Abstract
Objectives
Bracing is the primary treatment for preventing spine curve progression and the subsequent need for surgery among patients with adolescent idiopathic scoliosis (AIS), and poor bracing compliance is a major factor limiting its treatment benefits. We compared the effectiveness of a mindfulness-based intervention program called MBrace, which is a shorter version of the Mindfulness-Based Stress Reduction program, versus that of a supervised physiotherapy exercise (PE) program in enhancing bracing compliance among AIS patients followed for eight months.
Method
Eighty-three AIS patients with unsatisfactory bracing compliance (< 18 hr/day) were randomly allocated to MBrace (n = 45) or PE (n = 38) program. The primary outcome was bracing compliance at Month 8 (six months post-intervention). Secondary outcomes included validated inventory of quality-of-life measures, self-compassion, emotion regulation, self-efficacy, stress, and mindfulness level at Month 2 (end of intervention) and Month 8.
Results
Although bracing compliance was considerably improved in the MBrace program group compared with control at Month 8 (difference in changes between-group (DD), 1.64 hr/day; 95% confidence interval (CI), − 0.25 to 3.53 hr/day; p = 0.09), statistical significance was achieved only after the exclusion of outliers (DD, 2.27 hr/day; 95% CI, 0.49–4.05 hr/day; p = 0.01). At Month 2, a significant treatment effect was estimated both with and without the exclusion of outliers. No significant between-group differences were observed in other secondary outcomes.
Conclusions
Mindfulness-based interventions may be effective to improve bracing compliance among AIS patients in the short term. Larger randomized controlled trials with longer follow-up durations are needed to confirm the long-term effects of mindfulness-based interventions.
Trial Registration
Chinese Clinical Trial Register (ChiCTR), ChiCTR-IOR-16010299.
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Data Availability
The de-identified data for this study is available at the Open Science Framework (https://osf.io/5vqhz/).
References
Amann, M., Subudhi, A. W., & Foster, C. (2006). Predictive validity of ventilatory and lactate thresholds for cycling time trial performance. Scandinavian Journal of Medicine & Science in Sports, 16(1), 27–34. https://doi.org/10.1111/j.1600-0838.2004.00424.x
Asher, M., Min Lai, S., Burton, D., & Manna, B. (2003). Discrimination validity of the scoliosis research society-22 patient questionnaire: Relationship to idiopathic scoliosis curve pattern and curve size. Spine (Phila Pa 1976), 28(1), 74–78. https://doi.org/10.1097/00007632-200301010-00017
Bates, D., Mächler, M., Bolker, B., & Walker, S. (2015). Fitting linear mixed-effects models using lme4. Journal of Statistical Software, 67(1), 1–48. https://doi.org/10.18637/jss.v067.i01
Ben-Shachar, M. S., Lüdecke, D., & Makowski, D. (2020). Effectsize: Estimation of effect size indices and standardized parameters. Journal of Open Source Software, 5(56), 2815. https://doi.org/10.21105/joss.02815
Bluth, K., & Blanton, P. W. (2014). Mindfulness and self-compassion: Exploring pathways to adolescent emotional well-being. Journal of Child and Family Studies, 23(7), 1298–1309. https://doi.org/10.1007/s10826-013-9830-2
Carmody, J. (2009). Evolving conceptions of mindfulness in clinical settings. Journal of Cognitive Psychotherapy, 23(3), 270–280. https://doi.org/10.1891/0889-8391.23.3.270
Cheng, J. C., Castelein, R. M., Chu, W. C., Danielsson, A. J., Dobbs, M. B., Grivas, T. B., Gurnett, C. A., Luk, K. D., Moreau, A., Newton, P. O., Stokes, I. A., Weinstein, S. L., & Burwell, R. G. (2015). Adolescent idiopathic scoliosis. Nature Reviews Disease Primers, 1(1), 15030. https://doi.org/10.1038/nrdp.2015.30
Cheung, K. M. C., Senkoylu, A., Alanay, A., Genc, Y., Lau, S., & Luk, K. D. (2007). Reliability and concurrent validity of the adapted Chinese version of Scoliosis Research Society-22 (SRS-22) Questionnaire. Spine (Phila Pa 1976), 32(10), 1141–1145. https://doi.org/10.1097/01.brs.0000261562.48888.e3
Cheung, P. W. H., Wong, C. K. H., Samartzis, D., Luk, K. D. K., Lam, C. L. K., Cheung, K. M. C., & Cheung, J. P. Y. (2016). Psychometric validation of the EuroQoL 5-dimension 5-level (EQ-5D-5L) in Chinese patients with adolescent idiopathic scoliosis. Scoliosis and Spinal Disorders, 11(1), 19. https://doi.org/10.1186/s13013-016-0083-x
Cheung, M.-C., Law, D., Yip, J., & Cheung, J. P. (2022). Adolescents’ experience during brace treatment for scoliosis: A qualitative study. International Journal of Environmental Research and Public Health, 19(17), 10585. https://doi.org/10.3390/ijerph191710585
Chiesa, A., Calati, R., & Serretti, A. (2011). Does mindfulness training improve cognitive abilities? A systematic review of neuropsychological findings. Clinical Psychology Review, 31(3), 449–464. https://doi.org/10.1016/j.cpr.2010.11.003
Cladder-Micus, M. B., Speckens, A. E. M., Vrijsen, J. N. T., Donders, A. R., Becker, E. S., & Spijker, J. (2018). Mindfulness-based cognitive therapy for patients with chronic, treatment-resistant depression: A pragmatic randomized controlled trial. Depression and Anxiety, 35(10), 914–924. https://doi.org/10.1002/da.22788
Cohen, J. (2013). Statistical power analysis for the behavioral sciences. Routledge.
Diarbakerli, E., Grauers, A., Danielsson, A., & Gerdhem, P. (2018). Health-related quality of life in adulthood in untreated and treated individuals with adolescent or juvenile idiopathic scoliosis. The Journal of Bone and Joint Surgery, 100(10), 811–817. https://doi.org/10.2106/JBJS.17.00822
Donzelli, S., Zaina, F., & Negrini, S. (2012). In defense of adolescents: They really do use braces for the hours prescribed if good help is provided Results from a prospective everyday clinic cohort using thermobrace. Scoliosis, 7(1), 12–12. https://doi.org/10.1186/1748-7161-7-12
Dunning, D. L., Griffiths, K., Kuyken, W., Crane, C., Foulkes, L., Parker, J., & Dalgleish, T. (2019). Research review: The effects of mindfulness-based interventions on cognition and mental health in children and adolescents – A meta-analysis of randomized controlled trials. Journal of Child Psychology and Psychiatry, 60(3), 244–258. https://doi.org/10.1111/jcpp.12980
García-Botello, S. A., García-Granero, E., Lillo, R., López-Mozos, F., Millán, M., & Lledó, S. (2006). Randomized clinical trial to evaluate the effects of perioperative supplemental oxygen administration on the colorectal anastomosis. British Journal of Surgery, 93(6), 698–706. https://doi.org/10.1002/bjs.5370
Hasler, C. C., Wietlisbach, S., & Büchler, P. (2010). Objective compliance of adolescent girls with idiopathic scoliosis in a dynamic SpineCor brace. Journal of Children’s Orthopaedics, 4(3), 211–218. https://doi.org/10.1007/s11832-010-0249-7
Hawary, R. E., Zaaroor-Regev, D., Floman, Y., Lonner, B. S., Alkhalife, Y. I., & Betz, R. R. (2019). Brace treatment in adolescent idiopathic scoliosis: Risk factors for failure—A literature review. The Spine Journal, 19(12), 1917–1925. https://doi.org/10.1016/j.spinee.2019.07.008
Helenius, L., Diarbakerli, E., Grauers, A., Lastikka, M., Oksanen, H., Pajulo, O., Löyttyniemi, E., Manner, T., Gerdhem, P., & Helenius, I. (2019). Back pain and quality of life after surgical treatment for adolescent idiopathic scoliosis at 5-year follow-up: Comparison with healthy controls and patients with untreated idiopathic scoliosis. The Journal of Bone and Joint Surgery, 101(16), 1460–1466. https://doi.org/10.2106/jbjs.18.01370
Hou, J., Wong, S.Y.-S., Lo, H.H.-M., Mak, W.W.-S., & Ma, H.S.-W. (2014a). Validation of a Chinese version of the Five Facet Mindfulness Questionnaire in Hong Kong and development of a short form. Assessment, 21(3), 363–371. https://doi.org/10.1177/1073191113485121
Hou, R. J., Wong, S. Y. S., Yip, B. H. K., Hung, A. T. F., Lo, H. H. M., Chan, P. H. S., Lo, C. S. L., Kwok, T. C. Y., Tang, W. K., Mak, W. W. S., Mercer, S. W., & Ma, S. H. (2014b). The effects of mindfulness-based stress reduction program on the mental health of family caregivers: A randomized controlled trial. Psychotherapy and Psychosomatics, 83(1), 45–53. https://doi.org/10.1159/000353278
Johannsen, M., O’Connor, M., O’Toole, M. S., Jensen, A. B., Højris, I., & Zachariae, R. (2016). Efficacy of mindfulness-based cognitive therapy on late post-treatment pain in women treated for primary breast cancer: A randomized controlled trial. Journal of Clinical Oncology, 34(28), 3390–3399. https://doi.org/10.1200/JCO.2015.65.0770
Jones, C. J., Smith, H., & Llewellyn, C. (2014). Evaluating the effectiveness of health belief model interventions in improving adherence: A systematic review. Health Psychology Review, 8(3), 253–269. https://doi.org/10.1080/17437199.2013.802623
Jones, C. J., Smith, H. E., & Llewellyn, C. D. (2016). A systematic review of the effectiveness of interventions using the common sense self-regulatory model to improve adherence behaviours. Journal of Health Psychology, 21(11), 2709–2724. https://doi.org/10.1177/1359105315583372
Kabat-Zinn, J. (2013). Full catastrophe living, revised edition: How to cope with stress, pain and illness using mindfulness meditation. Hachette UK.
Karol, L. A., Virostek, D., Felton, K., & Wheeler, L. (2016). Effect of compliance counseling on brace use and success in patients with adolescent idiopathic scoliosis. The Journal of Bone and Joint Surgery, 98(1). https://doi.org/10.2106/JBJS.O.00359
Khan, A., Tansel, A., White, D. L., Kayani, W. T., Bano, S., Lindsay, J., El-Serag, H. B., & Kanwal, F. (2016). Efficacy of psychosocial interventions in inducing and maintaining alcohol abstinence in patients with chronic liver disease: A systematic review. Clinical Gastroenterology and Hepatology, 14(2), 191-202.e194. https://doi.org/10.1016/j.cgh.2015.07.047
Kwok, J. Y. Y., Kwan, J. C. Y., Auyeung, M., Mok, V. C. T., Lau, C. K. Y., Choi, K. C., & Chan, H. Y. L. (2019). Effects of mindfulness yoga vs stretching and resistance training exercises on anxiety and depression for people with parkinson disease: A randomized clinical trial. JAMA Neurology, 76(7), 755–763. https://doi.org/10.1001/jamaneurol.2019.0534
Lau, N.-S., & Hue, M.-T. (2011). Preliminary outcomes of a mindfulness-based programme for Hong Kong adolescents in schools: Well-being, stress and depressive symptoms. International Journal of Children’s Spirituality, 16(4), 315–330. https://doi.org/10.1080/1364436X.2011.639747
Leung, D. Y. P., Lam, T.-H., & Chan, S. S. C. (2010). Three versions of Perceived Stress Scale: Validation in a sample of Chinese cardiac patients who smoke. BMC Public Health, 10(1), 513. https://doi.org/10.1186/1471-2458-10-513
Li, M., Wang, C.-F., Gu, S.-X., He, S.-S., Zhu, X.-D., Zhao, Y.-C., & Zhang, J.-T. (2009). Adapted simplified Chinese (mainland) version of Scoliosis Research Society-22 questionnaire. Spine, 34(12), 1321–1324. https://doi.org/10.1097/BRS.0b013e31819812b7
Lin, J., Chadi, N., & Shrier, L. (2019). Mindfulness-based interventions for adolescent health. Current Opinion in Pediatrics, 31(4), 469–475. https://doi.org/10.1097/mop.0000000000000760
Lin, Y., Lou, E., Lam, T. P., Cheng, J. C. Y., Sin, S. W., Kwok, W. K., & Wong, M. S. (2020). The intelligent automated pressure-adjustable orthosis for patients with adolescent idiopathic scoliosis: A bi-center randomized controlled trial. Spine (Phila Pa 1976), 45(20), 1395–1402. https://doi.org/10.1097/BRS.0000000000003559
Liu, W., Chen, L., & Tu, X. (2017). Chinese adaptation of Emotion Regulation Questionnaire for Children and Adolescents (ERQ-CCA): A psychometric evaluation in Chinese children. International Journal of Psychology, 52(5), 398–405. https://doi.org/10.1002/ijop.12233
Liu, S., Zhou, G., Xu, N., Mai, S., Wang, Q., Zeng, L., Du, C., Du, Y., Zeng, Y., Yu, M., & Liu, Z. J. T. P. (2021). Translation and validation of the Chinese version of Brace Questionnaire (BrQ). Translational Pediatrics, 10(3), 598–603. https://doi.org/10.21037/tp-20-377
Lou, E., Hill, D., Hedden, D., Mahood, J., Moreau, M., & Raso, J. (2011). An objective measurement of brace usage for the treatment of adolescent idiopathic scoliosis. Medical Engineering & Physics, 33(3), 290–294. https://doi.org/10.1016/j.medengphy.2010.10.016
MacDonald, L., Chapman, S., Syrett, M., Bowskill, R., & Horne, R. (2016). Improving medication adherence in bipolar disorder: A systematic review and meta-analysis of 30 years of intervention trials. Journal of Affective Disorders, 194, 202–221. https://doi.org/10.1016/j.jad.2016.01.002
Malinowski, P. (2013). Neural mechanisms of attentional control in mindfulness meditation. Frontiers in Neuroscience, 7 https://doi.org/10.3389/fnins.2013.00008
McCambridge, J., Witton, J., & Elbourne, D. R. (2014). Systematic review of the Hawthorne effect: new concepts are needed to study research participation effects. Journal of Clinical Epidemiology, 67(3), 267–277. https://doi.org/10.1016/j.jclinepi.2013.08.015
Miller, D. J., Franzone, J. M., Matsumoto, H., Gomez, J. A., Avendaño, J., Hyman, J. E., Roye, D. P. J., & Vitale, M. G. (2012). Electronic monitoring improves brace-wearing compliance in patients with adolescent idiopathic scoliosis: A randomized clinical trial. Spine (Phila Pa 1976)., 37(9), 717–721. https://doi.org/10.1097/BRS.0b013e31822f4306
Morton, V., & Torgerson, D. J. (2003). Effect of regression to the mean on decision making in health care. BMJ, 326(7398), 1083–1084. https://doi.org/10.1136/bmj.326.7398.1083
Nardi, W. R., Harrison, A., Saadeh, F. B., Webb, J., Wentz, A. E., & Loucks, E. B. (2020). Mindfulness and cardiovascular health: Qualitative findings on mechanisms from the mindfulness-based blood pressure reduction (MB-BP) study. PLoS ONE, 15(9), e0239533. https://doi.org/10.1371/journal.pone.0239533
Neff, K. D. (2003). The development and validation of a scale to measure self-compassion. Self and Identity, 2(3), 223–250. https://doi.org/10.1080/15298860309027
Negrini, S., Aulisa, A. G., Aulisa, L., Circo, A. B., de Mauroy, J. C., Durmala, J., Grivas, T. B., Knott, P., Kotwicki, T., Maruyama, T., Minozzi, S., O’Brien, J. P., Papadopoulos, D., Rigo, M., Rivard, C. H., Romano, M., Wynne, J. H., Villagrasa, M., Weiss, H.-R., & Zaina, F. (2012). 2011 SOSORT guidelines: Orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis, 7(1), 3. https://doi.org/10.1186/1748-7161-7-3
Negrini, A., Donzelli, S., Lusini, M., Minnella, S., Zaina, F., & Negrini, S. (2014). A cognitive behavioral approach allows improving brace wearing compliance: An observational controlled retrospective study with thermobrace. Scoliosis, 9(Suppl 1), O79. https://doi.org/10.1186/1748-7161-9-S1-O79
Niazi, A., & Niazi, S. (2011). Mindfulness-based stress reduction: A non-pharmacological approach for chronic illnesses. North American Journal of Medical Sciences, 3(1), 20–23. https://doi.org/10.4297/najms.2011.320
Panza, G. A., Weinstock, J., Ash, G. I., & Pescatello, L. S. (2012). Psychometric evaluation of the timeline followback for exercise among college students. Psychology of Sport and Exercise, 13(6), 779–788. https://doi.org/10.1016/j.psychsport.2012.06.002
Pbert, L., Madison, J. M., Druker, S., Olendzki, N., Magner, R., Reed, G., Allison, J., & Carmody, J. (2012). Effect of mindfulness training on asthma quality of life and lung function: A randomised controlled trial. Thorax, 67(9), 769–776. https://doi.org/10.1136/thoraxjnl-2011-200253
Podsakoff, P. M., MacKenzie, S. B., & Podsakoff, N. P. (2011). Sources of method bias in social science research and recommendations on how to control It. Annual Review of Psychology, 63(1), 539–569. https://doi.org/10.1146/annurev-psych-120710-100452
Richards BS, Bernstein RM, D’Amato CR, & Thompson GH (2005) Standardization of criteria for adolescent idiopathic scoliosis brace studies: SRS committee on bracing and nonoperative management. Spine (Phila Pa 1976), 30(18). https://doi.org/10.1097/01.brs.0000178819.90239.d0
Sanger, K. L., & Dorjee, D. (2015). Mindfulness training for adolescents: A neurodevelopmental perspective on investigating modifications in attention and emotion regulation using event-related brain potentials. Cognitive, Affective, & Behavioral Neuroscience, 15(3), 696–711. https://doi.org/10.3758/s13415-015-0354-7
Schuman-Olivier, Z., Trombka, M., Lovas, D. A., Brewer, J. A., Vago, D. R., Gawande, R., Dunne, J. P., Lazar, S. W., Loucks, E. B., & Fulwiler, C. (2020). Mindfulness and behavior change. Harvard Review of Psychiatry, 28(6), 371–394. https://doi.org/10.1097/HRP.0000000000000277
Sofia, S. A., Lysaker, P. H., Smith, E., Celesia, B. M., & Dimaggio, G. (2018). Therapy adherence and emotional awareness and regulation in persons with human immunodeficiency virus. The Journal of Nervous and Mental Disease, 206(12), 925–930. https://doi.org/10.1097/NMD.0000000000000901
Tang, Y.-Y., Tang, R., & Posner, M. I. (2013). Brief meditation training induces smoking reduction. Proceedings of the National Academy of Sciences, 110(34), 13971–13975. https://doi.org/10.1073/pnas.1311887110
Tang, Y.-Y., Tang, R., & Posner, M. I. (2016). Mindfulness meditation improves emotion regulation and reduces drug abuse. Drug and Alcohol Dependence, 163, S13–S18. https://doi.org/10.1016/j.drugalcdep.2015.11.041
Tessadri, F., Pellegrini, A., Tavernaro, M., Zonta, A., & Negrini, S. (2012). Importance of team to increase compliance in adolescent spinal deformities brace treatment: A cross-sectional study of two different settings. Scoliosis, 7(1), O5. https://doi.org/10.1186/1748-7161-7-S1-O5
Ugwonali, O. F., Lomas, G., Choe, J. C., Hyman, J. E., Lee, F. Y., Vitale, M. G., & Roye, D. P., Jr. (2004). Effect of bracing on the quality of life of adolescents with idiopathic scoliosis. The Spine Journal, 4(3), 254–260. https://doi.org/10.1016/j.spinee.2003.12.001
van Buuren, S., & Groothuis-Oudshoorn, K. (2011). Mice: Multivariate imputation by chained equations in R. Journal of Statistical Software, 45(3), 1–67.
Vasiliadis, E., Grivas, T. B., & Gkoltsiou, K. (2006). Development and preliminary validation of Brace Questionnaire (BrQ): A new instrument for measuring quality of life of brace treated scoliotics. Scoliosis, 1(1), 7. https://doi.org/10.1186/1748-7161-1-7
Vickers, A. J., & Altman, D. G. (2001). Analysing controlled trials with baseline and follow up measurements. BMJ, 323(7321), 1123–1124. https://doi.org/10.1136/bmj.323.7321.1123
Vignaud, P., Reilly, K. T., Donde, C., Haesebaert, F., & Brunelin, J. (2019). Clinical effects of mindfulness-based intervention in patients with first episode psychosis and in individuals with ultra-high risk for transition to psychosis: A review. Frontiers in Psychiatry, 10, 797. https://doi.org/10.3389/fpsyt.2019.00797
Weinstein, S. L., Dolan, L. A., Cheng, J. C. Y., Danielsson, A., & Morcuende, J. A. (2008). Adolescent idiopathic scoliosis. The Lancet, 371(9623), 1527–1537. https://doi.org/10.1016/S0140-6736(08)60658-3
Weinstein, S. L., Dolan, L. A., Wright, J. G., & Dobbs, M. B. (2013). Effects of bracing in adolescents with idiopathic scoliosis. New England Journal of Medicine, 369(16), 1512–1521. https://doi.org/10.1056/NEJMoa1307337
White, I. R., Horton, N. J., Carpenter, J., & Pocock, S. J. (2011). Strategy for intention to treat analysis in randomised trials with missing outcome data. BMJ, 342, d40. https://doi.org/10.1136/bmj.d40
Wong, C. C. Y., & Mak, W. W. S. (2013). Differentiating the role of three self-compassion components in buffering cognitive-personality vulnerability to depression among Chinese in Hong Kong. Journal of Counseling Psychology, 60(1), 162–169. https://doi.org/10.1037/a0030451
Wong, M. S., Cheng, J. C., Lam, T. P., Ng, B. K., Sin, S. W., Lee-Shum, S. L., Chow, D. H., & Tam, S. Y. (2008). The effect of rigid versus flexible spinal orthosis on the clinical efficacy and acceptance of the patients with adolescent idiopathic scoliosis. Spine, 33(12), 1360–1365. https://doi.org/10.1097/BRS.0b013e31817329d9
Wong, S. Y., Zhang, D., Li, C. C., Yip, B. H., Chan, D. C., Ling, Y., Lo, C. S., Woo, D. M., Sun, Y., Ma, H., Mak, W. W., Gao, T., Lee, T. M., & Wing, Y. (2017). Comparing the effects of mindfulness-based cognitive therapy and sleep psycho-education with exercise on chronic insomnia: A randomised controlled trial. Psychotherapy and Psychosomatics, 86(4), 241–253. https://doi.org/10.1159/000470847
Wong, E. L. Y., Ramos-Goñi, J. M., Cheung, A. W. L., Wong, A. Y. K., & Rivero-Arias, O. (2018). Assessing the use of a feedback module to model EQ-5D-5L health states values in Hong Kong. The Patient, 11(2), 235–247. https://doi.org/10.1007/s40271-017-0278-0
Workman, J. K., Wilkes, J., Presson, A. P., Xu, Y., Heflin, J. A., & Smith, J. T. (2018). Variation in adolescent idiopathic scoliosis surgery: Implications for improving healthcare value. The Journal of Pediatrics, 195, 213-219.e213. https://doi.org/10.1016/j.jpeds.2017.12.031
Yip, B. H. K., Li, X., Leung, C. H. Y., Gao, T., Chung, V. C. H., Yu, F. W. P., Lam, T. P., Cheng, J. C. Y., & Wong, S. Y. S. (2018). Trial protocol: The use of mindfulness-based intervention for improving bracing compliance for adolescent idiopathic scoliosis patients: Protocol for a randomised, controlled trial. Journal of Physiotherapy, 64(3), 193. https://doi.org/10.1016/j.jphys.2018.02.019
Zeileis, A., & Grothendieck, G. (2005). zoo: S3 infrastructure for regular and irregular time series. Journal of Statistical Software, 14(6), 1–27. https://doi.org/10.18637/jss.v014.i06
Zeng, G., Fung, S.-F., Li, J., Hussain, N., & Yu, P. (2022). Evaluating the psychometric properties and factor structure of the general self-efficacy scale in China. Current Psychology, 41(6), 3970–3980. https://doi.org/10.1007/s12144-020-00924-9
Zhang, J., & Schwarzer, R. (1995). Measuring optimistic self-beliefs: A Chinese adaptation of the General Self-Efficacy Scale. Psychologia: An International Journal of Psychology in the Orient, 38, 174–181.
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This work was supported by the General Research Fund of the University Grants Committee Research Grants Council (Grant Number: 14614416) awarded to Benjamin Hon Kei Yip.
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XL executed the study and data analyses and drafted and edited the manuscript. ENSL collaborated with the design, executed the study, and edited the final manuscript. SKCC reviewed and edited the final manuscript. TPL collaborated with the data collection and reviewed and edited the final manuscript. JCYC collaborated with the data collection and reviewed and edited the final manuscript. EKPL reviewed and edited the final manuscript. SYSW collaborated with the design and writing of the study. BHKY conceptualized and designed the study, conducted data analyses, and drafted and edited the manuscript.
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Li, X., Lau, E.N.S., Chan, S.K.C. et al. Effects of Mindfulness-Based Intervention to Improve Bracing Compliance in Adolescent Idiopathic Scoliosis Patients: a Randomized Controlled Trial. Mindfulness 14, 322–334 (2023). https://doi.org/10.1007/s12671-022-02021-3
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DOI: https://doi.org/10.1007/s12671-022-02021-3