Development and Evaluation of the GATOT SCOLI-CARE Application for Monitoring Brace Compliance and Clinical Outcomes in Adolescents with Adolescent Idiopathic Scoliosis

Gatot Sunarto; Ellysa Okky Gusma; Roni Susanto; Gian Lisuari Adityasiwi; Hana Kristina

doi:10.30872/

Authors

Gatot Sunarto RSUD Sumberglagah Provinsi Jawa Timur Author https://orcid.org/0009-0000-0595-6528 (unauthenticated)
Ellysa Okky Gusma Sekolah Tinggi Ilmu Kesehatan Bethesda Yakkum Author https://orcid.org/0009-0001-0267-870X (unauthenticated)
Roni Susanto RSUD Sumberglagah Provinsi Jawa Timur Author
Gian Lisuari Adityasiwi Sekolah Tinggi Ilmu Kesehatan Bethesda Yakkum Author
Hana Kristina Sekolah Tinggi Ilmu Kesehatan Bethesda Yakkum Author

DOI:

https://doi.org/10.30872/

Keywords:

Adolescent idiopathic scoliosis, brace adherence, digital health

Abstract

Brace adherence is an important factor in conservative treatment of Adolescent Idiopathic Scoliosis (AIS); however, its monitoring remains challenging due to limited patient engagement and suboptimal continuous monitoring. This study aimed to evaluate the use of the GATOT SCOLI-CARE application as a digital monitoring tool for brace therapy in AIS patients. A prospective controlled study with a pretest-posttest control group design was conducted involving 30 AIS patients, consisting of an intervention group (n=15) using the application and a control group (n=15) receiving conventional monitoring for three months. The assessed outcomes included brace adherence, height change, and Cobb angle change. The GATOT SCOLI-CARE application demonstrated expert validity of 92.8%, a System Usability Scale (SUS) score of 86.4 ± 5.8, and a User Acceptance Test (UAT) score of 92.2%. Brace adherence in the intervention group was 84.6%, compared with 68.4% in the control group. The intervention group showed greater Cobb angle changes than the control group (−5.53° vs −4.27°; p=0.010), while height changes showed no significant difference. Effect size analysis demonstrated a large effect on Cobb angle change (Cohen’s d=1.02). The use of GATOT SCOLI-CARE was associated with better patient engagement in brace adherence monitoring and may support clinical monitoring in AIS management.

Author Biographies

Gatot Sunarto, RSUD Sumberglagah Provinsi Jawa Timur

Sumberglagah Regional General Hospital, East Java Province, Mojokerto, Indonesia
Ellysa Okky Gusma, Sekolah Tinggi Ilmu Kesehatan Bethesda Yakkum

Bachelor of Physiotherapy Study Program, STIKES Bethesda Yakkum, Yogyakarta, Indonesia
Roni Susanto, RSUD Sumberglagah Provinsi Jawa Timur

Sumberglagah Regional General Hospital, East Java Province, Mojokerto, Indonesia
Gian Lisuari Adityasiwi, Sekolah Tinggi Ilmu Kesehatan Bethesda Yakkum

Bachelor of Physiotherapy Study Program, STIKES Bethesda Yakkum, Yogyakarta, Indonesia
Hana Kristina, Sekolah Tinggi Ilmu Kesehatan Bethesda Yakkum

Bachelor of Physiotherapy Study Program, STIKES Bethesda Yakkum, Yogyakarta, Indonesia

References

[1] E. O. Gusma, G. Sunarto, G. L. Adityasiwi, N. A. Khenda, and N. A. P. Susanto, “Quality of life and physical activity participation in adolescent girls with idiopathic scoliosis treated with bracing,” J. Ilm. Kesehat. Sandi Husada, vol. 15, no. 1, pp. 20–29, Mar. 2026, doi: 10.35816/jiksh.v15i1.203.

[2] E. O. Gusma, G. Sunarto, G. L. Adityasiwi, H. Kristina, and N. A. Khenda, “Health-Related Quality of Life Among Adolescent Girls with Idiopathic Scoliosis Using Spinal Orthoses: A Systematic Review,” Epidemiol. Soc. Health Rev. ESHR, vol. 8, no. 2, pp. 84–95, Jul. 2026, doi: 10.26555/eshr.v8i2.16061.

[3] Y. Liu et al., “Correlational analysis of three-dimensional spinopelvic parameters with standing balance and gait characteristics in adolescent idiopathic scoliosis: A preliminary research on Lenke V,” Front. Bioeng. Biotechnol., vol. 10, p. 1022376, Nov. 2022, doi: 10.3389/fbioe.2022.1022376.

[4] N. Ramadhani, D. L. Romadhoni, and A. Awanis, “Prevalence and determinants associated with adolescent idiopathic scoliosis: Results of screening in Surakarta, Indonesia,” Int. J. Public Health Sci. IJPHS, vol. 13, no. 4, p. 1548, Aug. 2024, doi: 10.11591/ijphs.v13i4.23884.

[5] S. Schreiber et al., “Effect of Schroth exercises added to the standard of care on the scoliosis curve and postural control in adolescents with idiopathic scoliosis,” Spine, vol. 41, no. 4, pp. E177–E184, 2016.

[6] L. A. Karol, D. Virostek, K. Felton, and L. Wheeler, “Effect of compliance counseling on brace use and success in patients with adolescent idiopathic scoliosis,” J. Bone Jt. Surg., vol. 98, no. 1, pp. 9–14, Jan. 2016, doi: 10.2106/JBJS.O.00359.

[7] S. Negrini et al., “2016 SOSORT guidelines: Orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth,” Scoliosis Spinal Disord., vol. 13, no. 1, Jan. 2018, doi: 10.1186/s13013-017-0145-8.

[8] F. Cantele, E. Posanti, C. Pittarello, and S. Masiero, “Is higher compliance to brace therapy associated with poorer quality of life and self-image? A 36-months follow-up study,” J. Back Musculoskelet. Rehabil., vol. 36, no. 5, pp. 1163–1169, Jul. 2023, doi: 10.3233/BMR-220361.

[9] S. Donzelli, F. Zaina, S. Minnella, M. Lusini, and S. Négrini, “Consistent and regular daily wearing improve bracing results: A case-control study,” Scoliosis Spinal Disord., vol. 13, no. 1, Jul. 2018, doi: 10.1186/s13013-018-0164-0.

[10] M. Sapienza et al., “Clinical, psychological, and social determinants of brace compliance in adolescent idiopathic scoliosis: A systematic review and meta-analysis,” J. Funct. Morphol. Kinesiol., vol. 11, no. 1, p. 68, Feb. 2026, doi: 10.3390/jfmk11010068.

[11] G. Davies et al., “Methods for assessment of patient adherence to removable orthoses used after surgery or trauma to the appendicular skeleton: A systematic review,” Trials, vol. 21, no. 1, p. 507, Jun. 2020, doi: 10.1186/s13063-020-04456-2.

[12] T. Rahman et al., “Electronic monitoring of orthopedic brace compliance,” J. Child. Orthop., vol. 9, no. 5, pp. 365–369, Aug. 2015, doi: 10.1007/s11832-015-0679-3.

[13] E. O. Gusma and G. Sunarto, “Hubungan riwayat menarke dini dengan derajat keparahan skoliosis pada remaja putri pengguna brace skoliosis di Klinik Ortotik Prostetik Mojokerto,” Excell. Midwifery J., vol. 9, no. 1, pp. 515–524, Apr. 2026, doi: 10.55541/emj.v9i1.405.

[14] M. Smuck, C. A. Odonkor, J. K. Wilt, N. Schmidt, and M. A. Swiernik, “The emerging clinical role of wearables: Factors for successful implementation in healthcare,” Npj Digit. Med., vol. 4, no. 1, p. 45, Mar. 2021, doi: 10.1038/s41746-021-00418-3.

[15] H. E. Cho, C. W. Jang, S.-R. Cho, W. A. Choi, and J. H. Park, “Mobile apps to improve brace-wearing compliance in patients with idiopathic scoliosis: A quality analysis, functionality review and future directions,” J. Clin. Med., vol. 12, no. 5, p. 1972, Mar. 2023, doi: 10.3390/jcm12051972.

[16] J. Sánchez-Raya, J. Salat-Batlle, D. Castilla, I. Zaragozá, A. García-Palacios, and C. Suso-Ribera, “Utilizing mobile health technology to enhance brace compliance: Feasibility and effectiveness of an app-based monitoring system for adolescents with idiopathic scoliosis,” J. Pers. Med., vol. 15, no. 9, p. 405, Sep. 2025, doi: 10.3390/jpm15090405.

[17] K. Sýkorová et al., “Co-designing a scoliosis self-management mobile app with adolescents and parents: A theory-informed qualitative study (Preprint),” Mar. 2026, doi: 10.2196/preprints.95698.

[18] P. Ulldemolins et al., “Cor-Esc-25: A low-cost prototype for monitoring brace adherence and pressure in adolescent idiopathic scoliosis,” Sensors, vol. 25, no. 18, p. 5616, Sep. 2025, doi: 10.3390/s25185616.

[19] E. O. Gusma, G. Sunarto, G. L. Adityasiwi, and H. Kristina, “Effectiveness of digital consultation in orthotic and prosthetic services: A systematic review,” J. Manaj. Kesehat. Yayasan RSDr Soetomo, vol. 12, no. 1, p. 159, May 2026, doi: 10.29241/jmk.v12i1.2522.

[20] R. Thomas, A. Zanudin, and Y. A. Hazrin, “Validity of mobile application Scoscreen for early screening of adolescent idiopathic scoliosis,” Malays. J. Med. Health Sci., vol. 19, no. 3, pp. 152–159, May 2023, doi: 10.47836/mjmhs19.3.20.

[21] J. B. do Nascimento et al., “Barriers and facilitators to utilizing digital health technologies by healthcare professionals,” Npj Digit. Med., vol. 6, no. 1, p. 161, Sep. 2023, doi: 10.1038/s41746-023-00899-4.

[22] Ulaya, B. Aulya, B. Ade, and A. A. A, “Evaluasi dampak implementasi electronic health record (EHR) terhadap kualitas pelayanan rumah sakit: Studi kuantitatif,” PREPOTIF J. Kesehat. Masy., vol. 9, no. 3, pp. 10785–10791, Dec. 2025, doi: 10.31004/prepotif.v9i3.52380.

[23] E. Volkan, İ. Köse, S. Cece, and Ö. Elmas, “Analysis of the effect of digital hospital efforts on paper savings in inpatient procedures and on the duration of nursing care services,” Front. Digit. Health, vol. 6, p. 1367149, Jun. 2024, doi: 10.3389/fdgth.2024.1367149.

[24] R. Baghbani, M. Ashoorirad, B. Jamalpour, A. Akbari, A. Miresmaeili, and M. A. Laribi, “The development of a smart electronic cervical headgear to record time of dental patients log,” SPIRE - Sci. Po Institutional Repos., vol. 24, no. 20, pp. 33281–33288, Aug. 2024, doi: 10.1109/jsen.2024.3446714.

[25] G. Sunarto, R. Apriyanto, D. Septianiputri, R. Permatasari, and P. Rahmadho, “Inovasi konsultasi ortotik prostetik berbasis WhatsApp meningkatkan akses dan kesiapan pelayanan,” J. Kreat. Dan Inov. J. Kreanova, vol. 6, no. 1, pp. 39–45, Jan. 2026, doi: 10.24034/kreanova.v6i1.7747.

[26] G. Sunarto, P. Rahmadho, B. R. Winardi, D. Septianiputri, R. Apriyanto, and R. Permatasari, “Pengembangan KPOP PLUS berbasis digital untuk efisiensi dan transparansi layanan ortotik prostetik di RSUD Sumberglagah,” J. Innov. Res. Knowl., vol. 5, no. 8, pp. 10083–10098, Jan. 2026, doi: 10.53625/jirk.v5i8.12263.

[27] Zhu et al., “A compliance real-time monitoring system for the management of the brace usage in adolescent idiopathic scoliosis patients: A pilot study,” BMC Musculoskelet. Disord., vol. 22, no. 1, p. 152, Feb. 2021, doi: 10.1186/s12891-021-03976-5.

[28] S. Parent, M. Roy-Beaudry, J. Dufresne, R. Imbeault, S. Barchi, and M. Beauséjour, “Artificial intelligence-driven 3D surface-topography app for screening and monitoring adolescent scoliosis: Early results from a single institution,” Spine Deform., Jan. 2026, doi: 10.1007/s43390-026-01282-5.

[29] Wang et al., “The efficacy of 3D personalized insoles in moderate adolescent idiopathic scoliosis: A randomized controlled trial,” BMC Musculoskelet. Disord., vol. 23, no. 1, p. 983, Nov. 2022, doi: 10.1186/s12891-022-05952-z.

[30] H.-R. Weiss, D. Turnbull, S. Seibel, and A. Kleban, “First end-result of a prospective cohort with AIS treated with a CAD Chêneau style brace,” J. Phys. Ther. Sci., vol. 31, no. 12, pp. 983–991, Jan. 2019, doi: 10.1589/jpts.31.983.

[31] P. W. H. Cheung et al., “Immediate vs gradual brace weaning protocols in adolescent idiopathic scoliosis,” JAMA Pediatr., vol. 178, no. 7, p. 657, Jun. 2024, doi: 10.1001/jamapediatrics.2024.1484.

[32] S. Mao, X. Sun, B. Shi, Y. Qiu, B. Qian, and J. C. Y. Cheng, “Association between braced curve behavior by pubertal growth peak and bracing effectiveness in female idiopathic scoliosis: A longitudinal cohort study,” BMC Musculoskelet. Disord., vol. 19, no. 1, p. 88, Mar. 2018, doi: 10.1186/s12891-018-1987-9.

[33] M. C. Welborn et al., “Biomarker longitudinal idiopathic scoliosis study: Predicting growth in idiopathic scoliosis,” J. Pediatr. Orthop., vol. 45, no. 9, Jun. 2025, doi: 10.1097/bpo.0000000000003022.

[34] R. P. Woon et al., “How precise are clinical height measurements in scoliosis patients,” Curr. Orthop. Pract., vol. 29, no. 3, pp. 223–225, Mar. 2018, doi: 10.1097/bco.0000000000000612.

[35] O. Gusma, G. Sunarto, G. L. Adityasiwi, and H. Kristina, “Brace compliance, Cobb angle, and quality of life in adolescent idiopathic scoliosis,” Sci. J. J. Terkait, 2026. [Online]. Available: [https://forikes-ejournal.com/index.php/SF/article/view/7084](https://forikes-ejournal.com/index.php/SF/article/view/7084)

[36] V. Martínez-Borba et al., “mHealth for the monitoring of brace compliance and wellbeing in adolescents with idiopathic scoliosis: Study protocol for a feasibility study,” Int. J. Environ. Res. Public. Health, vol. 18, no. 15, p. 7767, Jul. 2021, doi: 10.3390/ijerph18157767.

[37] S. Donzelli, F. Zaina, S. Minnella, M. Lusini, and S. Négrini, “Consistent and regular daily wearing improve bracing results: A case-control study,” Scoliosis Spinal Disord., vol. 13, no. 1, p. 16, Jul. 2018, doi: 10.1186/s13013-018-0164-0.

[38] J. Kohne and C. Montag, “ChatDashboard: A framework to collect, link, and process donated WhatsApp chat log data,” Behav. Res. Methods, vol. 56, no. 4, pp. 3658–3684, Dec. 2023, doi: 10.3758/s13428-023-02276-1.

[39] K. Manji, J. Hanefeld, J. Vearey, H. Walls, and T. De Gruchy, “Using WhatsApp messenger for health systems research: A scoping review of available literature,” Health Policy Plan., vol. 36, no. 5, pp. 774–789, Jun. 2021, doi: 10.1093/heapol/czab024.

[40] Z. Bazancir et al., “Does in-brace correction affect coronal spinal and thoracic cage parameters in individuals with idiopathic scoliosis? A retrospective cohort study,” Acta Orthop. Belg., vol. 89, no. 3, pp. 399–408, Sep. 2023, doi: 10.52628/89.3.10767.

[41] Gao, Y. Zheng, C. Fan, Y. Yang, C. He, and M. S. Wong, “Could the clinical effectiveness be improved under the integration of orthotic intervention and scoliosis-specific exercise in managing adolescent idiopathic scoliosis?,” PolyU Institutional Res. Arch. Hong Kong Polytech. Univ., vol. 98, no. 8, pp. 642–648, Jan. 2019, doi: 10.1097/phm.0000000000001160.