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Lookup NU author(s): Professor Fraser Birrell
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© 2026 The AuthorsObjective: To explore agreement between self-report and objectively measured adherence to brace wearing by patients with knee osteoarthritis. Method: A single-arm observational analysis nested within the PROP OA randomised controlled trial (ISRCTN28555470). Of 237 adults with symptomatic knee osteoarthritis randomised to brace treatment, 60 were included in this sub-study investigating three different methods of assessing knee brace wear time over 26 weeks: 1. Self-report questionnaires (SRQ) at 12 weeks and 26 weeks; 2. Short message service (SMS) questions (days worn in past week, typical hours per day when worn) administered from week 1 to week 24; 3. A skin temperature sensor embedded in the brace, sampling every 10 min for 26 weeks. The presence and reason for the sensor were concealed from participants. The estimated proportion of participants meeting “minimum brace use”, defined a priori as ≥1 h on ≥2 days in past week, was described for each measurement method, overall and by brace type (unloader, neutral). For temperature sensor measurements, time spent above 24°C and time spent above 25°C were used. Agreement between the measures was summarised by percentage agreement and kappa (ĸ). Results: The estimated proportions of participants meeting “minimum brace use” at 12 weeks were 83% (SRQ), 83% (SMS), 60% and 58% (temperature sensor, 24°C and 25°C thresholds, respectively). At 26 weeks, the corresponding estimates reduced to 72%, 71% (SMS at 24 weeks), 43% and 37%. Sensor data suggested the sharpest decline in brace use occurred within the first 12 weeks. Agreement between self-report measures was higher than between self-report measures and sensor (SRQ vs SMS at 12 weeks: 92% agreement, ĸ=0.67 (95%CI: 0.34, 1.00); SRQ vs Sensor at 12 weeks: 74%, 0.35 (0.10, 0.60); SMS vs Sens at 12 weeks: 76%, 0.36 (0.05, 0.66). Agreement between all measurement methods reduced at 26 weeks. Conclusions: This novel use of a temperature sensor to monitor brace adherence in knee osteoarthritis indicates that self-report adherence substantially overestimates knee brace wearing time, with implications for clinical trials and practice.
Author(s): Callaghan MJ, Felson DT, Holden MA, Borrelli B, Nicholls E, Birrell F, Foster NE, Halliday N, Ingram C, Jinks C, Peat GM
Publication type: Article
Publication status: Published
Journal: Osteoarthritis and Cartilage
Year: 2026
Pages: epub ahead of print
Online publication date: 13/07/2026
Acceptance date: 09/06/2026
Date deposited: 10/08/2026
ISSN (print): 1063-4584
ISSN (electronic): 1522-9653
Publisher: Elsevier
URL: https://doi.org/10.1016/j.joca.2026.06.005
DOI: 10.1016/j.joca.2026.06.005
PubMed id: 42442456
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