Scoliosis Research Society members attitudes towards physical therapy and physiotherapeutic scoliosis specific exercises for adolescent idiopathic scoliosis.

Cindy L. Marti,Steven D. Glassman,Patrick T. Knott,Michael T. Hresko,Leah Y. Carreon

doi:10.1186/s13013-015-0041-z

Abstract

BackgroundAttitudes regarding non-operative treatment for adolescent idiopathic scoliosis (AIS) may be changing with the publication of BRAiST. Physiotherapeutic Scoliosis Specific Exercises (PSSE) are used to treat AIS, but high-quality evidence is limited. The purpose of this study is to assess the attitudes of members of the Scoliosis Research Society towards PSSE.MethodsA survey was sent to all SRS members with questions on use of Physical Therapy (PT) and PSSE for AIS.ResultsThe majority of the 263 respondents were from North America (175, 67 %), followed by Asia (37, 14 %) and Europe (36, 14 %). The majority of respondents (166, 63 %) prescribed neither PT nor PSSE, 28 (11 %) prescribed both PT and PSSE, 39 (15 %) prescribe PT only and 30 (11 %) prescribe PSSE only. PT was prescribed by 67 respondents, as an adjunct to bracing (39) and in small curves (32); with goals to improve aesthetics (27) and post-operative outcomes (25). Of the 196 who do not prescribe PT, the main reasons were lack of evidence (149) and the perception that PT had no value (112).PSSE was prescribed by 58 respondents. The most common indication was as an adjunct to bracing (49) or small curves (41); with goals to improve aesthetics (36), prevent curve progression (35) and improve quality of life (31). Of the respondents who do not prescribe PSSE, the main reasons were lack of supporting research (149), a perception that PSSE had no value (108), and lack of access (63). Most respondents state that evidence of efficacy may increase the role of PSSE, with 85 % (223 of 263) favoring funding PSSE studies by the SRS.ConclusionThe results show that 22 % of the respondents use PSSE for AIS, skepticism remains regarding the benefit of PSSE for AIS. Support for SRS funded research suggests belief that there is potential benefit from PSSE and the best way to assess that potential is through evidence development.

Highlights

Attitudes regarding non-operative treatment for adolescent idiopathic scoliosis (AIS) may be changing with the publication of BRAiST
The purpose of this study is to explore the attitudes of scoliosis surgeons regarding Physiotherapeutic Scoliosis Specific Exercise (PSSE)
The reported use of standard physical therapy (PT) was more common in Europe, there was no statistically significant difference in prescribing pattern based on region, with an almost equal proportion of surgeons in Asia, South America and North America

Summary

Introduction

Attitudes regarding non-operative treatment for adolescent idiopathic scoliosis (AIS) may be changing with the publication of BRAiST. Physiotherapeutic Scoliosis Specific Exercises (PSSE) are used to treat AIS, but high-quality evidence is limited. Marti et al Scoliosis (2015) 10:16 were at level IV or lower in terms of their Level of Evidence [6, 9] This deficiency is due in part to inconsistent indications for PSSE treatment, the diversity of therapy programs, ranging from outpatient postural training to intensive and prolonged in-patient regimens, and the difficulty in assuring compliance when patients are receiving therapy over an extended period. Publication of the BRAiST study, which demonstrated efficacy of bracing for AIS based upon clearly defined clinical parameters [17], has encouraged both patients and surgeons to the potential for brace treatment. At least in the public sector, this interest seems to extend beyond bracing to encompass a wider array of nonsurgical options

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