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.

1. Ананичева, С.Р. (2021). Стигматизация и ее проявления в современном обществе. Гуманитарные, социально-экономические и общественные науки, 8, 17—20. URL: https://elibrary.ru/item.asp?id=46547332 (дата обращения: 05.10.2025)Ananicheva, S.R. (2021). Stigmatization and its manifestations in modern society. Humanitarian, socio-economic and social sciences, 8, 17—20. (In Russ.). URL: https://elibrary.ru/item.asp?id=46547332 (viewed: 05.10.2025)
2. Косаревская, Т. Е., Кутькина, Р. Р. (2009). Психосемантический подход к исследованию индивидуального сознания: методические рекомендации. Витебск: УО «ВГУ им. П.М. Машерова».Kosarevskaya, T. E., Kutkina, R. R. (2009). Psychosemantic approach to the study of individual consciousness: methodological recommendations. Vitebsk: UO «VGU im. P. M. Masherova».(In Russ.).
3. Котельникова, А.В., Кукшина, А.А. (2016). Психодиагностические аспекты приверженности к лечению в процессе медицинской реабилитации. Вопросы курортологии, физиотерапии и лечебной физической культуры, 93(3), 4—9. https://doi.org/10.17116/kurort201634-9Kotelnikova, A.V., Kukshina, A.A. (2016). Psychodiagnostic aspects of adherence to treatment in the process of medical rehabilitation. Problems of balneology, physiotherapy and therapeutic physical culture, 93(3), 4—9. (In Russ.). https://doi.org/10.17116/kurort201634-9
4. Лебедева, О.В., Фомина, Н.В. (2014). Отношение к соматическому здоровью как показатель развития психологического здоровья личности (на материале изучения различных возрастных групп испытуемых). Вестник Нижегородского университета им. Н.И. Лобачевского. Серия: Социальные науки, 4(36), 150—158. URL: https://elibrary.ru/item.asp?id=22823583 (дата обращения: 05.10.2025)Lebedeva, O.V., Fomina, N.V. (2014). Attitude to somatic health as an indicator of the development of a person's psychological health (based on the study of various age groups of subjects). Bulletin of the Lobachevsky University of Nizhny Novgorod. Series: Social Sciences, 4(36), 150—158. (In Russ.). URL: https://elibrary.ru/item.asp?id=22823583(viewed: 05.10.2025)
5. Набойченко, Е.С. (2015). Внутренние и внешние детерминанты, влияющие на стигматизацию личности с атипичными особенностями внешности. Здоровье и образование в XXIвеке. Журнал научных статей, 1, 88—92. URL: https://elibrary.ru/tfmfpx (дата обращения: 06.10.2025)Naboichenko , E.S. (2015). Internal and external determinants influencing the stigmatization of individuals with atypical physical features. Health and Education in the XXI Century. Journal of Scientific Articles, 1, 88—92. (In Russ.). URL: https://elibrary.ru/tfmfpx (viewed: 06.10.2025)
6. Николаев, Н.А. (2024). Система комплексной оценки приверженности в медицине КОП-25: авторское руководство для врачей и исследователей: научная монография. М.: Издательскийдом Академии естествознания.Nikolaev, N.A. (2024). System of comprehensive assessment of adherence in medicine KOP-25: author’s guide for doctors and researchers: scientific monograph. Moscow: Publishing House of the Academy of Natural History. (In Russ.).
7. Николаев, Н.А., Мартынов, А.И., Скирденко, Ю.П., Анисимов, В.Н., Васильева, И.А., Виноградов, О.И., Лазебник, Л.Б., Поддубная, И.В., Ройтман, Е.В., Ершов, А.В., Агеев, Ф.Т., Андреев, К.А., Бабичева, Л.Г., Бунова, С.С., Викторова, И.А., Волчегорский, И.А., Воробьев, П.А., Галявич, А.С., Гаус, О.В., … Якушин С.С.(2020). Управлениелечением на основе приверженности. Consilium Medicum, 22(5), 9—18. https://doi.org/10.26442/20751753.2020.5.200078Nikolaev, N.A., Martynov, A.I., Skirdenko, Y.P., Anisimov, V.N., Vasilieva, I.A., Vinogradov, O.I., Lazebnik, L.B., Poddubnaya, I.V., Roitman, E.V., Ershov, A.V., Ageev, F.T., Andreev, K.A., Babicheva, L.G., Bunova, S.S., Viktorova, I.A., Volchegorskiy, I.A., Vorobyev, P.A., Galyavich, A.S., Gaus, O.V. … Yakushin S.2020). Management of treatment based on adherence. Consilium Medicum, 22(5), 9—18. (In Russ.). https://doi.org/10.26442/20751753.2020.5.200078
8. Осгуд, Ч., Суси, Дж., Танненбаум, П. (1972). Приложение методики семантического дифференциала к исследованиям по эстетике и смежным проблемам. В: Ю. М. Лотмана и В. М. Петрова(ред.), Семиотика и искусствометрия. (с. 278—297) М: Мир. Osgood, C., Suci, G., Tannenbaum, P. (1972). Application of the semantic differential technique to research in aesthetics and related problems. In: Yu.M. Lotman & V.M. Petrov (Eds.), Semiotics and artmetrics (pp. 278—297). Moscow: Mir. (In Russ.).
9. Смулевич, А.Б., Тхостов, А.Ш., Сыркин, А.Л. и др. (1997). Клинические и психологические аспекты реакции на болезнь (к проблеме нозогений). Журнал неврологии и психиатрии им. С.С. Корсакова,97(2), 4—9. URL: https://elibrary.ru/item.asp?id=29464689 (дата обращения: 05.10.2025)Smulevich, A.B., Tkhostov, A.Sh., Syrkin, A.L. et al. (1997). Clinical and psychological aspects of reaction to illness (on the problem of nosogenery). Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova, 97(2), 4—9. (In Russ.). URL: https://elibrary.ru/item.asp?id=29464689 (viewed: 05.10.2025)
10. Татаурова, С.С. (2009). Актуальные проблемы исследования образа тела. Психологический вестник Уральского государственного университета, 8, 142—154. URL: https://elibrary.ru/item.asp?id=25396572 (дата обращения: 05.10.2025)Tataurova, S.S. (2009). Actual problems of body image research. Psikhologicheskiy vestnik Ural’skogo gosudarstvennogo universiteta, 8, 142—154. (In Russ.). URL: https://elibrary.ru/item.asp?id=25396572 (viewed: 05.10.2025)
11. Karataş, Ö., Karaman, N.S., Tombak, K., Pota, K., Yapar, D., Yapar, A., Şenköylü, A. (2025). Stigmatization negatively affects exercise compliance in children with adolescent idiopathic scoliosis: A cross-sectional study. European Spine Journal, 34, e5262—e5270. https://doi.org/10.1007/s00586-025-09240-x
12. Kireeva, T. (2020). Socio-psychological adaptation and self-attitude of adolescents with scoliosis. International Research Journal, 11(101), article № 59.https://doi.org/10.23670/IRJ.2020.101.11.059
13. Li, X., Huo, Z., Hu, Z., Lam, T. P., Cheng, J. C. Y., Chung, V. C., Yip, B. H. K. (2022). Which interventions may improve bracing compliance in adolescent idiopathic scoliosis? A systematic review and meta-analysis. PLoS One, 17(7), e0271612. https://doi.org/10.1371/journal.pone.0271612
14. Perkins, Z. B., De’Ath, H. D., Sharp, G., Tai, N. R. (2012). Factors affecting outcome after traumatic limb amputation. British Journal of Surgery, 99(1), 75—86. https://doi.org/10.1002/bjs.7766
15. Rahman, T., Bowen, J. R., Takemitsu, M., Scott, C. (2005). The association between brace compliance and outcome for patients with idiopathic scoliosis. Journal of Pediatric Orthopaedics,25(4), 420—422. https://doi.org/10.1097/01.bpo.0000161097.61586.bb
16. Stangl, A.L., Earnshaw, V.A., Logie, C.H., van Brakel, W., Simbayi, L., Barré, I., Dovidio, J.F. (2019). The Health Stigma and Discrimination Framework: a global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC Medicine, 17(1), article № https://doi.org/10.1186/s12916-019-1271-3