Stigmatization negatively affects exercise compliance in children with adolescent idiopathic scoliosis: a cross-sectional study.

Objective: Adolescent Idiopathic Scoliosis (AIS) is a spinal deformity that can impact both physical and psychosocial well-being. Stigmatization, particularly during adolescence, may influence adherence to conservative treatment strategies, including exercise therapy. This study examines the relationship between scoliosis-related stigma and adherence to exercise therapy in AIS patients.

Methods: This cross-sectional study included 88 AIS patients (mean age: 14.8 ± 2.5 years; 77.3% female) who were receiving conservative treatment. Only patients enrolled in a physiotherapeutic scoliosis-specific exercise program as part of their routine follow-up were included. Exercise adherence was classified based on the frequency of weekly home exercise sessions and patients' self-reported regularity. Adherence was defined as exercising at least three days per week and rating adherence as 'Moderately regular,' 'Quite regular,' or 'Completely regular'. Scoliosis-related stigma was assessed using the Adolescent Idiopathic Scoliosis Stigma Assessment Scale (AIS-SAS). Statistical analyses included Mann-Whitney U tests, chi-square tests, and multivariate logistic regression.

Results: Exercise non-adherence was identified in 68.2% of patients. Non-adherent participants had significantly higher scoliosis-related stigma scores (median: 9.7 vs. 5.6, p = 0.014) and brace-related stigma scores (median: 40.0 vs. 25.0, p = 0.016). Patients receiving both bracing and exercise therapy reported higher scoliosis-related stigma scores than those receiving exercise alone (p = 0.004). Among patients receiving bracing, stigma scores were significantly higher in those who did not wear the brace for the recommended duration (p = 0.043 for scoliosis-related stigma, p = 0.019 for brace-related stigma). Multivariate logistic regression showed that both scoliosis-related stigma (p = 0.015, OR = 1.107) and brace treatment (p = 0.041, OR = 3.225) were significant predictors of non-adherence.

Conclusion: Perceived stigmatization may contribute to exercise non-adherence in adolescents with AIS. Increasing awareness and supportive interventions could enhance treatment success and quality of life. Longitudinal studies are needed to clarify causality and explore other psychosocial factors.