**1. Introduction**

Surgery is the only form of treatment currently offered by the United Kingdom National Health Service (NHS) as standard care for adults who develop scoliosis. However, this treatment method has associated risks, such as trauma to the body, substantial blood loss and a high complication rate [1]. Operative treatment for adult lumbar scoliosis has a complication rate ranging between 56 and 75% with an 18–58% re-operative rate [2]. Compared to adolescents, adults and older adults who develop scoliosis have a greater risk of suffering from surgical complications due to age, as degenerative scoliosis predominantly develops in older adults.

An alternative method of treatment to surgery is bracing. There are several types of braces used to treat adults with scoliosis; the most frequently used brace is the thoracolumbar-sacral orthoses (TLSO). This type of brace is a two-piece plastic brace that is required to be worn full time [3]. One type of TLSO brace is the Boston

brace. This brace is made from prefabricated polypropylene material and is used to treat deformities that range from spinal regions T5 to L4 [4, 5]. Most braces are made up from at least one rigid component that affects the overall comfort and hence the efficacy of the brace. Additionally, most braces require a wearing time in excess of 12 hours, which has the potential to have an impact on wearers' lives.

This mixed methods study evaluated both the subjective patients' views of the effectiveness of the soft brace as well as the objective results of brace effectiveness [6]. The brace encourages corrective movements in the spine through manipulation using soft flexible bands, which are altered on a regular basis depending on the progress of the individual. The brace is made up from three individual sections: pelvic shorts, a body jacket and elastic corrective bands. The pelvic shorts act as an anchor and attachment point for the elastic corrective bands with the jacket acting as the second attaching point. The bands are designed to encourage spinal correction by reactivating (pulling the muscles back into the correct position and training the muscles to stay in that position) the spinal muscles. Furthermore, the brace aims to improve the patients' coronal and sagittal plane balance through the use of the corrective elastic bands as past research has indicated that an improvement in the coronal and sagittal plane can lead to an improvement in pain and/or functionality [7, 8].

To our knowledge, this is the first study to explore the experiences of wearing a spinal brace in a group of older adults with degenerative scoliosis using a qualitative design as previously this type of brace has only been used on adolescents [9–12]. The practicalities of the brace design for adults were unknown. Therefore, the use of a qualitative data collection method allowed for this new information to be gathered. For these reasons, it was decided that semi-structured interviews would provide a deeper understanding of the issues faced by patients with scoliosis than quantitative data by providing a much richer in-depth account and would allow the participants to give detailed descriptions of their experiences of living with scoliosis and wearing the brace [13].

Only two previous studies have examined the views of patients regarding the impact of scoliosis on their lives. Schwab et al. [14] in 2003 reported a self-assessment of 49 patients, 22 of whom had adolescent onset scoliosis and 27 patients who had degenerative scoliosis. Participants had a mean age of 63. The main aim of their study was to investigate the impact scoliosis had on health. They found that when comparing the SF-36 questionnaire data between patients with adult scoliosis against adults who experienced lower back pain, those with scoliosis had significantly higher perceptions of their health than those who had lower back pain. One of the main limitations of this study was that 22 of the patients had adult idiopathic scoliosis and their analysis did not differentiate between the two groups.

The second paper investigated individuals' self-assessment of their healthrelated quality of life when living with scoliosis [15]. The scores on the SF-36 and the Walter Reed Visual Assessment Scale questionnaires (WRVAS) were collected on 71 individuals who had an age range of 17–66, with a mean age of 33. They concluded that on both the SF-36 and WRVAS, older adults reported more pain than younger ones. However, one of the main issues with the study was that no Cobb angle measurements were taken; this is a limitation as previous research [16] has shown that there are correlations between an individual's Cobb angle and selfassessment. The second limitation is related to the ratio of gender in the sample: of the 71 participants, only 13 were male.

All other papers we found focused upon adult idiopathic scoliosis or solely operative management methods to treat scoliosis and therefore were not relevant to this study. Although the two papers described above did not present qualitative accounts, they are based on the self-assessment of living with scoliosis. The primary *A Mixed Methods Study of the Experiences and Effectiveness of a Soft Brace for Adults… DOI: http://dx.doi.org/10.5772/intechopen.92387*

aim of this study was to explore patients' experiences of living with scoliosis using a qualitative approach. The secondary aims of the study were to evaluate patient perceptions of wearing a soft spinal brace and to explore the functionality and practicalities of wearing this type of brace.
