Abstract
BackgroundThe North American non-surgical standard of care for adolescent idiopathic scoliosis (AIS) includes observation and bracing, but not exercises. Schroth physiotherapeutic scoliosis-specific exercises (PSSE) showed promise in several studies of suboptimal methodology. The Scoliosis Research Society calls for rigorous studies supporting the role of exercises before including it as a treatment recommendation for scoliosis.ObjectivesTo determine the effect of a six-month Schroth PSSE intervention added to standard of care (Experimental group) on the Cobb angle compared to standard of care alone (Control group) in patients with AIS.MethodsFifty patients with AIS aged 10–18 years, with curves of 10°-45° and Risser grade 0–5 were recruited from a single pediatric scoliosis clinic and randomized to the Experimental or Control group. Outcomes included the change in the Cobb angles of the Largest Curve and Sum of Curves from baseline to six months. The intervention consisted of a 30–45 minute daily home program and weekly supervised sessions. Intention-to-treat and per protocol linear mixed effects model analyses are reported.ResultsIn the intention-to-treat analysis, after six months, the Schroth group had significantly smaller Largest Curve than controls (-3.5°, 95% CI -1.1° to -5.9°, p = 0.006). Likewise, the between-group difference in the square root of the Sum of Curves was -0.40°, (95% CI -0.03° to -0.8°, p = 0.046), suggesting that an average patient with 51.2° at baseline, will have a 49.3° Sum of Curves at six months in the Schroth group, and 55.1° in the control group with the difference between groups increasing with severity. Per protocol analyses produced similar, but larger differences: Largest Curve = -4.1° (95% CI -1.7° to -6.5°, p = 0.002) and (95% CI -0.8 to 0.2, p = 0.006).ConclusionSchroth PSSE added to the standard of care were superior compared to standard of care alone for reducing the curve severity in patients with AIS.Trial RegistrationNCT01610908
Highlights
Adolescent idiopathic scoliosis (AIS), a three-dimensional torsional deformity of the spine and trunk[1], is the most common (84%-89%) form of scoliosis[2] with a prevalence between 0.47 and 5.2% in the general adolescent population.[3]
In the intention-to-treat analysis, after six months, the Schroth group had significantly smaller Largest Curve than controls (-3.5 ̊, 95% CI -1.1 ̊ to -5.9 ̊, p = 0.006)
The between-group difference in the square root of the Sum of Curves was -0.40 ̊, suggesting that an average patient with 51.2 ̊ at baseline, will have a 49.3 ̊ Sum of Curves at six months in the Schroth group, and 55.1 ̊ in the control group with the difference between groups increasing with severity
Summary
Adolescent idiopathic scoliosis (AIS), a three-dimensional torsional deformity of the spine and trunk[1], is the most common (84%-89%) form of scoliosis[2] with a prevalence between 0.47 and 5.2% in the general adolescent population.[3]. It is generally agreed that curves less than 30 ̊ are unlikely to progress after skeletal maturity.[10] early treatment is recommended throughout pubertal growth to prevent progression. The North American non-surgical standard of care for adolescent idiopathic scoliosis (AIS) includes observation and bracing, but not exercises. Schroth physiotherapeutic scoliosisspecific exercises (PSSE) showed promise in several studies of suboptimal methodology. The Scoliosis Research Society calls for rigorous studies supporting the role of exercises before including it as a treatment recommendation for scoliosis
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