Psychological aspects of adherence to treatment in female patients with idiopathic scoliosis

Context and Relevance. The study of psychological determinants of treatment adherence in conditions characterized by a visible physical defect is of high importance, as therapeutic success directly depends on the patient's long-term, conscious, and personal engagement in the rehabilitation process. The insufficient exploration of the relationship between specific illness perceptions and selective non-adherence in patients with idiopathic scoliosis defines the relevance of this study. Objective. To investigate the contribution of illness perception to the formation of treatment and rehabilitation adherence in patients with idiopathic scoliosis. Hypothesis. Subjective illness perception determines the selective nature of treatment adherence: hypernosognosia is significantly associated with lower adherence to lifestyle modifications compared to normonosognosia. Methods and Materials. Using the semantic differential method (assessing the perception of the word «scoliosis»), 174 women (124 with idiopathic scoliosis, 50 conditionally healthy) were examined. Treatment adherence was investigated using the KOP-25 questionnaire. Results. Patients with idiopathic scoliosis perceived their illness as "noticeable," "severe," and impacting their autonomy. Three types of illness perception were identified: normonosognosia and two variants of hypernosognosia, the key difference between which was the experience of the illness as a limiting factor ("dependence"). The overall level of adherence was low, with differences between clusters found only for "adherence to lifestyle modifications" (p=0.03)—lowest in patients who experienced their illness as a restriction of freedom. Conclusions. Low treatment adherence primarily affects aspects requiring personal patient responsibility (lifestyle modifications). A hypernosognosic illness perception, accompanied by self-stigmatization and a perceived loss of autonomy, is a critical risk factor for impaired adherence. The targets for psychological intervention are the correction of stigmatizing attitudes and fostering an internal locus of control.