Quality of life and mental health in adolescents with idiopathic scoliosis undergoing brace treatment: a systematic review and pooled analysis of quantitative studies.

INTRODUCTION: Adolescent idiopathic scoliosis (AIS) is the most common paediatric spinal deformity. While bracing limits curve progression, its psychological and social effects remain unclear. This review and pooled analysis evaluate bracing's impact on quality of life (QoL) and mental health in AIS. METHODS: Searches were conducted in MEDLINE, EMBASE and PsycINFO (Dec 2024). Quantitative studies involving AIS patients undergoing brace treatment were included. Primary outcomes were QoL scores and reported mental health impact, assessed using validated tools. Risk of bias was assessed. A narrative synthesis was completed, with a pooled analysis to show effect sizes. RESULTS: The searches identified 78 studies. A narrative review of the QoL questionnaires in cross-sectional studies, cohort studies and comparisons of brace treatment versus observation in AIS patients found mild and often non-statistically significant reduction in psychological well-being, more social difficulties, impaired physical functioning, more discomfort and lower self-image. These changes were often transient, improving or stabilising during bracing and mostly resolving after brace treatment. Longer brace prescriptions (more hours per day) and bulkier brace designs were negative factors. Family support, brace adherence and bracing success seemed to have a positive effect. Studies comparing brace treatment with surgery found surgically treated patients had mild and often non-statistically significantly improved QoL, self-image and psychological well-being but reduced satisfaction. Most studies showed a moderate risk of bias. The review included a pooled analysis of 51 studies using SRS-22 (n = 4193) with an overall, mean SRS-22 score during bracing of 4.05 (95% CI: 3.96, 4.13). Comparing bracing with observation (8 studies, n = 2374) shows a small QoL difference favouring no bracing (pooled effect size: - 0.11; 95% CI: - 0.21, 0.00), with extreme heterogeneity (I2 = 83%). CONCLUSION: Bracing generally resulted in lower scores for psychological issues, physical and social function and self-image compared to no treatment. Overall pooled differences were small and braced patients retained good QoL. Long-term data suggest improvement after brace treatment completion. Given high heterogeneity and risk of bias, high-quality research is needed to better evaluate psychosocial outcomes during and after AIS bracing including confounding factors and factors that may improve QoL. LEVEL OF EVIDENCE: IV (systematic review of level IV studies).