How Schroth Therapists Vary the Implementation of Schroth Worldwide for Adolescents with Idiopathic Scoliosis: A Mixed Methods Study.

Abstract

(1) Background: Schroth is a type of physiotherapeutic scoliosis specific exercise (PSSE) prescribed to adolescents with idiopathic scoliosis (AIS). Studies have investigated the effectiveness of Schroth but are yet to elucidate how Schroth is applied clinically and the factors that influence their prescription. (2) Methods: A mixed methods design was used comprising an anonymous survey and semi-structured interviews of Schroth therapists who treated AIS and who were publicly listed on the Barcelona Scoliosis Physical Therapy School or the International Schroth 3-dimensional Scoliosis Therapy School websites. The survey included 64 questions covering demographics, session and treatment characteristics, and whether therapists included other treatment modalities in their clinical practice. A convenience sample of survey participants were invited to participate in a semi-structured interview to further explore the factors that influenced their prescription of Schroth for AIS. Results from the survey were analyzed descriptively (n, %), whereas inductive thematic analysis was used for the interviews. (3) Results: of the 173 survey respondents (18% response rate), most were from Europe and North America (64.0%), female (78.6%), physiotherapists (96.0%), and worked in private settings (72.3%). Fifty-two per cent of participants used other types of PSSE as an adjunct to Schroth, the Scientific Exercise Approach to Scoliosis (SEAS) being the most frequently used (37.9%). Non-PSSE methods were used 'at some point' as an adjunct by 98.8% of participants, including massage and other soft tissue techniques (80.9%), Pilates (46.6%), and Yoga (31.5%). The Schroth techniques used by all survey respondents included breathing and pelvic corrections. Seven participants were interviewed, but data saturation was achieved after only four interviews. Thematic analysis revealed four, inter-related broad themes describing the factors that influenced Schroth prescription for AIS: (1) the adolescent as a whole, including physical, emotional and mental characteristics, and patient goals, (2) family, including parent relationship with the adolescent and the motivation of parents in regard to Schroth, (3) the systems within which the treatment was being offered, such as vicinity to the clinic and the presence of financial insurance support, and (4) therapist characteristics, such as their training and experience. (4) Conclusions: Schroth therapists worldwide use a variety of adjunctive methods to treat AIS. Therapists prescribing Schroth exercises to AIS consider the complex interplay of intra-, inter- and extra-personal factors in clinical practice. These considerations move beyond the three components of evidence-based practice of research, patient preferences, and clinical expertise, towards a systems-based reflection on exercise prescription.