⁸ Scoliosis Center, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, Japan. ⁹ Department of Orthopaedic Surgery, Niigata University Medical and Dental Sciences, 757 Ichibancho, Asahimachi-dori, Chuo-ku, Niigata, Japan. ¹⁰ Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-ku, Hamamatsu, Shizuoka, Japan. ¹¹ Department of Orthopaedic Surgery, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan. ¹² Department of Orthopaedic Surgery, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo, Japan. ¹³ Spine Surgery Center, Japan Community Health Care Organization Sendai Hospital, 2-1-1 Murasakiyama, Izumi-ku, Sendai, Miyagi, Japan. ¹⁴ Department of Orthopaedic Surgery, University of Toyama, 2630 Sugitani, Toyama, Japan. ¹⁵ Department of Orthopaedic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga-gun, Tochigi, Japan. ¹⁶ Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan. Funding No funds were received in support of this work. Author Contribution TD (corresponding author) designed the research, analyzed the data, and wrote the manuscript. YT contributed to manuscript writing and revision. YT, SK, SD, KW, HO, TA, TK, YH, AM, TN, MO, HTa, TB, HA, YY, ST, HTe, TT, RS, ShS, HU, SaS, and NH collected the data and supervised the study. KO supervised the study. All authors read and approved the final manuscript. Acknowledgements The authors thank all the orthopedic surgeons, their staff, and the patients who willingly participated in this study. Data Availability The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. References Cheng JC, Castelein RM, Chu WC, Danielsson AJ, Dobbs MB, Grivas TB, Gurnett CA, Luk KD, Moreau A, Newton PO, et al. Adolescent idiopathic scoliosis. Nat Rev Dis Primers. 2015;1:15030. Weinstein SL, Dolan LA, Cheng JC, Danielsson A, Morcuende JA. Adolescent idiopathic scoliosis. Lancet. 2008;371(9623):1527–37. Weinstein SL, Dolan LA, Wright JG, Dobbs MB. Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med. 2013;369(16):1512–21. Wang H, Tetteroo D, Arts JJC, Markopoulos P, Ito K. Quality of life of adolescent idiopathic scoliosis patients under brace treatment: a brief communication of literature review. Qual Life Res. 2021;30(3):703–11. Schwieger T, Campo S, Weinstein SL, Dolan LA, Ashida S, Steuber KR. Body Image and Quality-of-Life in Untreated Versus Brace-Treated Females With Adolescent Idiopathic Scoliosis. Spine (Phila Pa 1976). 2016;41(4):311–9. Peiro-Garcia A, Garcia RG, Martin-Gorgojo V, Vilalta-Vidal I, Gonzalez-Gonzalez L, Martin-Moreno JM, Silvestre-Munoz A. Impact on Quality of Life of Full-time and Night-time Braces in Adolescent Idiopathic Scoliosis: A Randomized Clinical Trial. Spine (Phila Pa 1976). 2025;50(4):231–7. Asada T, Kotani T, Sakuma T, Iijima Y, Nakayama K, Inage K, Shiga Y, Akazawa T, Minami S, Ohtori S, et al. 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. Spine Surg Relat Res. 2023;7(4):377–84. Asada T, Kotani T, Sakuma T, Iijima Y, Sakashita K, Ogata Y, Akazawa T, Minami S, Ohtori S, Koda M, et al. Factors Influencing Optimal Bracing Compliance in Adolescent Idiopathic Scoliosis: A Single-center Prospective Cohort Study. Spine (Phila Pa 1976). 2024;49(24):1708–15. Dolan LA, Weinstein SL, Dobbs MB, Flynn JMJ, Green DW, Halsey MF, Hresko MT, Krengel WF 3rd, Mehlman CT, Milbrandt TA, et al. BrAIST-Calc: Prediction of Individualized Benefit From Bracing for Adolescent Idiopathic Scoliosis. Spine (Phila Pa 1976). 2024;49(3):147–56. Hawary RE, Zaaroor-Regev D, Floman Y, Lonner BS, Alkhalife YI, Betz RR. Brace treatment in adolescent idiopathic scoliosis: risk factors for failure-a literature review. Spine J. 2019;19(12):1917–25. Liu S, Ho LY, Hassan Beygi B, Wong MS. Effectiveness of Orthotic Treatment on Clinical Outcomes of the Patients with Adolescent Idiopathic Scoliosis Under Different Wearing Compliance Levels: A Systematic Review. JBJS Rev. 2023;11(10):e2300110. Rivett L, Rothberg A, Stewart A, Berkowitz R. The relationship between quality of life and compliance to a brace protocol in adolescents with idiopathic scoliosis: a comparative study. BMC Musculoskelet Disord. 2009;10:5. Watanabe K, Lenke LG, Bridwell KH, Hasegawa K, Hirano T, Endo N, Cheh G, Kim YJ, Hensley M, Stobbs G, et al. Cross-cultural comparison of the Scoliosis Research Society Outcomes Instrument between American and Japanese idiopathic scoliosis patients: are there differences? Spine (Phila Pa 1976). 2007;32(24):2711–4. Doi T, Inoue H, Arai Y, Shirado O, Doi T, Yamazaki K, Uno K, Yanagida H, Takeshita K. Reliability and validity of a novel quality of life questionnaire for female patients with adolescent idiopathic scoliosis: Scoliosis Japanese Questionnaire-27: a multicenter, cross-sectional study. BMC Musculoskelet Disord. 2018;19(1):99. Alzakri A. Reliability and validity of an adapted Arabic version of Scoliosis Japanese Questionnaire-27 in Saudi Arabia. J Orthop Sci. 2024;29(6):1341–5. Bazancir Z, Yagci G, Bek N. Reliability and validity of Turkish version of the Scoliosis Japanese Questionnaire- 27 in patients with adolescent idiopathic scoliosis. J Orthop Sci. 2021;26(6):974–8. Kim HS, Kim K, Cho YJ, Goh TS, Lee JS. Validation of the Scoliosis Japanese Questionnaire-27 in Korean patients with adolescent idiopathic scoliosis. J Clin Neurosci. 2024;129:110830. Kuru Colak T, Apti A, Colak I, Akcay B, Dereli EE. Translation, reliability and validity of the Turkish version of Scoliosis Japanese Questionnaire-27 in adolescent idiopathic scoliosis. Spine Deform. 2023;11(5):1049–55. Doi T, Watanabe K, Doi T, Inoue H, Sugawara R, Arai Y, Shirado O, Yamazaki K, Uno K, Yanagida H, et al. Associations between curve severity and revised Scoliosis Research Society-22 and scoliosis Japanese Questionnaire-27 scores in female patients with adolescent idiopathic scoliosis: a multicenter, cross-sectional study. BMC Musculoskelet Disord. 2021;22(1):312. Asada T, Kotani T, Sakuma T, Iijima Y, Sakashita K, Ogata Y, Minami S, Ohtori S, Koda M, Yamazaki M. Impact of Baseline HRQOL on Brace-Related Stress in Female Patients with Adolescent Idiopathic Scoliosis: A Longitudinal Retrospective Study. Spine Surg Relat Res. 2025;9(6):682–9. Negrini S, Donzelli S, Aulisa AG, Czaprowski D, Schreiber S, de Mauroy JC, Diers H, Grivas TB, Knott P, Kotwicki T, et al. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis Spinal Disord. 2018;13:3. Negrini S, Hresko TM, O'Brien JP, Price N, Boards S, Committee SRSN-O. Recommendations for research studies on treatment of idiopathic scoliosis: Consensus 2014 between SOSORT and SRS non-operative management committee. Scoliosis. 2015;10:8. Richards BS, Bernstein RM, D'Amato CR, Thompson GH. Standardization of criteria for adolescent idiopathic scoliosis brace studies: SRS Committee on Bracing and Nonoperative Management. Spine (Phila Pa 1976). 2005;30(18):2068–75. discussion 2076 – 2067. Heegaard M, Tondevold N, Dahl B, Andersen TB, Gehrchen M, Ohrt-Nissen S. Does Risser stage accurately predict the risk of curve progression in patients with adolescent idiopathic scoliosis treated with night-time bracing? Eur Spine J. 2023;32(9):3077–83. Sato M, Ohashi M, Tashi H, Makino T, Shibuya Y, Hirano T, Watanabe K. Association of success of brace treatment and various aspects of in-brace correction in patients with adolescent idiopathic scoliosis. J Orthop Sci. 2023;28(6):1221–6. Sakashita K, Asada T, Kotani T, Sakuma T, Iijima Y, Ogata Y, Okuwaki S, Ohyama S, Mizutani M, Akazawa T, et al. Skeletal Maturity, Brace Compliance, and In-Brace Correction Rate Are Important Factors Associated with Cobb Angle Progression after Brace Treatment in Patients with Adolescent Idiopathic Scoliosis. Spine Surg Relat Res. 2025;9(5):539–45. Katz DE, Herring JA, Browne RH, Kelly DM, Birch JG. Brace wear control of curve progression in adolescent idiopathic scoliosis. J Bone Joint Surg Am. 2010;92(6):1343–52. Konieczny MR, Hieronymus P, Krauspe R. Time in brace: where are the limits and how can we improve compliance and reduce negative psychosocial impact in patients with scoliosis? A retrospective analysis. Spine J. 2017;17(11):1658–64. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9102080","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":621984075,"identity":"dba9d73f-0e4d-4c39-802c-aca029a703d2","order_by":0,"name":"Toru 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population.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-9102080/v1/714d6b1f0cfa1f98b766b290.png"},{"id":106961444,"identity":"118bf57a-fca4-4462-8a07-6d741968745e","added_by":"auto","created_at":"2026-04-15 09:25:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1528750,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9102080/v1/74f7cbea-fc48-497d-a14d-f719c2b5761e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Association of Brace-Wearing Time With Changes in Health-Related Quality of Life Assessed by the Scoliosis Japanese Questionnaire-27 in Braced Female Adolescents With Idiopathic Scoliosis: A Multicenter Cohort Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAdolescent idiopathic scoliosis (AIS) is the most common spinal deformity in adolescents, with an estimated prevalence of 1%\u0026ndash;4% worldwide. [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] Brace treatment is commonly indicated for moderate scoliosis, typically defined as a major Cobb angle of approximately 20\u0026deg;\u0026ndash;40\u0026deg;, in patients considered to be at risk of progression during growth. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] Bracing is the only evidence-based effective conservative therapy for AIS to reduce progression to the surgical threshold, as established by the Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST). [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] BrAIST also demonstrated a dose\u0026ndash;response relationship, with greater daily brace-wearing time associated with a higher likelihood of treatment success. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eAlthough bracing is effective for curve control, it can impose a substantial treatment burden and may affect multiple aspects of health-related quality of life (HRQOL) in adolescents. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] In BrAIST, HRQOL assessed using the Pediatric Quality of Life Inventory (PedsQL) showed no significant changes associated with brace treatment. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] In contrast, a literature review reported that studies using the revised version of the Scoliosis Research Society-22 (SRS-22r) and brace-specific patient-reported outcome (PRO) measures, such as the Bad Sobernheim Stress Questionnaire (BSSQ) and the Brace Questionnaire (BrQ), have suggested potential negative effects of bracing on HRQOL, including self-image, mental health, and vitality. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] These findings highlight the clinical need to balance the benefits of curve-control with preservation of HRQOL during brace treatment. To achieve this balance, it is important to better understand how bracing, particularly brace-wearing time, relates to longitudinal changes in HRQOL. Although a recent study comparing full-time and night-time bracing suggested that shorter wear schedules may be associated with less adverse impact on HRQOL domains such as self-image and pain despite comparable curve-control effects [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], evidence regarding the relationship between brace-wearing time and HRQOL trajectories remains limited. Moreover, previous studies have indicated that poorer brace-related quality of life may be associated with lower compliance with prescribed brace-wearing protocols, suggesting that HRQOL during bracing is closely linked to adherence. [\u003cspan additionalcitationids=\"CR8 CR9 CR10 CR11\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] Accordingly, a better understanding of HRQOL changes during brace treatment\u0026mdash;and how these changes relate to brace-wearing time\u0026mdash;may help optimize patient counseling and shared decision-making, and ultimately support adherence in routine clinical practice.\u003c/p\u003e \u003cp\u003eThe SRS-22r questionnaire is widely used as a gold-standard PRO measure for AIS; however, cultural and healthcare-system differences across regions may limit the suitability of some SRS-22r items. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] To address AIS-specific concerns relevant to Japanese adolescent girls, the Scoliosis Japanese Questionnaire-27 (SJ-27) was developed and has demonstrated acceptable reliability and validity. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] SJ-27 comprises 27 items across five domains\u0026mdash;Pain, Discomfort when wearing clothes, Appearance (self-consciousness about appearance), Cognition (anxiety/depressive feelings), and Participation (difficulties in physical activities)\u0026mdash;with a total score ranging from 0 to 108, where higher scores indicate worse HRQOL. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] The SJ-27 has also been cross-culturally adapted and validated in multiple languages, including Arabic, Korean, and Turkish, supporting its broader international applicability. [\u003cspan additionalcitationids=\"CR16 CR17\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] In addition, SJ-27 scores have been reported to be associated with curve severity and may be useful for identifying patients with moderate scoliosis who may require brace treatment. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] Early HRQOL assessment using the SJ-27 during brace treatment may also help identify patients at higher risk of brace-related psychological distress. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] However, no study has longitudinally evaluated HRQOL changes during brace treatment using the SJ-27 or examined how such changes relate to brace-wearing time.\u003c/p\u003e \u003cp\u003eTherefore, the aim of this multicenter cohort study was to investigate longitudinal changes in HRQOL assessed by the SJ-27 among braced female patients with AIS and to determine whether brace-wearing time is associated with changes in SJ-27 domain scores and total score.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThis multicenter observational cohort study was conducted under the leadership of the Japanese Scoliosis Society Registry Outcome Committee and was design to longitudinally assess HRQOL in patients with AIS undergoing brace treatment. The study protocol was reviewed and approved by the institutional review board of the Japanese Scoliosis Society and by the ethics committees of all participating institutions, in accordance with local ethical standards. Written informed consent was obtained from all participants and/or their legal guardians before enrollment, and assent was obtained from the participants when appropriate.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePatient recruitment\u003c/h3\u003e\n\u003cp\u003eA total of 303 patients with AIS who initiated brace treatment between January 2022 and October 2023 were recruited from 13 participating institutions. Because the SJ-27 is a female-specific PRO measure, male patients were excluded (n\u0026thinsp;=\u0026thinsp;26). Eligible patients were females aged 10\u0026ndash;15 years with a major Cobb angle of 20\u0026deg;\u0026ndash;40\u0026deg;. Accordingly, two patients were excluded due to age and 11 because of major Cobb angle. Among the remaining 264 eligible patients, 85 were excluded because of incomplete major Cobb angle and/or SJ-27 data at baseline and/or follow-up (\u0026gt;\u0026thinsp;1-year after brace initiation). Because this study was designed to evaluate HRQOL changes during ongoing brace treatment, patients who had completed brace treatment before follow-up assessment, including those who may have transitioned to surgery, were not included in the analysis and were considered likely to be included among those with incomplete follow-up data. Consequently, 179 patients were included in the final analytic cohort (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eBrace indication\u003c/h3\u003e\n\u003cp\u003eBrace treatment was prescribed in routine clinical practice at each participating institution, generally in accordance with contemporary recommendations and commonly used criteria for AIS bracing. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] Because this study aimed to capture real-world practice and longitudinal PROs, brace treatment was not restricted to the most stringent research criteria. In selected patients who were relatively skeletally mature (e.g., Risser grade\u0026thinsp;\u0026ge;\u0026thinsp;3) but still considered at risk of curve progression, bracing could be offered at the treating physician\u0026rsquo;s discretion through shared decision-making with the patient and family after discussion of expected benefits and limitations.\u003c/p\u003e\n\u003ch3\u003eData collection and radiographic assessment\u003c/h3\u003e\n\u003cp\u003eBaseline variables were assessed at each participating institution and included age, body mass index (BMI), Risser grade, and brace type. Skeletal maturity was dichotomized based on the Risser grade (0\u0026ndash;2: skeletally immature; 3\u0026ndash;5: skeletally mature). [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] Standing anteroposterior whole-spine radiographs were obtained at baseline and follow-up (\u0026gt;\u0026thinsp;1-year after brace initiation). The Cobb method was used to measure the major curve angle. Scoliosis progression was defined as an increase of \u0026ge;\u0026thinsp;6\u0026deg; in the major Cobb angle from baseline to follow-up. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] At follow-up, daily brace-wearing time was assessed using a patient-reported questionnaire with four response categories (\u0026lt;\u0026thinsp;6 h/day, 6\u0026ndash;12 h/day, 12\u0026ndash;18 h/day, or \u0026gt;\u0026thinsp;18 h/day). Patients were divided into two groups using a 12 h/day cutoff, as commonly adopted in previous studies. [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] After excluding 10 patients with missing brace-wearing time data, 110 were classified into the \u0026lt;\u0026thinsp;12 h/day group and 59 into the \u0026ge;\u0026thinsp;12 h/day group.\u003c/p\u003e\n\u003ch3\u003eHRQOL assessment using the SJ-27\u003c/h3\u003e\n\u003cp\u003ePatients\u0026rsquo; HRQOL was assessed using the SJ-27 at baseline and at \u0026gt;\u0026thinsp;1-year follow-up. The SJ-27 was designed to cover a wide range of HRQOL issues among young female patients with AIS in Japan and comprises five domains: Pain (Q1\u0026ndash;4), Discomfort when wearing clothes (Q5\u0026ndash;10 and 27), Appearance/self-consciousness about scoliosis (Q12\u0026ndash;14, 22, 25, and 26), Cognition/psychological distress (Q17, 18, 20, 21, 23, and 24), and Participation/physical activity (Q11, 15, 16, and 19). [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] Each of the 27 items is scored on a 5-point scale from no impairment (0 point) to severe impairment (4 points), yielding a total score ranging from 0 to 108, with higher scores indicating worse HRQOL.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eData are presented as mean (standard deviation) or frequency (percentage), as appropriate. Baseline demographic characteristics (age, BMI, skeletal maturity, and major Cobb angle), scoliosis progression, and follow-up period were compared between the \u0026lt;\u0026thinsp;12 h/day and \u0026ge;\u0026thinsp;12 h/day groups using Fisher\u0026rsquo;s exact test for categorical variables and the Mann-Whitney U test for continuous variables. The major Cobb angle and SJ-27 scores (domain scores and total score) were compared between baseline and follow-up using the Wilcoxon signed-rank test in the overall cohort and within each brace-wearing time group. To explore factors potentially associated with HRQOL changes during bracing, multiple linear regression analyses were performed with the change (Δ) in each SJ-27 domain score and the total score from baseline to follow-up as dependent variables. Independent variables were prespecified as potential correlates of HRQOL change and included age, BMI, skeletal maturity, scoliosis progression, and \u0026ge;\u0026thinsp;12 h/day brace-wearing time. A \u003cem\u003ep\u003c/em\u003e value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. All data were analyzed using IBM SPSS Statistics, version 29 (IBM Corp., Armonk, NY, USA).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003ePatient characteristics\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarizes the demographic characteristics of the overall cohort and of each brace-wearing time group (\u0026lt;\u0026thinsp;12 h/day and \u0026ge;\u0026thinsp;12 h/day). In the overall cohort, the mean age was 12.2 (1.1) years, mean BMI was 17.7 (2.4), and mean major Cobb angle was 29.0\u0026deg; (4.5\u0026deg;). Seventy patients (39.1%) were skeletally mature (Risser grade\u0026thinsp;\u0026ge;\u0026thinsp;3). The mean follow-up duration was 24.7 (2.5) months. The brace types used were the Boston brace (n\u0026thinsp;=\u0026thinsp;104, 58.1%), High Boston brace (n\u0026thinsp;=\u0026thinsp;23, 12.8%), Ch\u0026ecirc;neau brace (n\u0026thinsp;=\u0026thinsp;29, 16.2%), underarm brace (n\u0026thinsp;=\u0026thinsp;11, 6.1%), OMC brace (n\u0026thinsp;=\u0026thinsp;6, 3.4%), and Semoto\u0026ndash;Nagano brace (n\u0026thinsp;=\u0026thinsp;6, 3.4%). Compared with the \u0026lt;\u0026thinsp;12 h/day group, patients in the \u0026ge;\u0026thinsp;12 h/day group were younger, had a lower BMI, and had a greater major Cobb angle at baseline. In contrast, the proportion of skeletally mature patients, the rate of scoliosis progression, and the follow-up period were comparable between the groups.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline demographic characteristics, scoliosis progression, and mean follow-up period in the overall cohort and in the \u0026lt;\u0026thinsp;12 h/day and \u0026ge;\u0026thinsp;12 h/day groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge, years\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;179)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;12 h/day\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;110)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;12 h/day\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;59)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.2 (1.1)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.4 (1.1)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.9 (1.0)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI, kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17.7 (2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.9 (2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.4 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSkeletal maturity (Risser\u0026thinsp;\u0026ge;\u0026thinsp;3), n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70 (39.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44 (40.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20 (33.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.507\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCobb angles, degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.0 (4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28.1 (4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30.3 (4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScoliosis progression, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (22.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23 (20.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16 (27.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.444\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFollow-up period, months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.7 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.8 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24.3 (2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.224\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eValues are reported as mean (standard deviation). \u003cem\u003eBMI\u003c/em\u003e, body mass index\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eComparison of major Cobb angle and SJ-27-assessed HRQOL between baseline and \u0026gt;\u0026thinsp;1-year follow-up in the overall cohort\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe major Cobb angle and SJ-27 scores (domain scores and total score) were compared between baseline and \u0026gt;\u0026thinsp;1-year follow-up in the overall cohort (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The mean major Cobb angle increased significantly from 29.0\u0026deg; (4.5\u0026deg;) at baseline to 30.5\u0026deg; (8.0\u0026deg;) at follow-up, and scoliosis progression (\u0026ge;\u0026thinsp;6\u0026deg; increase in the major Cobb angle) was observed in 41 patients (22.9%). At \u0026gt;\u0026thinsp;1-year follow-up, the SJ-27 Pain and Discomfort when wearing clothes domain scores were significantly worse than at baseline. In contrast, the Cognition/psychological distress and Participation/physical activity domain scores significantly improved, and the total SJ-27 score showed no significant change.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Cobb angle and SJ-27-assessed HRQOL between baseline and \u0026gt;\u0026thinsp;1-year follow-up in the overall cohort\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;179)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;1-year follow-up\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCobb angles, degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.0 (4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.5 (8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.040\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eSJ-27 score\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.5 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.2 (2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiscomfort when wearing clothes score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.3 (3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.5 (5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAppearance score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.9 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.2 (3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.547\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCognition score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.5 (4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.6 (5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipation score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.9 (3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.7 (3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17.0 (13.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.1 (14.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.563\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eValues are reported as mean (standard deviation). \u003cem\u003eHRQOL\u003c/em\u003e, health-related quality of life; \u003cem\u003eSJ-27\u003c/em\u003e, Scoliosis Japanese Questionnaire-27.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn summary, over a mean follow-up of approximately 2 years, braced patients showed a significant increase in the major Cobb angle; however, the mean change was only 1.5\u0026deg;. Regarding HRQOL change assessed by the SJ-27, pain and discomfort when wearing clothes\u0026mdash;both likely related to brace wear\u0026mdash;worsened, whereas psychological distress and physical activity improved, resulting in largely preserved overall HRQOL as reflected by the unchanged total score.\u003c/p\u003e \u003cp\u003e \u003cb\u003eComparison of major Cobb angle and SJ-27-assessed HRQOL between baseline and \u0026gt;\u0026thinsp;1-year follow-up in \u0026lt;\u0026thinsp;12 h/day and \u0026ge;\u0026thinsp;12 h/day groups\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe major Cobb angle and SJ-27 scores were compared between baseline and \u0026gt;\u0026thinsp;1-year follow-up in the \u0026lt;\u0026thinsp;12 h/day group (n\u0026thinsp;=\u0026thinsp;110) and the \u0026ge;\u0026thinsp;12 h/day group (n\u0026thinsp;=\u0026thinsp;59) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). No significant change in the mean major Cobb angle was observed over time in either group, and the proportion of patients with scoliosis progression did not differ significantly between groups (\u0026lt;\u0026thinsp;12 h/day: 20.9% vs. \u0026ge; 12 h/day: 27.1%; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.444). In the \u0026lt;\u0026thinsp;12 h/day group, the Pain and Discomfort when wearing clothes domain scores worsened significantly, whereas the Cognition and Participation domain scores improved significantly; the total SJ-27 score showed no significant change. In contrast, in the \u0026ge;\u0026thinsp;12 h/day group, not only the Pain and Discomfort when wearing clothes domain scores but also the Appearance/self-consciousness domain score worsened significantly, resulting in a significant worsening of the total SJ-27 score.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Cobb angle and SJ-27-assessed HRQOL between baseline and \u0026gt;\u0026thinsp;1-year follow-up in the \u0026lt;\u0026thinsp;12 h/day and \u0026ge;\u0026thinsp;12 h/day groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;12 h/day group (n\u0026thinsp;=\u0026thinsp;110)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;1-year follow-up\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCobb angles, degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.1 (4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.6 (8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.081\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eSJ-27 score\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.8 (2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.4 (3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiscomfort when wearing clothes score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.5 (3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.9 (5.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAppearance score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.0 (2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.8 (2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.070\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCognition score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.4 (4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.2 (4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipation score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.4 (3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.6 (3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17.9 (13.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.8 (14.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.093\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003e\u0026ge;\u0026thinsp;12 h/day group (n\u0026thinsp;=\u0026thinsp;59)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCobb angles, degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30.3 (4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.6 (7.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.478\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eSJ-27 score\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.0 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.8 (2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiscomfort when wearing clothes score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.3 (3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.4 (5.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAppearance score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.7 (2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.8 (3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCognition score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.7 (4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.1 (5.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.568\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipation score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.2 (3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.7 (3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.131\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.9 (13.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.8 (14.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eValues are reported as mean (standard deviation). \u003cem\u003eHRQOL\u003c/em\u003e, health-related quality of life; \u003cem\u003eSJ-27\u003c/em\u003e, Scoliosis Japanese Questionnaire-27.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThus, curve progression did not differ according to brace-wearing time, and pain and discomfort when wearing clothes worsened regardless of daily brace-wearing time. However, deterioration in appearance-related self-consciousness was more evident in patients with longer brace-wearing time, which may have contributed to an overall decline in HRQOL.\u003c/p\u003e \u003cp\u003e \u003cb\u003eMultivariate linear regression analysis of changes in SJ-27 domain scores and total score from baseline to \u0026gt;\u0026thinsp;1-year follow-up\u003c/b\u003e \u003c/p\u003e \u003cp\u003eBecause baseline age, BMI, and major Cobb angle differed between the \u0026lt;\u0026thinsp;12 h/day and \u0026ge;\u0026thinsp;12 h/day groups, multivariate linear regression analyses were performed to identify factors associated with changes in SJ-27 scores (each domain score and the total score) from baseline to \u0026gt;\u0026thinsp;1-year follow-up (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Brace-wearing time of \u0026ge;\u0026thinsp;12 h/day was significantly associated with worsening in the Appearance/self-consciousness domain (ΔAppearance; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.017) and the Participation/physical activity domain (ΔParticipation; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.036). BMI was also significantly associated with ΔParticipation (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.035). In addition, brace-wearing time\u0026thinsp;\u0026ge;\u0026thinsp;12 h/day was also independently associated with worsening in the total SJ-27 score (ΔTotal score; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.033).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate linear regression analyses of changes (Δ) in SJ-27 domain scores and total score between baseline and \u0026gt;\u0026thinsp;1-year follow-up\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eΔ \u003cb\u003ePain score\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eΔ \u003cb\u003eDiscomfort when wearing clothes score\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;0.297\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.700 to 0.105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.509\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;0.284 to 1.302\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.213\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.058 to 0.259\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;0.181\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.255\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;0.494 to 0.132\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSkeletal Maturity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.848\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.069\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.066 to 1.763\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;1.273\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.165\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;3.075 to 0.530\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScoliosis progression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;0.284\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.539\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;1.198 to 0.629\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.232\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.799\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;1.568 to 2.032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;12h/day bracing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.083\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.841\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.734 to 0.900\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.587\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;0.024 to 3.198\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eΔ \u003cb\u003eAppearance score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eΔ \u003cb\u003eCognition score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.262\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.258 to 0.783\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.797\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;0.675 to 0.878\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.946\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.198 to 0.213\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;0.074\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.635\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;0.381 to 0.233\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSkeletal Maturity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;0.732\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.224\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;1.915 to 0.451\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;1.222\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;2.987 to 0.543\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScoliosis progression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.062\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.056 to 2.307\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.410\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.647\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;1.353 to 2.172\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;12 h/day bracing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.286\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.228 to 2.343\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.427\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.594\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;1.150 to 2.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eΔ \u003cb\u003eParticipation score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eΔ \u003cb\u003eTotal score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.724\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.478 to 0.688\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.680\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.524\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;1.422 to 2.782\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.247\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.017 to 0.478\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.812\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;0.730 to 0.930\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSkeletal Maturity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;0.636\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.344\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;1.961 to 0.689\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;3.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.215\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;7.792 to 1.764\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScoliosis progression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.242\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.081 to 2.566\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.725\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.261\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;2.048 to 7.497\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;12 h/day bracing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.272\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.087 to 2.456\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.655\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.383 to 8.926\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cem\u003eB\u003c/em\u003e, unstandardized coefficients\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cem\u003eBMI\u003c/em\u003e, body mass index; \u003cem\u003eSJ-27\u003c/em\u003e, Scoliosis Japanese Questionnaire-27; \u003cem\u003e95% CI\u003c/em\u003e, 95% confidence interval.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTaken together, these findings suggest that longer daily brace wear (\u0026ge;\u0026thinsp;12 h/day) may be associated with deterioration in overall HRQOL, particularly in appearance-related self-consciousness and physical activity, regardless of age, BMI, skeletal maturity, and scoliosis progression.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eTo our knowledge, this is the first multicenter study to longitudinally evaluate changes in HRQOL during brace treatment using the SJ-27 and to examine how these changes relate to daily brace-wearing time. Our findings can be summarized as follows. First, among female patients with AIS undergoing bracing, pain and discomfort when wearing clothes worsened over a mean follow-up of approximately 2 years; however, overall HRQOL was largely preserved, as indicated by the unchanged SJ-27 total score. Second, in analyses stratified by brace-wearing time using a 12 h/day cutoff, pain and discomfort when wearing clothes worsened regardless of daily brace-wearing time, whereas patients wearing the brace for \u0026ge;\u0026thinsp;12 h/day additionally showed deterioration in appearance-related self-consciousness and a significant worsening of overall HRQOL. Notably, multivariate regression analysis adjusting for age, BMI, scoliosis progression, and skeletal maturity further supported an independent association between \u0026ge;\u0026thinsp;12 h/day bracing and deterioration in the SJ-27 Appearance/self-consciousness domain, Participation/physical activity domain, and total score. Collectively, these findings suggest that longer brace wear (\u0026gt;\u0026thinsp;12 h/day) may be associated with poorer HRQOL, particularly appearance-related self-consciousness and physical activity. Therefore, changes in HRQOL and patients\u0026rsquo; preferences regarding physical activity may be important considerations when discussing recommended brace-wearing time, ideally with ongoing monitoring using disease-specific PRO measures such as the SJ-27.\u003c/p\u003e \u003cp\u003eThe SJ-27 was developed as an AIS-specific instrument for Japanese adolescent girls and has been reported to be useful for identifying patients with moderate scoliosis who may require brace treatment. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] Previous work has also suggested that early HRQOL assessment using the SJ-27 may help identify patients at risk of brace-related psychological distress and facilitate timely support. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] A distinctive strength of the SJ-27 for HRQOL assessment in braced patients is the \u0026ldquo;Discomfort when wearing clothes\u0026rdquo; domain, which may capture brace-specific burden in daily-life that can be underrepresented in more general instruments such as the SRS-22r. This clothing-related discomfort may be particularly important for adolescent girls, in whom interest in fashion and appearance typically increases during adolescence. As expected, female adolescents undergoing brace treatment in this study showed significant worsening in both pain and discomfort when wearing clothes at \u0026gt;\u0026thinsp;1-year follow-up after brace initiation. Notably, these deteriorations were observed regardless of daily brace-wearing time, suggesting that pain and clothing-related discomfort may represent common and, to some extent, unavoidable problems during bracing. Therefore, it may be important to proactively discuss potential issues that may arise during bracing with patients and their families before and during treatment to facilitate timely support. Because these symptoms were not dependent on daily wear duration, mitigation strategies may be needed for all braced patients, including optimization of brace fitting, management of skin irritation and pressure-related problems, guidance on underwear and clothing adaptations, appropriate pain management, and accommodations for school life.\u003c/p\u003e \u003cp\u003eIn contrast, the SJ-27 Cognition/psychological distress and Participation/physical activity domains improved over time in the overall cohort. Although the mechanisms remain unclear, one plausible explanation is that limited curve progression (mean change, 1.5\u0026deg;) and reassurance provided by active treatment may confer psychological and functional benefits for some patients. Communicating these potential positive aspects, while acknowledging brace-related discomfort, may be useful for patient education and could help support adherence to brace treatment.\u003c/p\u003e \u003cp\u003eIn analyses stratified by brace-wearing time using a 12 h/day cutoff, patients in the \u0026ge;\u0026thinsp;12 h/day group showed significant deterioration in appearance-related self-consciousness and overall HRQOL as assessed by the SJ-27. Moreover, multivariate regression analyses demonstrated that brace wear of \u0026ge;\u0026thinsp;12 h/day was significantly associated with worsening in the Appearance/self-consciousness domain, the Participation/physical activity domain, and the total SJ-27 score, independent of baseline patient characteristics and scoliosis progression. One possible explanation for the poorer HRQOL observed in the \u0026ge;\u0026thinsp;12 h/day group is that longer daily brace wear may more often extend into school life and other daytime activities. In contrast to shorter wear schedules, such as night-time bracing, this may increase the day-to-day visibility of the brace and may therefore contribute to greater appearance-related self-consciousness and limitations in physical activity. If higher daily wear-time targets are recommended, strategies to minimize HRQOL burden may include providing counseling to address body image and appearance-related concerns, adjusting wear schedules around school life and other daytime activities where feasible, and setting realistic, lifestyle-compatible wear-time goals through shared decision-making with patients and their families.\u003c/p\u003e \u003cp\u003eWhen comparing our results with previous studies on brace-wearing time and HRQOL, our findings are consistent with the report by Peiro-Garcia \u003cem\u003eet al\u003c/em\u003e., who compared full-time and night-time bracing and found comparable deformity-control outcomes, whereas HRQOL assessed by the SRS-22r was more favorable in the night-time group, which entails a shorter daily wear time. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] In contrast, Asada \u003cem\u003eet al\u003c/em\u003e. reported that objectively monitored brace-wearing time did not significantly affect brace-related psychological stress during the first year of treatment, as assessed by the Japanese version of the Bad Sobernheim Stress Questionnaire-brace (JBSSQ-brace), which differs from our findings. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] One possible reason for this discrepancy is that Asada \u003cem\u003eet al\u003c/em\u003e. focused on changes in brace-related psychological stress within 1 year, whereas we examined changes in disease-specific HRQOL assessed by the SJ-27 over a mean follow-up of approximately 2 years. Another possible reason is differences in the assessment and timing of wear-time measurement (objective thermal sensor monitoring early after brace initiation vs. patient-reported wear time at follow-up). Future studies incorporating objective wear-time monitoring, longer follow-up, and post-bracing HRQOL assessments may further clarify how wear-time prescriptions can be optimized to balance curve control with HRQOL.\u003c/p\u003e \u003cp\u003eThe present study has several limitations. First, brace-wearing time was assessed by patient self-report using categorical responses at follow-up rather than by continuous, objectively monitored wear-time data (e.g., thermal sensors); therefore, wear-time estimates may have been imprecise. Second, because this was an observational study and brace-wearing time was not randomly assigned, causal relationships between longer brace wear and HRQOL changes cannot be established. Although multivariate regression analyses were performed, residual confounding may remain, particularly because baseline characteristics differed between the \u0026lt;\u0026thinsp;12 h/day and \u0026ge;\u0026thinsp;12 h/day groups and other potentially relevant factors, including individual psychological and behavioral characteristics that may influence both adherence to brace wear and perception of brace-related burden, were not assessed. Third, this registry-based cohort included only patients with available baseline and follow-up data during ongoing brace treatment; therefore, patients who discontinued bracing, completed brace treatment, transitioned to surgery, or were lost to follow-up may have been underrepresented, potentially leading to underestimation of HRQOL burden and curve progression in the broader braced population. Fourth, this study lacked a non-braced control group, and brace type was not standardized across institutions; therefore, changes in HRQOL cannot be attributed exclusively to bracing, and differences in brace design, fit, and clinical management may have influenced both HRQOL and radiographic outcomes. Fifth, follow-up was defined as \u0026gt;\u0026thinsp;1-year after brace initiation, with a mean duration of approximately 2 years, and longer-term outcomes, including HRQOL after brace discontinuation, were not assessed. Finally, the study did not include other commonly used outcome measures (e.g., SRS-22r or JBSSQ-brace), did not assess some potentially relevant clinical factors related to scoliosis progression, such as menarche timing, and, because the SJ-27 is a female-specific instrument, the findings may not be generalizable to male patients with AIS. Future prospective studies designed to address these limitations are warranted.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur study showed that brace treatment was associated with worsening pain and discomfort when wearing clothes as assessed by the SJ-27; however, psychological distress and physical activity domains improved over time, resulting in largely preserved overall HRQOL. In contrast, longer daily brace wear (\u0026ge;\u0026thinsp;12 h/day) was associated with poorer overall HRQOL, including appearance-related self-consciousness. Moreover, \u0026ge; 12 h/day bracing was significantly associated with worsening in appearance-related self-consciousness, participation/physical activity, and overall HRQOL, independent of scoliosis progression. These findings suggest that, in braced female patients with AIS, changes in HRQOL should be considered when discussing wear-time targets and patient education.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAIS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAdolescent idiopathic scoliosis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBody mass index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBrAIST\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBracing in Adolescent Idiopathic Scoliosis Trial\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBrQ\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBrace Questionnaire\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBSSQ\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBad Sobernheim Stress Questionnaire\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHRQOL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHealth-related quality of life\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eJBSSQ-brace\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eJapanese version of the Bad Sobernheim Stress Questionnaire-Brace\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePedsQL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePediatric Quality of Life Inventory\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePRO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePatient-reported outcome\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSRS-22r\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRevised version of the Scoliosis Research Society-22\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSJ-27\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eScoliosis Japanese Questionnaire-27.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003eWritten informed consent was obtained from all participants and/or their legal guardians before enrollment, and assent was obtained from the participants when appropriate. The study protocol was reviewed and approved by the institutional review board of the Japanese Scoliosis Society, and by the Ethics Committee of Jichi Medical University, the lead institution for this study (approval no. 21\u0026ndash;123), and by the ethics committees of all participating institutions.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eAuthor details\u003c/h2\u003e \u003cp\u003e\u0026sup1; Department of Orthopaedic Surgery, Tokyo Women\u0026rsquo;s Medical University, 8\u0026thinsp;\u0026minus;\u0026thinsp;1 Kawada-cho, Shinjuku-ku, Tokyo, Japan.\u003c/p\u003e \u003cp\u003e\u0026sup2; Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.\u003c/p\u003e \u003cp\u003e\u0026sup3; Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13\u0026thinsp;\u0026minus;\u0026thinsp;1 Takara-machi, Kanazawa, Ishikawa, Japan.\u003c/p\u003e \u003cp\u003e⁴ Niigata Spine Surgery Center, Kameda Daiichi Hospital, 2-5-22 Nishi-machi, Konan-ku, Niigata, Japan.\u003c/p\u003e \u003cp\u003e⁵ Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan.\u003c/p\u003e \u003cp\u003e⁶ Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan.\u003c/p\u003e \u003cp\u003e⁷ Department of Orthopaedic Surgery, Seirei Sakura Citizen Hospital, 2-36-2 Ebaradai, Sakura, Chiba, Japan.\u003c/p\u003e \u003cp\u003e⁸ Scoliosis Center, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, Japan.\u003c/p\u003e \u003cp\u003e⁹ Department of Orthopaedic Surgery, Niigata University Medical and Dental Sciences, 757 Ichibancho, Asahimachi-dori, Chuo-ku, Niigata, Japan.\u003c/p\u003e \u003cp\u003e\u0026sup1;⁰ Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-ku, Hamamatsu, Shizuoka, Japan.\u003c/p\u003e \u003cp\u003e\u0026sup1;\u0026sup1; Department of Orthopaedic Surgery, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan.\u003c/p\u003e \u003cp\u003e\u0026sup1;\u0026sup2; Department of Orthopaedic Surgery, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo, Japan.\u003c/p\u003e \u003cp\u003e \u0026sup1;\u0026sup3; Spine Surgery Center, Japan Community Health Care Organization Sendai Hospital, 2-1-1 Murasakiyama, Izumi-ku, Sendai, Miyagi, Japan.\u003c/p\u003e \u003cp\u003e\u0026sup1;⁴ Department of Orthopaedic Surgery, University of Toyama, 2630 Sugitani, Toyama, Japan.\u003c/p\u003e \u003cp\u003e\u0026sup1;⁵ Department of Orthopaedic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga-gun, Tochigi, Japan.\u003c/p\u003e \u003cp\u003e\u0026sup1;⁶ Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eNo funds were received in support of this work.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eTD (corresponding author) designed the research, analyzed the data, and wrote the manuscript. YT contributed to manuscript writing and revision. YT, SK, SD, KW, HO, TA, TK, YH, AM, TN, MO, HTa, TB, HA, YY, ST, HTe, TT, RS, ShS, HU, SaS, and NH collected the data and supervised the study. KO supervised the study. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eThe authors thank all the orthopedic surgeons, their staff, and the patients who willingly participated in this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCheng JC, Castelein RM, Chu WC, Danielsson AJ, Dobbs MB, Grivas TB, Gurnett CA, Luk KD, Moreau A, Newton PO, et al. Adolescent idiopathic scoliosis. Nat Rev Dis Primers. 2015;1:15030.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeinstein SL, Dolan LA, Cheng JC, Danielsson A, Morcuende JA. Adolescent idiopathic scoliosis. Lancet. 2008;371(9623):1527\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeinstein SL, Dolan LA, Wright JG, Dobbs MB. Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med. 2013;369(16):1512\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang H, Tetteroo D, Arts JJC, Markopoulos P, Ito K. Quality of life of adolescent idiopathic scoliosis patients under brace treatment: a brief communication of literature review. Qual Life Res. 2021;30(3):703\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchwieger T, Campo S, Weinstein SL, Dolan LA, Ashida S, Steuber KR. Body Image and Quality-of-Life in Untreated Versus Brace-Treated Females With Adolescent Idiopathic Scoliosis. Spine (Phila Pa 1976). 2016;41(4):311\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeiro-Garcia A, Garcia RG, Martin-Gorgojo V, Vilalta-Vidal I, Gonzalez-Gonzalez L, Martin-Moreno JM, Silvestre-Munoz A. Impact on Quality of Life of Full-time and Night-time Braces in Adolescent Idiopathic Scoliosis: A Randomized Clinical Trial. Spine (Phila Pa 1976). 2025;50(4):231\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAsada T, Kotani T, Sakuma T, Iijima Y, Nakayama K, Inage K, Shiga Y, Akazawa T, Minami S, Ohtori S, et al. 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. Spine Surg Relat Res. 2023;7(4):377\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAsada T, Kotani T, Sakuma T, Iijima Y, Sakashita K, Ogata Y, Akazawa T, Minami S, Ohtori S, Koda M, et al. 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Effectiveness of Orthotic Treatment on Clinical Outcomes of the Patients with Adolescent Idiopathic Scoliosis Under Different Wearing Compliance Levels: A Systematic Review. JBJS Rev. 2023;11(10):e2300110.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRivett L, Rothberg A, Stewart A, Berkowitz R. The relationship between quality of life and compliance to a brace protocol in adolescents with idiopathic scoliosis: a comparative study. BMC Musculoskelet Disord. 2009;10:5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWatanabe K, Lenke LG, Bridwell KH, Hasegawa K, Hirano T, Endo N, Cheh G, Kim YJ, Hensley M, Stobbs G, et al. Cross-cultural comparison of the Scoliosis Research Society Outcomes Instrument between American and Japanese idiopathic scoliosis patients: are there differences? 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J Orthop Sci. 2021;26(6):974\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim HS, Kim K, Cho YJ, Goh TS, Lee JS. Validation of the Scoliosis Japanese Questionnaire-27 in Korean patients with adolescent idiopathic scoliosis. J Clin Neurosci. 2024;129:110830.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKuru Colak T, Apti A, Colak I, Akcay B, Dereli EE. Translation, reliability and validity of the Turkish version of Scoliosis Japanese Questionnaire-27 in adolescent idiopathic scoliosis. Spine Deform. 2023;11(5):1049\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDoi T, Watanabe K, Doi T, Inoue H, Sugawara R, Arai Y, Shirado O, Yamazaki K, Uno K, Yanagida H, et al. Associations between curve severity and revised Scoliosis Research Society-22 and scoliosis Japanese Questionnaire-27 scores in female patients with adolescent idiopathic scoliosis: a multicenter, cross-sectional study. BMC Musculoskelet Disord. 2021;22(1):312.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAsada T, Kotani T, Sakuma T, Iijima Y, Sakashita K, Ogata Y, Minami S, Ohtori S, Koda M, Yamazaki M. Impact of Baseline HRQOL on Brace-Related Stress in Female Patients with Adolescent Idiopathic Scoliosis: A Longitudinal Retrospective Study. Spine Surg Relat Res. 2025;9(6):682\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNegrini S, Donzelli S, Aulisa AG, Czaprowski D, Schreiber S, de Mauroy JC, Diers H, Grivas TB, Knott P, Kotwicki T, et al. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis Spinal Disord. 2018;13:3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNegrini S, Hresko TM, O'Brien JP, Price N, Boards S, Committee SRSN-O. Recommendations for research studies on treatment of idiopathic scoliosis: Consensus 2014 between SOSORT and SRS non-operative management committee. Scoliosis. 2015;10:8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRichards BS, Bernstein RM, D'Amato CR, Thompson GH. Standardization of criteria for adolescent idiopathic scoliosis brace studies: SRS Committee on Bracing and Nonoperative Management. Spine (Phila Pa 1976). 2005;30(18):2068\u0026ndash;75. discussion 2076\u0026thinsp;\u0026ndash;\u0026thinsp;2067.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHeegaard M, Tondevold N, Dahl B, Andersen TB, Gehrchen M, Ohrt-Nissen S. Does Risser stage accurately predict the risk of curve progression in patients with adolescent idiopathic scoliosis treated with night-time bracing? Eur Spine J. 2023;32(9):3077\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSato M, Ohashi M, Tashi H, Makino T, Shibuya Y, Hirano T, Watanabe K. Association of success of brace treatment and various aspects of in-brace correction in patients with adolescent idiopathic scoliosis. J Orthop Sci. 2023;28(6):1221\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSakashita K, Asada T, Kotani T, Sakuma T, Iijima Y, Ogata Y, Okuwaki S, Ohyama S, Mizutani M, Akazawa T, et al. Skeletal Maturity, Brace Compliance, and In-Brace Correction Rate Are Important Factors Associated with Cobb Angle Progression after Brace Treatment in Patients with Adolescent Idiopathic Scoliosis. Spine Surg Relat Res. 2025;9(5):539\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKatz DE, Herring JA, Browne RH, Kelly DM, Birch JG. Brace wear control of curve progression in adolescent idiopathic scoliosis. J Bone Joint Surg Am. 2010;92(6):1343\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKonieczny MR, Hieronymus P, Krauspe R. Time in brace: where are the limits and how can we improve compliance and reduce negative psychosocial impact in patients with scoliosis? A retrospective analysis. Spine J. 2017;17(11):1658\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"adolescent idiopathic scoliosis, bracing, brace-wearing time, health-related quality of life, patient-reported outcome measure, Scoliosis Japanese Questionnaire (SJ-27)","lastPublishedDoi":"10.21203/rs.3.rs-9102080/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9102080/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eBrace treatment is the only evidence-based effective conservative therapy for adolescent idiopathic scoliosis (AIS). However, the relationship between brace treatment and health-related quality of life (HRQOL), and the extent to which brace-wearing time is associated with HRQOL, remain unclear. This study investigated longitudinal changes in HRQOL, assessed using the Scoliosis Japanese Questionnaire-27 (SJ-27) and their association with daily brace-wearing time.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis multicenter observational cohort study included 179 female patients with AIS undergoing brace treatment. Daily brace-wearing time at follow-up (\u0026gt;\u0026thinsp;1-year after brace initiation) was assessed by questionnaire and categorized using a 12 h/day cutoff (\u0026lt;\u0026thinsp;12 vs. \u0026ge; 12 h/day). In the overall cohort and in each brace-wearing time group, the major Cobb angle and SJ-27 scores (Pain, Discomfort when wearing clothes, Cognition/psychological distress, Appearance/self-consciousness, Participation/physical activity, and total score) were compared between baseline and follow-up. Multivariate regression analyses were performed to examine the association between brace-wearing time and changes (Δ) in HRQOL as assessed by the SJ-27.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe mean follow-up duration was 24.7 months. In the overall cohort, the SJ-27 Pain and Discomfort when wearing clothes domain scores worsened, whereas the Cognition/psychological distress and Participation/physical activity domain scores improved; the total SJ-27 score showed no significant change. In analyses stratified by brace-wearing time (\u0026lt;\u0026thinsp;12 vs. \u0026ge; 12 h/day), neither group showed a significant change in the major Cobb angle from baseline to follow-up. Pain and clothing-related discomfort worsened regardless of wear time, whereas the \u0026ge;\u0026thinsp;12 h/day group additionally showed deterioration in the Appearance/self-consciousness domain and the total score. In multivariate analysis, \u0026ge; 12 h/day bracing was independently associated with worsening in ΔAppearance (p\u0026thinsp;=\u0026thinsp;0.017), ΔParticipation (p\u0026thinsp;=\u0026thinsp;0.036), and ΔTotal score (p\u0026thinsp;=\u0026thinsp;0.033).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eDuring brace treatment, pain and clothing-related discomfort worsened, whereas overall HRQOL was largely preserved. Longer daily brace wear (\u0026ge;\u0026thinsp;12 h/day) was independently associated with deterioration in appearance-related self-consciousness, physical activity, and overall HRQOL. These findings suggest that, in braced female patients with AIS, changes in HRQOL should be considered when discussing wear-time targets during follow-up.\u003c/p\u003e","manuscriptTitle":"Association of Brace-Wearing Time With Changes in Health-Related Quality of Life Assessed by the Scoliosis Japanese Questionnaire-27 in Braced Female Adolescents With Idiopathic Scoliosis: A Multicenter Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-14 16:05:28","doi":"10.21203/rs.3.rs-9102080/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-14T16:01:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"126777342864790225797865359632628519389","date":"2026-04-08T12:00:34+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-07T15:20:29+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-13T18:23:16+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-13T03:09:50+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-13T03:09:41+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Musculoskeletal Disorders","date":"2026-03-12T08:16:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fa0d7fa3-2583-4094-bbab-6eaafa8a2af0","owner":[],"postedDate":"April 14th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-14T16:05:28+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-14 16:05:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9102080","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9102080","identity":"rs-9102080","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}