Physiotherapeutic Scoliosis-specific Exercises Research Articles

Physiotherapeutic Scoliosis-Specific Exercise for the treatment of adolescent idiopathic scoliosis: A systematic review and network meta-analysis.

To compare the rehabilitative efficacy of different physiotherapy scoliosis-specific exercises (PSSE) for adolescent idiopathic scoliosis (AIS) using a network meta-analysis. PubMed, Cochrane Library, Web of Science, EMBASE, VIP Database for Chinese Technical Periodicals, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and Wan Fang Data were searched until October 2023. Meta-analysis and network meta-analysis were conducted using RevMan 5.4 and R4.3.1. This study follows the PRISMA statement and was registered on the PROSPERO platform (No. CRD42022379206). Seventeen RCTs involving 857 patients were included. The meta-analysis showed that PSSE therapy improved Cobb's angle than conventional rehabilitation therapy (standardized mean difference [SMD] = -0.7; 95% confidence interval [CI] = -0.95, -0.44; p = 0.001), angle of trunk rotation (ATR; SMD = -1.05; 95% CI = -1.52, -0.58; p < 0.001), and quality of life (QoL; SMD = 0.61; 95% CI = 0.16, 1.07; p < 0.001). Network meta-analysis showed that Schroth + Scientific Exercise Approach to Scoliosis (SEAS) was the most effective in improving Cobb angle and ATR, while Schroth alone was most effective in improving the QoL. The combination of Schroth and SEAS improved the body posture and trunk deformity in patients with AIS, while Schroth alone improved the QoL. The effectiveness of combining different PSSE techniques supports future evidence-based research on AIS treatment.

Effect of adding Schroth physiotherapeutic scoliosis specific exercises to standard care in adolescents with idiopathic scoliosis on posture assessed using surface topography: A secondary analysis of a Randomized Controlled Trial (RCT).

Adolescent idiopathic scoliosis (AIS) is a three-dimensional structural asymmetry of the spine and trunk affecting 2-4% of adolescents. Standard treatment is observation, bracing, and surgery for small, moderate, and large curves, respectively. Schroth exercises aim to correct posture and reduce curve progression. This study aimed to determine the effect of Schroth exercises added to the standard care compared to standard care alone on torso asymmetry in AIS. In a randomized controlled trial (NCT01610908), 124 participants with AIS (age: 10-18, Cobb: 10°-45°, Risser: ≤3) were randomly assigned to the control (Standard care only) or Schroth (Standard care + Schroth treatment) group. Schroth treatment consisted of 1-hour weekly supervised sessions and 30-45 minutes of daily home exercises for six months. The control group received Schroth exercises in the last six months of the 1-year monitoring period. Markerless 3D surface topography assessed torso asymmetry measured by maximum deviation (MaxDev) and root mean square (RMS). Intention to treat linear mixed effects model analysis was compared to the per protocol analysis. In the intention to treat analysis, the Schroth group (n = 63) had significantly larger decreased RMS (-1.2 mm, 95%CI [-1.5,-0.9]mm, p = 0.012) and MaxDev (-1.9mm, 95%CI [-2.4,-1.5]mm, p = 0.025) measurements compared to controls (n = 57) after six months of intervention. In the per protocol analysis (Schroth n = 39, control n = 36), the Schroth group also had a significantly larger decrease compared to the control in both the RMS (-1.0mm, 95%CI [-1.9, -0.2]mm, p = 0.013) and MaxDev measurements (-2.0mm, 95%CI [-3.3,-0.5]mm, p = 0.037). For the control group, both the intention to treat and per protocol analysis showed no difference in RMS and MaxDev in the last six months of Schroth intervention (p>0.5). Schroth Exercise treatment added to standard care (observation or bracing) reduced asymmetry measurements in AIS. As expected, a greater effect was observed for participants who followed the prescribed exercise treatment per protocol.

New and Traditional Treatment Options for Idiopathic Scoliosis in Children and Adolescents

Scoliosis is a medical condition common in children and adolescents, which causes an abnormal curvature of the spine in a “C” or “S” shape. Three main forms of scoliosis exist: neuromuscular, congenital, and idiopathic with idiopathic being most common. Traditional treatments include observation, rigid bracing (a corrective orthosis), casting, surgery, and physiotherapeutic scoliosis-specific exercises. Surgical corrections include spinal fusion or placement of traditional or growing rods. Treatment options for scoliosis have recently expanded, to include newer flexible bracing and surgical procedures such as tethering and posterior dynamic deformity correction. Providers should be screening for scoliosis, and all providers can benefit from knowing the latest options available to help their patients receive the best care before reaching skeletal maturity.

Prevalence of Scoliosis in Children and Adolescents with Cystic Fibrosis.

The prevalence of scoliosis in people with cystic fibrosis (CF) seems to be greater than in the normal population. Over the last two years, a screening for spinal deformities was carried out in patients with CF aged 5 to 18 years, followed up at the CF regional Centre in Parma (Italy). Forty-three patients (twenty-seven males, mean age: 11.8 ± 4.5 years) were enrolled in the study. Nine patients (20.9%) were diagnosed with scoliosis, with a mean Cobb angle of 20.8 ± 9.4 (12-38°). Five patients (11.6%) were diagnosed with a postural kyphosis attitude and one with pathological fixed kyphosis. All patients with scoliosis and postural kyphosis started daily physiotherapeutic scoliosis-specific exercises (PSSE). Compared to people without CF, the prevalence of scoliosis in our paediatric CF population seems to be higher and more present in males; the curves were thoracic and mostly right-sided. CF disease, hyposthenic postural attitude and sedentary lifestyle can contribute to the pathogenesis of this musculoskeletal alteration. Spinal deformities may negatively affect pulmonary function, resulting in disability, pain and a decreased quality of life. Since the prevention of musculoskeletal deformities is easier than restoration, in CF population targeted screening during growth and interventions, including regular physical exercise, are mandatory.

Physiotherapeutic Scoliosis-Specific Exercises (PSSE-Schroth) can reduce the risk for progression during early growth in curves below 25°: prospective control study.

The main treatment aim in mild scoliosis is to prevent progression and if possible, to avoid bracing. Physiotherapeutic Scoliosis Specific Exercises (PSSE) are curve pattern specific exercises, based on 3D self-correction and activities of daily living training. The objective of this study was to evaluate the efficacy of PSSE - Schroth, as an exclusive treatment, during the riskiest period of rapid growth. Prospective control study. Outpatient treatment. Adolescents with scoliosis. One hundred and sixty-three patients (148 girls,15 boys; mean age 12.6 years, Risser sign 1.1, thoracic (Th) Cobb angle 20.8° and lumbar/thoracolumbar (L/TL) Cobb angle 20.7°) performed PSSE - Schroth exercises in our clinic. They were asked to regularly attend supervised sessions and to follow a home-program at least 5 times per week. Our inclusion criteria were Cobb angle 15°-25°, Risser 0-2 and angle trunk rotation (ATR) >5°, measured by scoliometer. The outcome parameters were the Cobb angle before and after the intervention (improvement or progression were defined as angle difference more than 5°) and the number of patients that finally needed a brace. Average follow up time was 29.4 months. Control group was consisted of 58 patients (54 girls, 4 boys; mean age 13.1 years, Risser sign 0-2, Th Cobb 19.4°, L/TL Cobb 19.2°), that were retrospectively analyzed and performed general or no exercises. Compliance was self-reported. Statistical analysis was performed by paired t-test. For PSSE - Schroth group, 103 patients (63.2%) remained stable, 39 (23.9%) improved and 21 (12.9%) worsened. The success rate (87.1%) was significantly higher compared to Control group (P=0.002), where 15 subjects (25.9%) were stable and 43 (74.1%) worsened. Similarly, 16 patients (9.8%) from PSSE - Schroth group finally needed a brace, while 39 (67.2%) from control group (P=0.01). PSSE - Schroth reduced the risk of progression in Adolescent Idiopathic Scoliosis (AIS) patients, during early growth. Our results are in accordance with the recently published literature, showing the effectiveness of PSSE and their superiority compared to general exercises or natural history. Scoliosis specific exercises can be the first step of scoliosis treatment in mild curves, to avoid progression and bracing.

Development, validity and reliability of patient perception of scoliosis-specific physiotherapy (physio-is) questionnaire

Purpose To develop a questionnaire for adolescent idiopathic scoliosis (AIS) patients undergoing physiotherapeutic scoliosis-specific exercises (PSSE) and to evaluate its content validity, structural validity, and reliability. Methodology Seven PSSE treatment experts checked the content validity of the Patient’s Perception of Scoliosis-Specific Physiotherapy Questionnaire (Physio-IS). For each Physio-IS item, the content validity indexes must be ≥ 90%. Regarding structural validity and reliability 52 adolescents (ages 10–17) with AIS completed the questionnaire. Structural validity was assessed through exploratory factor analysis. Reliability was verified through internal consistency. Results Physio-IS content was validated in three evaluation rounds, obtaining 100% expert agreement. About structural validity we identified four domains (cumulative explained variance = 68.2%): (1) specific knowledge (seven questions on understanding their scoliosis condition); (2) social repercussion (five questions about social relationship implications); (3) pain (two questions about scoliosis-associated pain); and (4) associated concern (apprehension/expectations regarding the future). The Physio-IS demonstrated very good internal consistency (Cronbach’s alpha = 0.76–0.92). Conclusion The Physio-IS is a valid and reliable tool for assessing AIS patients undergoing PSSE and helping physiotherapists identify aspects requiring more attention, thus facilitating intervention strategies, as knowing the patient’s perception of their condition or treatment is fundamental to AIS treatment success.

The Improvement of Trunk Muscle Endurance in Adolescents with Idiopathic Scoliosis Treated with ScoliBrace® and the ScoliBalance® Exercise Approach

The impact of scoliosis bracing combined with physiotherapeutic scoliosis-specific exercises (PSSE) on trunk muscle endurance in adolescents with idiopathic scoliosis is unknown. ScoliBrace®, a rigid, three-dimensional, over-corrective thoraco-lumbar-sacral orthosis (TLSO), and ScoliBalance®, a PSSE program, were used to treat adolescent idiopathic scoliosis (AIS) patients. A retrospective study of the trunk muscle endurance of 33 AIS patients who received ScoliBrace® and ScoliBalance® was conducted. The patients were treated with ScoliBrace® and an individualized ScoliBalance® program. Trunk extensor muscle endurance (TE) and abdominal muscle endurance (AE) tests were performed at initial assessment and then at averages of 6.6 and 24.4 weeks of treatment. The data were analyzed using the Wilcoxon signed-rank test, Stata version 15.1. The participants were aged 13.24 years (SD = 1.64) with a mean Cobb angle of 38.97° (SD = 9.49°). TE improved significantly (p &lt; 0.001) at both short- and medium-term intervals using ScoliBalance® and ScoliBrace® in the AIS patients. AE also showed significant improvement between baseline and short-term follow-up, with non-significant improvement at medium-term follow-up. Overall, trunk muscle endurance showed improvement in the AIS patients using ScoliBrace® and ScoliBalance®. Future research is required to determine the individual and combined effects of each treatment. However, it seems likely that trunk muscle endurance will not deteriorate in AIS patients with this combined treatment.

A Questionnaire of Physiotherapeutic Specific Exercises of Scoliosis-QPSSE.

Creating and psychometric testing of a new QoL Questionnaire about Physiotherapeutic Specific Exercises of Scoliosis (Questionnaire of Physiotherapeutic Specific Exercises of Scoliosis-QPSSE). The purpose of this study is to create a reliable and valid questionnaire for patients suffering from mild and moderate adolescent idiopathic scoliosis (AIS) who have been treated with Physiotherapeutic Specific Exercises of Scoliosis (PSSE) in order to evaluate their quality of life. The developed questionnaire was based on a thorough literature review as well as on authors' experience. It consists of 53 questions, of which 37 have a positive meaning, 15 have a negative meaning, and 1 is a multiple choice question; additionally, there are 6 "open" questions. Except for the multiple choice question, all other questions are answered on a Likert scale ranging from 1 to 5 points. Five represents a positive meaning or very positive one, whereas one stands for a negative meaning or none at all. Questions were developed by the authors who subsequently categorized the 53 questions into the following eight domains: physical functioning, self-image, Physiotherapeutic Scoliosis-Specific Exercises (PSSEs), psychosocial functioning, cognitive functioning, compliance, motivation, and pain. A pilot study was conducted so that we could calculate Cronbach's Alpha based on the outcome. Due to the COVID-19 pandemic, the authors worked through the Zoom online platform to structure the questionnaire. Pearson's correlation coefficient was used for all correlations evaluated. P values of less than 0.05 were considered to be significant. Internal consistency was evaluated with Cronbach's Alpha. Although there were very few missing values, accounting for 0.78% of the total values of the questionnaire, the expectation maximization likelihood algorithm was used to impute data. IBM® SPSS® Statistics Software v.25 was used for the analysis. Cronbach's Alpha coefficients for the overall score were 0.84. This original QPSSE was found to be a reliable and valid tool for AIS treated conservatively with PSSE and for the patients' clinicians.

A scoping review of the different types of exercise programs proposed for the improvement of postural balance in adolescents with idiopathic scoliosis.

Adolescent idiopathic scoliosis (AIS), which is the most common type of scoliosis, is a progressive disease that occurs in children aged 10-16 years. Abnormal curvature in AIS provokes spinal asymmetry of the upper body alignment and might deteriorate postural balancing and control ability. To evaluate the effect of exercise interventions on balance and postural stability in patients with adolescent idiopathic scoliosis. Embase, Scopus, Pubmed (Medline) and Web of Science databases were searched using the terms idiopathic scoliosis, physiotherapy, and balance. The articles selected were published in English in peer-reviewed journals from 2012 to July 2022. Ten studies met the inclusion criteria. The PEDro scale values ranged from 2 to 6 (mean, 3.6), indicating a low level of scientific rigor. In the sample studies, spinal stabilization exercises were most often trialed (n= 3), followed by Schroth's exercise (n= 2), stretching and self-elongation exercise (n= 2), the exercise protocol of Blount and Moe, physiotherapeutic scoliosis-specific exercise, and proprioceptive neuromuscular facilitation exercise (all n= 1). Physical therapists will be able to apply hippotherapy, Schroth exercise, physiotherapy scoliosis-specific exercise, trunk stabilization, proprioceptive neuromuscular facilitation exercise, spinal stabilization exercise, core stabilization exercise, and body awareness therapy to manage balance impairments in patients with adolescent idiopathic scoliosis, and further studies are needed to provide stronger evidence.

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

(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.

Schroth Physiotherapeutic Scoliosis-Specific Exercise (PSSE) Trials-Systematic Review of Methods and Recommendations for Future Research.

The Schroth method is a non-operative treatment for scoliosis and kyphosis, used standalone or as an adjunct to bracing. While supporting evidence for its effectiveness is emerging, methodologic standardization and rigor are equivocal. Thus, we aimed to systematically review methods of published Schroth physiotherapeutic scoliosis-specific exercise (PSSE) trials and provide guidance for future research. We searched six databases for randomized controlled trials (RCT) and non-randomized studies of interventions (NRSIs) investigating the effect of Schroth in children and adults with scoliosis or kyphosis. General characteristics, methodological approaches, treatment protocols, and outcomes reporting were analyzed. Risk of bias (RoB) was assessed using an adapted Cochrane RoB2 tool for RCTs and ROBINS-I for NRSI. Eligible studies (n = 7) were conducted in six countries and included patients with Scheuermann's kyphosis (n = 1) and adolescent idiopathic scoliosis (n = 6). Though all seven studies used the term Schroth to describe their interventions, the Schroth method was used in four of seven studies, of which only one used Schroth classification, three used Schroth therapists, and none prospectively registered the study protocol. Overall, methodological rigor was suboptimal, potentially invalidating evidence synthesis. Authors should follow minimum standards for reporting, including prospectively registering detailed protocols; using appropriate exercise labeling, Schroth classification and certified therapists; naming and describing exercises per classification; and providing therapy dosages, prescription methods, and adherence.

The Addition of Daytime Physiotherapeutic Scoliosis-specific Exercises to Adolescent Idiopathic Scoliosis Nighttime Bracing Reduces Curve Progression.

The effectiveness of physiotherapeutic scoliosis-specific exercises (PSSE) in addition to nighttime bracing compared with nighttime bracing alone is unknown. The purpose of this prospective comparative study was to evaluate the effectiveness of PSSE in skeletally immature patients with adolescent idiopathic scoliosis treated with nighttime bracing (PSSE group) compared with the standard of care of nighttime bracing alone (control group). Patients with adolescent idiopathic scoliosis thoracolumbar or lumbar primary curves <35 degrees at Risser stage 0 who wore a Providence brace were prospectively enrolled into the PSSE or control group. A temperature sensor recorded the number of hours of brace wear. The PSSE group was instructed in the Schroth-based physical therapy method and a home exercise program for at least 15 minutes per day, 5 days per week, for 1 year. Seventy-four patients (37 PSSE, 37 controls) were followed until the final visit of skeletal maturity or surgery. The PSSE and control groups had similar baseline Cobb angles (24 vs. 25 degrees) and average hours of brace wear (8.0 vs. 7.3h). The PSSE group had no change in curve magnitude at the final visit compared with curve progression in the control group (1 vs. 7 degrees, P <0.01). Furthermore, the PSSE group had a lower rate of curve progression >5 degrees at the final visit (14% vs. 43%, P <0.01). The PSSE group also had less conversion to full-time bracing after 1 year (5% vs. 24%, P =0.046), but differences were no longer significant at the final visit (14% vs. 27%). In this prospective series of patients in nighttime Providence braces, the addition of Schroth-based physical therapy reduced curve progression after 1 year and at skeletal maturity. These findings can educate motivated families interested in PSSE. Level II.

Intensive bracing management combined with physiotherapeutic scoliosis-specific exercises for adolescent idiopathic scoliosis patients with a major curve ranging from 40-60° who refused surgery: a prospective cohort study.

Current guidelines for brace management of adolescent idiopathic scoliosis (AIS) are mostly recommended for curves between 25° to 40°. For AIS patients with curves >40°, surgery is often considered since bracing may be less effective; however, there are still some patients and families who refuse operation. Therefore, further research is necessary to determine optimal bracing management in this group. To date, few protocols for such have been reported in literature. The aim of this study was to introduce and evaluate the effectiveness of the treatment protocol comprising of intensive bracing management and physiotherapeutic scoliosis-specific exercises (PSSE) in AIS patients with a major curve of 40-60° who refuse surgery. This is a prospective cohort study. The study was carried out in an outpatient clinic. 10-18-year-old AIS patients having 40-60°curves and a Risser grade of 0-3, but firmly refusing surgery were eligible. Patients who had a proximal thoracic curve or had undergone any other form of treatment previously were excluded from the study. A total of 82 patients were recruited and received the treatment. The primary outcome was defined as "success" when the main curve was below 50° upon reaching skeletal maturity, and "failure" if otherwise. The secondary outcome was defined as improved (>5° reduction), unchanged (≤5° change) or progressed (>5° increase) based on the evolution of the main curve. The per protocol (PP) and intent to treat (ITT) analyses were performed to quantify success rates, while the dropouts were considered as failures. Risk factors associated with bracing failure were identified and a receiver operating characteristic (ROC) curve was used to determine the cut-off value. A total of 77 patients completed the treatment, while 5 dropped out. The average main curve was 47.40±5.93° at baseline and 38.56±11.85° at last follow-up (P<0.001). Our management was successful in 83% and 78% of patients based on the PP and ITT analyses, respectively. When compared with the curve magnitude at baseline, 65% patients improved, 30% remained unchanged, and 5% progressed when using a 5° threshold. Univariate comparison and logistic regression analysis demonstrated that patients with successful outcomes had a significantly smaller baseline curve, larger Risser Stage, and larger in-brace correction (IBC) rate. For AIS patients with 40-60° curves who refused surgery, our intensive bracing management along with PSSE was practical and effective, achieving success in 78% of patients based on an ITT analysis. A larger baseline curve, smaller Risser Stage, and smaller IBC rate were associated with treatment failure. Our intensive management provides new insights into improving the effectiveness of bracing in patients with AIS who refuse surgery. This is a promising option for patients with 40-60° curves, since their scoliosis may be treated using a non-surgical technique instead of surgery in the future.

Combined non-operative treatment for adolescent idiopathic scoliosis (AIS) by brace and physiotherapeutic scoliosis specific exercises (PSSE), for curves at high risk of progression

Combined non-operative treatment for adolescent idiopathic scoliosis (AIS) by brace and physiotherapeutic scoliosis specific exercises (PSSE), for curves at high risk of progression

The effectiveness of Schroth method in Cobb angle, quality of life and trunk rotation angle in adolescent idiopathic scoliosis: a systematic review and meta-analysis.

The Schroth method is one of the most common physiotherapeutic scoliosis-specific exercises intervention applied in adolescent idiopathic scoliosis (AIS). This method consists of three-dimensional correction of the specific curve pattern of the patient using a combination of sensorimotor, postural, and corrective breathing exercises. The aim of this systematic review and meta-analysis was to analyse the effects of the Schroth method in isolation on Cobb angle, quality of life, and trunk rotation angle compared to no intervention or other conservative treatments in patients with AIS. PubMed, Physiotherapy Evidence Database, Scopus, Cochrane Library, and Web of Science databases were searched. Studies were included if they were randomized controlled trials that compared the effects of the Schroth method in isolation to conservative interventions or no intervention. The quality of the studies was assessed with the PEDro Scale, and the risk of bias with the Cochrane Collaboration tool. Two independent assessors extracted data through a standardized form. Meta-analyses were conducted using fixed or random effects models according to the heterogeneity assessed with I2 coefficient. Data on outcomes of interest were extracted by a researcher using RevMan 5.4 software. A total of 317 studies were screened. Six were included in the meta-analysis involving 144 patients with AIS. The methodological quality of the included studies ranged from high to low. Schroth method in isolation showed significant improvements in Cobb angle (mean difference [MD] =-3.18º; 95% CI: -4.30, -2.07; I2: 0%), quality of life (MD=0.28; 95% CI: 0.18, 0.38; I2: 0%) and trunk rotation angle (MD=-2.12º; 95% CI: -3.44, -0.80; I2: 71%) in the short-term. The Schroth method in isolation is effective for reducing the Cobb angle and the trunk rotation angle and for improving the QoL in the short-term compared to no intervention or other conservative therapies in AIS, but the improvement in Cobb angle did not exceed the minimum clinically important difference.

Effects of Exercises on Postural Balance in Patients with Adolescent Idiopathic Scoliosis: A Systematic Review

<h3>Objective(s)</h3> To evaluate the effect of exercise interventions on balance and postural stability in patients with adolescent idiopathic scoliosis (AIS). <h3>Data Sources</h3> Embase, Scopus, Pubmed (Medline), and Web of Science. <h3>Study Selection</h3> Databases were searched using the terms Idiopathic Scoliosis, Physiotherapy, and balance. The articles were published in English in peer-reviewed journals from January 2012 to July 2022. <h3>Data Extraction</h3> Two authors independently applied the inclusion criteria to potential studies. Methodological quality was assessed using the PEDro scale. A best-evidence grading system was used to determine the strength of the evidence. <h3>Data Synthesis</h3> Ten studies met the inclusion criteria. PEDro scale values ranged from 2 to 6 (mean, 3.6), indicating a low level of scientific rigor. In this sample, spinal stabilization exercises were most often examined (n=3), followed by Schroth's exercise (n=2), stretching and self-elongation exercise (n=2), exercise protocol of Moe and Blount, physiotherapeutic scoliosis specific exercise, and proprioceptive neuromuscular facilitation exercise (n=1). The most frequent outcomes investigated were the center of pressure variance (n=3), postural sway (n=2), overall stability index (n=2), body alignment changes (n=1), plantar pressure (n=1), and subjective postural perception (n=1). Emerging evidence was found that spinal stabilization exercises improved postural balance while stretching and self-elongation exercises did not affect the postural balance in patients with AIS. <h3>Conclusions</h3> Physical therapists will be able to apply physiotherapeutic scoliosis-specific exercise and spinal stabilization exercises to manage balance impairments of patients with AIS, while further studies providing more robust evidence are needed. <h3>Author(s) Disclosures</h3> No conflicts.

Brace and Physiotherapeutic Scoliosis Specific Exercises (PSSE) for Adolescent Idiopathic Scoliosis (AIS) treatment: a prospective study following Scoliosis Research Society (SRS) criteria

BackgroundA growing scientific evidence for conservative treatment of AIS has recently proved that bracing is superior to natural history. Our aim was to investigate the effectiveness of a combined treatment with brace and PSSE for AIS.MethodsProspective study, following SRS research inclusion criteria (> 10 years, 25ο – 40ο, Risser 0–2, < 1-year post-menarche, no prior treatment). 102 consecutive patients (87 females-15 males, mean age 12.8 years, Risser 0.48, Cobb Thoracic 29.2ο, Lumbar 27.8ο) received treatment with Cheneau brace and PSSE. Average follow-up time was 26.4 months. A scale from A to C was used to evaluate compliance with brace and PSSE (A: full-compliant, B: partially compliant, C: non-compliant). 7 subjects dropped-out (6.8%), so finally 95 patients included for statistical analysis, using paired t-test.ResultsSixty-two patients (65.3%) remained stable, 22 improved > 5ο (23.2%) and 11 progressed (11.5%). In-brace correction (IBC) was 49.7% for thoracic and 61.7% for lumbar curves. Analysis of progressed cases revealed that IBC (31.7% for thoracic and 34.4% for lumbar curves) and compliance (81.8% C for brace, 63.6% C for PSSE) was lower than average. Group A for treatment compliance (65.3%), showed significantly better results (70.9% stable, 29.1% improved, 0% progressed).ConclusionA combination of bracing and PSSE can effectively treat AIS, according to SRS inclusion criteria. 88.5% of patients avoided progression > 5ο and only 6.4% overpassed 40ο. IBC and compliance are the most important prognostic factors for successful treatment result. Early detection of AIS is also necessary for increased possibilities of effective conservative treatment.

Effects of physiotherapeutic scoliosis-specific exercise in patients with mild juvenile scoliosis

Study designA combined retrospective and prospective analysis on the therapeutic effect of physiotherapeutic scoliosis-specific exercise (PSSE) in mild juvenile idiopathic scoliosis (JIS) patients.BackgroundAt present, patients with mild JIS are generally treated by observation without any interventional treatment. This study analyzed the effects of PSSE on mild JIS, which provided a new approach for the treatment of JIS.MethodA total of 52 patients with mild JIS (Cobb angle 10–19°), aged 4–9 years, self-selected into an observation group and a PSSE group. Patients performed the corrective posture exercises daily based on the Scientific Exercise Approach to Scoliosis (SEAS) to the best of their ability, and performed the over-corrective training based on Schroth methods for 30 min each day. Before and one year after the treatment, the Cobb angle and the angle of trunk rotation (ATR) were evaluated, and the results were compared between the two groups.ResultsAfter one year of treatment, the Cobb angle in the PSSE group decreased from 15.0(11.0–17.0)° to 5.0(2.0–12.0)°(p ≤ 0.001), while the Cobb angle in the observation group increased from 13.5(11.0–17.3)° to 16.0(10.8–20.0)° (p = 0.010). The ATR in the PSSE group decreased from 5.0(2.0–7.0)° to 3.0(2.0–4.0)° (p = 0.009), while the change of ATR in the observation group was not significant. Compared with the observation group, 69.57% of patients in PSSE group had a decreased Cobb angle of more than 5 degrees, which was statistically significant(p ≤ 0.001).ConclusionFor mild JIS, PSSE decreased the Cobb angle and ATR.

Reliability, Quality, and Educational Suitability of TikTok Videos as a Source of Information about Scoliosis Exercises: A Cross-Sectional Study.

This study aimed to systematically assess the informational reliability, quality, and educational suitability of videos introducing scoliosis exercises on TikTok. We retrieved and screened 1904 TikTok videos with the hashtags: “#scoliosis”, “#scoliosisexercise”, and “#scoliosistips”, before collecting a final sample of 171 scoliosis exercises in March 2022. Then, two independent raters assessed the reliability and quality of the videos using the DISCERN instrument and evaluated the educational suitability of the information using “Scoliosis Exercise Education Score” (SEES; exercise cycle, target, effect, precaution, and rationale). None of the videos were rated as excellent or good according to DISCERN. The mean SEES score was 2.02 out of 5. Videos uploaded by health organizations had significantly lower DISCERN and SEES scores than those by general users and healthcare professionals. Regarding the propriety of physiotherapeutic scoliosis-specific exercises (PSSE), DISCERN and SEES scores were significantly higher in the PSSE proper group than in the PSSE non-proper group. Although TikTok has become a popular source of scoliosis-related information, the overall information quality, reliability, and educational suitability of videos on scoliosis exercises in TikTok appear to be low, suggesting that TikTok is not suitable source for obtaining scoliosis exercise information.

Physiotherapeutic Scoliosis-Specific Exercise Methodologies Used for Conservative Treatment of Adolescent Idiopathic Scoliosis, and Their Effectiveness: An Extended Literature Review of Current Research and Practice.

Due to the multifactorial etiology of scoliosis, a comprehensive treatment plan is essential for conservative management. Physiotherapeutic scoliosis-specific exercise (PSSE) methods have lately gained popularity for the conservative treatment of scoliosis. The aim of this study was to analyze the PSSE methodologies used for conservative treatment of adolescent idiopathic scoliosis (AIS), as well as their effectiveness. The study was based on an extended literature search conducted in the PubMed, Google Scholar, PEDro, eLABA, and BioMed Central databases. A total of 123 articles were selected for this study (including articles overviewed in systematic reviews and meta-analyses) after applying the inclusion criteria. The study revealed that inappropriate management of AIS could result in serious health problems. Conservative interventions that aid in stabilizing spine curvature and improving esthetics are preferred for scoliosis treatment. Bracing has traditionally been the mainstay of treatment, but growing evidence suggests that PSSE physiotherapy allows effective management of idiopathic adolescent scoliosis. Currently, there are the following PSSE physiotherapy schools in Europe: Schroth, SEAS, BSPTS, FED, FITS, Lyon, Side Shift, and DoboMed. The methodologies of these schools are similar, in that they focus on applying corrective exercises in three planes, developing stability and balance, breathing exercises, and posture awareness. Although high-quality research supporting the effectiveness of PSSE physiotherapy in the treatment of AIS is lacking, existing evidence indicates that PSSE physiotherapy helps to stabilize spinal deformity and improve patients’ quality of life. Among the abovementioned methodologies, Schroth is the most widely studied and has been proven to be effective. However, both SEAS and BSPTS effectively stabilize and even reduce the Cobb angle of scoliosis. Data supporting the validity of other methodologies are very limited. Only the Schroth method significantly reduces the angle of trunk rotation, while both SEAS and Schroth methods greatly improve the quality of life indicators. In any case, the available evidence is insufficient to confirm the advantage of one specific physiotherapy technique over others.