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    “The silent strain: Exploring self-image and mental health in braced adolescents with scoliosis”: a scoping review
    (Delhi Orthopedic Association, 2025) Al Hajaj, Sari Wathiq; Al Hajaj, Dawod; Singh, Prabhjit; Bharadwaj, Sanjeevi; Nair, Vishnu V.; Srinivasan, Sriram Harish
    Background: Adolescent Idiopathic Scoliosis (AIS) is a common spinal deformity. It can create surface deformities that affect adolescents' psychosocial health. Bracing is a non-surgical method to prevent curve progression and avoid surgery. However, the psychosocial effects of long-term brace use during adolescence are often overlooked. issues like decreased self-esteem, social withdrawal, and appearance anxiety may hinder compliance and impact quality of life. Methods: A comprehensive literature review used PubMed, Cochrane Library, and ScienceDirect to identify studies from 2015 to 2025. It was prospectively registered with the PROSPERO database (Registration ID: CRD420251083129). The search terms included: "adolescent idiopathic scoliosis,” "bracing and self-image,” "bracing compliance,” and "psychological impact of bracing.” Two independent reviewers screened studies based on PICOS criteria: (1) adolescents with AIS, (2) bracing or conservative treatment, (3) control or observational groups, (4) outcomes like self-image, quality of life, or compliance, and (5) RCTs, observational studies, systematic reviews, or meta-analyses. Exclusions included surgical interventions, non-adolescents, or non-English publications. Results: We found 807 studies; after removing duplicates, irrelevant titles, and abstracts, 26 full texts were screened. Of these, 10 met all criteria and were included. Adolescents in brace treatment often face negative self-image, low self-esteem, and social anxiety, especially at therapy start, affecting adherence. Concerns about appearance and discomfort hinder compliance. Some adapt over time, but others continue to experience mental health issues. Interventions like cognitive-behavioural therapy (CBT), peer support, and special exercise programs improve coping, adherence, and psychological well-being. Conclusion: Bracing treats Adolescent Idiopathic Scoliosis (AIS) but affects psychosocial well-being, lowering adherence and quality of life. A multidisciplinary, patient-centred approach with mental health support is essential. Early psychological distress identification and interventions like Cognitive Behavioural Therapy (CBT) and peer support can enhance compliance and outcomes. Protocols should include psychosocial screening and holistic care to lessen the adverse effects of brace treatment.