Exploring Predictors of Brace-Wearing Adherence in Non-Surgical Treatment of Acute Knee Medial Collateral Ligament Injuries.

Abstract

Objectives: (1) To estimate adherence to brace wearing for medial collateral ligament (MCL) injuries across 3 phases of conventional treatment and (2) to explore predictors of adherence for each phase.

Design: Exploratory cohort study.

Setting: Primary care center.

Patients: Fifty-nine patients aged 18 to 65 (27 men, 32 women) from a randomized clinical trial examined the effectiveness of 2 bracing techniques (0-90 degrees or 30-90 degrees) for acute isolated MCL or combined anterior cruciate ligament injuries. Patients were prescribed a 6-week bracing protocol and were followed for 12 weeks.

Interventions: Patients were prescribed constant brace wearing for 4 weeks (∼23 h/d), then daytime wear only (∼15 h/d) until brace discontinuation at 6 weeks. Rehabilitation exercises were prescribed from 2 weeks onward. Adherence to the protocol was assessed through daily self-reported logs. Clinical and patient-reported outcomes were collected throughout the randomized clinical trial (baseline, 2, 4, and 6 weeks). This study interpreted them as predictor variables of treatment adherence alongside patient and treatment characteristics.

Main outcome measures: Adherence to each 2-week phase, interpreted dichotomously (adherer or nonadherer). Adherers were identified as those who wore their brace according to the protocol.

Results: Adherence and pain decreased, while overall knee ratings improved throughout the treatment. Pain, affected knee, and brace range-of-motion settings were significant predictors of adherence in the exploratory logistic regressions.

Conclusions: Pain, affected knee, and brace range-of-motion settings were the primary predictors of brace wearing in the first 4 weeks of treatment. This study is the first to provide insight into MCL bracing adherence, potentially aiding clinicians in treatment management.