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Effectiveness of Schroth exercises during bracing in adolescent idiopathic scoliosis: Results from a preliminary study-SOSORT Award 2017 Winner


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Background Bracing has been shown to decrease significantly the progression of high-risk curves to the threshold for surgery in patients with adolescent idiopathic scoliosis (AIS), but the treatment failure rate remains high. There is evidence to suggest that Schroth scoliosis-specific exercises can slow progression in mild scoliosis. The aim of this study was to evaluate the efficacy of Schroth exercises in AIS patients with high-risk curves during bracing. Methods A prospective, historical cohort-matched study was carried out. Patients diagnosed with AIS who fulfilled the Scoliosis Research Society (SRS) criteria for bracing were recruited to receive Schroth exercises during bracing. An outpatient-based Schroth program was given. Data for these patients were compared with a 1:1 matched historical control group who were treated with bracing alone. The assessor and statistician were blinded. Radiographic progression, truncal shift, and SRS-22r scores were compared between cases and controls. Results Twenty-four patients (5 males and 19 females, mean age 12.3 ± 1.4 years) were included in the exercise group, and 24 patients (mean age 11.8 ± 1.1 years) were matched in the control group. The mean follow-up period for the exercise group was 18.1 ± 6.2 months. In the exercise group, spinal deformity improved in 17% of patients (Cobb angle improvement of ≥ 6°), worsened in 21% (Cobb angle increases of ≥ 6°), and remained stable in 62%. In the control group, 4% improved, 50% worsened, and 46% remained stable. In the subgroup analysis, 31% of patients who were compliant (13 cases) improved, 69% remained static, and none had worsened, while in the non-compliant group (11 cases), none had improved, 46% worsened, and 46% remained stable. Analysis of the secondary outcomes showed improvement of the truncal shift, angle of trunk rotation, the SRS function domain, and total scores in favor of the exercise group. Conclusion This is the first study to investigate the effects of Schroth exercises on AIS patients during bracing. Our findings from this preliminary study showed that Schroth exercise during bracing was superior to bracing alone in improving Cobb angles, trunk rotation, and QOL scores. Furthermore, those who were compliant with the exercise program had a higher rate of Cobb angle improvement. The results of this study form the basis for a randomized controlled trial to evaluate the effect of Schroth exercises during bracing in AIS. Trial registration HKUCTR-2226. Registered 22 June 2017 (retrospectively registered)
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R E S E A R C H Open Access
Effectiveness of Schroth exercises during
bracing in adolescent idiopathic scoliosis:
results from a preliminary studySOSORT
Award 2017 Winner
Kenny Yat Hong Kwan
, Aldous C.S. Cheng
, Hui Yu Koh
, Alice Y.Y. Chiu
and Kenneth Man Chee Cheung
Background: Bracing has been shown to decrease significantly the progression of high-risk curves to the threshold
for surgery in patients with adolescent idiopathic scoliosis (AIS), but the treatment failure rate remains high. There is
evidence to suggest that Schroth scoliosis-specific exercises can slow progression in mild scoliosis. The aim of this
study was to evaluate the efficacy of Schroth exercises in AIS patients with high-risk curves during bracing.
Methods: A prospective, historical cohort-matched study was carried out. Patients diagnosed with AIS who fulfilled
the Scoliosis Research Society (SRS) criteria for bracing were recruited to receive Schroth exercises during bracing.
An outpatient-based Schroth program was given. Data for these patients were compared with a 1:1 matched
historical control group who were treated with bracing alone. The assessor and statistician were blinded.
Radiographic progression, truncal shift, and SRS-22r scores were compared between cases and controls.
Results: Twenty-four patients (5 males and 19 females, mean age 12.3 ± 1.4 years) were included in the exercise
group, and 24 patients (mean age 11.8 ± 1.1 years) were matched in the control group. The mean follow-up period
for the exercise group was 18.1 ± 6.2 months. In the exercise group, spinal deformity improved in 17% of patients
(Cobb angle improvement of 6°), worsened in 21% (Cobb angle increases of 6°), and remained stable in 62%. In the
control group, 4% improved, 50% worsened, and 46% remained stable. In the subgroup analysis, 31% of patients who
were compliant (13 cases) improved, 69% remained static, and none had worsened, while in the non-compliant group
(11 cases), none had improved, 46% worsened, and 46% remained stable. Analysis of the secondary outcomes showed
improvement of the truncal shift, angle of trunk rotation, the SRS function domain, and total scores in favor of the
exercise group.
Conclusion: This is the first study to investigate the effects of Schroth exercises on AIS patients during bracing. Our
findings from this preliminary study showed that Schroth exercise during bracing was superior to bracing alone in
improving Cobb angles, trunk rotation, and QOL scores. Furthermore, those who were compliant with the exercise
program had a higher rate of Cobb angle improvement. The results of this study form the basis for a randomized
controlled trial to evaluate the effect of Schroth exercises during bracing in AIS.
Trial registration: HKUCTR-2226. Registered 22 June 2017 (retrospectively registered)
Keywords: Schroth, Scoliosis-specific exercise, Adolescent idiopathic scoliosis, Bracing, Curve progression, Conservative
* Correspondence:
Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of
Medicine, The University of Hong Kong, Pokfulam, Hong Kong
Full list of author information is available at the end of the article
© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (, which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
( applies to the data made available in this article, unless otherwise stated.
Kwan et al. Scoliosis and Spinal Disorders (2017) 12:32
DOI 10.1186/s13013-017-0139-6
The aim of treatment of adolescent idiopathic scoliosis
(AIS) is to prevent curve progression to 50°, beyond which
there is a risk of continued progression in adulthood.
Surgery is therefore usually recommended if the curve
reaches 50° during adolescence. Treatment with rigid bra-
cing has recently been shown in the Bracing in Adolescent
Idiopathic Scoliosis Trial (BRAIST) to decrease signifi-
cantly the progression of high-risk curves to the threshold
for surgery [1] and is the most widely accepted form of
treatment for the prevention of curve progression
worldwide. Nonetheless, the rate of treatment success was
reported to be 72%, suggesting a proportion of patients
will still need to undergo surgery despite bracing.
The standard of care for non-operative management
of scoliosis varies widely between North America and
Europe [2, 3], and the use of physiotherapy scoliosis-
specific exercises (PSSE) is not universally established or
accepted. Exercise therapy is well-received by patients
and parents [4], and several systematic reviews and
randomized controlled trials have reported the positive
effects of PSSE on slowing curve progression, improving
cosmetic appearance, and quality of life (QOL) outcomes
[57]. Nonetheless, these studies consisted of a hetero-
geneous population receiving mixed treatment regimens,
various stages of skeletal maturity, and non-standardized
outcome measures. Thus, the effect of PSSE on curve
progression in the clinical scenario where the curves are
at the highest risk of progression has remained unclear.
The Schroth method is the most widely studied and
used PSSE approach. It consists of three-dimensional
principles of correction, namely auto-elongation, deflec-
tion, derotation, rotational breathing, and stabilization
[8]. It uses specific rotational angular breathing for
vertebral and rib cage derotation, with muscle activation
and mobilization. It emphasizes postural corrections
throughout the day to change habitual postures and
improve alignment, pain, and progression. The Schroth
method exercises are curve pattern specific and can be
applied in ordinary daily activity, thereby allowing the
patients to spend more time in leisure activities and to
live a normal life [9].
The Society on Scoliosis Orthopaedic and Rehabilitation
Treatment (SOSORT) guidelines recommend the use of
PSSE as a stand-alone therapy, add-on to bracing, and
during the postoperative period [2]. Romano et al.
[10] found that exercises produced a significant
increase in the mechanical forces exerted at rest by
the fiberglass brace in AIS patients. The positive ef-
fects of PSSE can exert its maximal clinical benefit if
it improves the outcome of bracing in patients with
the highest risk for progression. An improvement of
the treatment success of bracing will decrease the
rate of surgical interventions in AIS patients.
Therefore, the aim of this study was to assess
prospectively the effect of Schroth exercise on curve
progression, appearance, and QOL in AIS patients with
high-risk curves during bracing.
Study design
A prospective, historical cohort-matched study was con-
ducted. The study was done in compliance with the prin-
ciples of Good Clinical Practice and the Declaration of
Helsinki. The local Institutional Review Board approved
the study protocol (Reference Number: UW 17-136). All
patientsparents or legal guardians gave written informed
Patient enrolment
Consecutive patients with AIS who met the Scoliosis
Research Society (SRS) criteria for bracing [11] and re-
ceived bracing were enrolled for the study. Inclusion cri-
teria were as follows: age of 10 to 15 years, skeletal
immaturity (defined on the Risser scale [12] as 02 in-
clusively or R6 U5 score or below on the Distal Radius
Ulna Classification [13]), a Cobb angle for the largest
curve of 25° to 40° [14], and ability to attend all the
physiotherapy sessions. Exclusion criteria were diagnoses
other than AIS, disabilities or systemic illnesses prevent-
ing exercise performance, and any other previous treat-
ment for AIS.
Study interventions
All patients received a rigid underarm orthosis (Fig. 1),
prescribed to be worn for a minimum of 18 h per
day. The SOSORT Management for bracing guidelines
for the physicians, orthotists, and physiotherapists
were followed [15].
Schroth-certified therapist was involved and provided all
the therapy sessions. No other treatments were advised
during the study period.
Experimental group
The Schroth exercise intervention consisted of an indi-
vidualized 8-week outpatient program that included four
initial private training sessions, once every 2 weeks,
where exercises were taught to the patient and their
caregivers. A home exercise program was instituted
thereafter, and patients were required to return for
supervised sessions once every 2 months. Exercises were
given in a pamphlet with a description of the corrective
movements required, the curve type for which they were
recommended, and digital photos of all the exercises
taken during their private sessions which they were
expected to perform at home. Figure 2 illustrates a case
example of a specific curve type and the exercises that
were prescribed.
Kwan et al. Scoliosis and Spinal Disorders (2017) 12:32 Page 2 of 7
Compliance was monitored and verified daily by their
caregivers and during the review sessions by the therapists.
During these sessions, adequate exercise performance was
assessed using a checklist. Attendance was calculated as a
percentage of the prescribed visits attended and com-
pliance as a percentage of the prescribed exercises
completed to the therapistssatisfaction. Compliance
was defined as > 80% of attendance of therapy ses-
sions and completion of the prescribed home exercise
program at least five out of 7 days per week.
Control group
A 1:1 historical cohort who was treated in the same in-
stitute with bracing only and matched for age, gender,
skeletal maturity, and curve magnitude was used as a
control group.
Outcome measures
The outcome measures were radiological deformities
(primary outcome), clinical deformities, and QOL scores
(secondary outcomes).
Cobb angles of all the major structural curves were mea-
sured on a standing posterior-anterior full-spine radio-
graph. Radiographic definitions of change were based on
the SOSORT and SRS non-operative committee consensus
Fig. 1 A typical underarm orthosis for curve whose apex is at T7 or
below, illustrating the view from the anterior (a) and posterior (b)
Fig. 2 An illustrative case demonstrating five sets of exercises prescribed to patients. aRadiograph pre-treatment showing a thoracolumbar major
curve from T11 to L3 with a Cobb angle of 40°. Exercises shown here include the following: bmuscle cylinder in standing, cshoulder counter-traction
in supine, dshoulder counter-traction in prone, eshoulder counter-traction in standing with two poles, and (f) shoulder counter-traction in side-lying.
gRadiograph at the completion of training showing an improvement of Cobb angle to 34.
Kwan et al. Scoliosis and Spinal Disorders (2017) 12:32 Page 3 of 7
[16]: improvement as 6° or more, unchanged as ± 5°, and
progressed as 6° or more.
Clinical deformity was recorded in terms of truncal
shift and angle of trunk rotation (ATR). The Bunnell
scoliometer was used to measure the ATR, i.e., the angle
between the horizontal plane and a plane across the pos-
terior aspect of the trunk, of the hump in the main
structural curve with the patient bending forward [17].
The SRS-22 questionnaire is a scoliosis-related QOL
questionnaire that assesses five domains: function, pain,
self-image, mental health (five questions each), and satis-
faction with care (two questions). Each question is
scored from 1 to 5, where 1 is the worst and 5 the best.
The Chinese version was administered, which had been
validated [18].
Adverse effects
Patients were asked to record any serious symptoms or
events they experienced during the study.
Students paired ttest (p< 0.05) was made for each of
the outcome measures. Sub-analysis was performed
within the experimental group to study the effects of
compliance. The data were analyzed using SPSS 21.0
Twenty-four (5 males and 19 females) were recruited
into the experimental group, and 24 patients were
matched in the control group. Both groups did not differ
at baseline for age, gender, Risser sign, and magnitude of
the main structural curves (Table 1). The mean age was
12.3 ± 1.4 years in the experimental group and
11.8 ± 1.1 years in the control group. The experimental
and control groups had a mean follow-up period of
18.1 ± 6.2 and 38.8 ± 11 months, respectively.
Effects of the interventions
After training, the spinal deformity improved in 17% of
the patients in the experimental group (Cobb angle de-
creases by 6° or more), worsened in 21% (Cobb angle in-
creases by 6° or more), and remained stable in 62% (Cobb
angle was ± 5°). In the control group, 4% improved, 50%
worsened, and 46% remained stable.
After training, the mean ATR improved from
9.43° ± 3.27° to 8.45° ± 3.45°, although it did not reach
statistical significance (p= 0.08), and it remained stable
in the control group. There was no statistical significant
difference in the mean truncal shift in the experimental
and the control groups.
For the SRS-22 domains, high scores were noted at
the baseline for both groups (mean of 4.25 ± 0.38 and
4.10 ± 0.52 out of 5). Statistical significant improvements
were found in the experimental group in the function
domain (4.60 ± 0.44 to 4.76 ± 0.33, p= 0.05) and the
total score (4.25 ± 0.38 to 4.45 ± 0.34, p= 0.04) whereas
changes in the other domains did not reach statistical
significance. No significant changes were noted for the
control group in any of the domains or the total score.
Effects of compliance
Brace compliance was rated as good in 70.8% in the
experimental group and 79.2% in the historical cohort
group. In the experimental group, 76.9% of patients who
were compliant to the Schroth exercises had good
bracing compliance, whereas only 63.6% of those who
were non-compliant to the exercises had good bracing
In the experimental group, 13 patients were found to
be compliant to Schroth exercises according to our
definition above, and 11 patients did not meet this
criterion. Compliance was strongly associated with curve
improvement (31 vs 0%) and negatively associated with
curve progression (0 vs 46%). Compliance was also posi-
tively associated with improvements in truncal shift from
11.87 ± 8.16 to 7.09 ± 6.41 mm (p= 0.01) and ATR from
10.15° ± 3.65° to 8.69° ± 3.01° (p= 0.043).
Adverse effects
No adverse effects were noted during the study period.
This is the first prospective study investigating the effect
of Schroth exercises on curve progression, topographical
Table 1 Baseline characteristics of the scoliosis-specific exercise
and the historical-matched cohort groups
SSE group cohort
Number of subjects 24 24
Age (mean/SD) 12.3 (1014)/1.4 11.83 (1014)/1.1
Gender (%)
Female 79.2 79.2
Male 20.8 20.8
Risser sign at the start of
treatment (%)
01 54.2 79.2
2 29.2 16.7
3 16.6 4.2
Region of largest curve (%)
Thoracic 20.8 33.3
Thoracolumbar/lumbar 79.2 66.7
Period of re-assessment/
months (mean/SD)
18.1/6.2 38.75/11
SSE scoliosis specific exercise, SD standard deviation
Kwan et al. Scoliosis and Spinal Disorders (2017) 12:32 Page 4 of 7
changes, and SRS-22 scores in AIS patients during
bracing. The findings of this study show that Schroth
exercises during bracing can increase the proportion of
patients with Cobb angle improvement 6° by 6%
compared with bracing alone. In addition, our results
suggest that 20% more patients have improved Cobb an-
gles of 6° if they are compliant with Schroth exercises
during bracing compared with bracing alone. However,
the outcomes of non-compliant patients were slight
worse than the historical cohort, which might partly due
to a worse compliance to brace treatment in this group.
Although previous studies have demonstrated the su-
periority of scoliosis-specific exercises in reducing curve
progression, they were performed in a population under-
going conservative treatment for mild AIS only [1923].
Furthermore, their data cannot be generalized to
rehabilitation under other clinical scenarios, such as
during bracing or after surgical correction. This
preliminary study focused on a group of high-risk
patients who were all treated with bracing. The usual
intervention after treatment failure in these patients
would be surgical correction and fusion and was
recently reported in the BRAIST to be 2528% [1].
Thus, any further treatment during bracing that can
improve the outcome can lower the surgical rate. We
show that the efficacy of bracing can be further
improved by the addition of Schroth exercises with a
strong compliance-response relationship.
Although there was a trend towards ATR reduction in
the experimental group, it did not reach statistical signifi-
cance in our study. All previous studies that reported ATR
showed a decrease after scoliosis-specific exercises ranging
from 0.33° to 4.23° [24, 25]. Schroth exercises have been
shown to improve the cosmetic appearance in children,
demonstrated in some studies to decrease the height of
the hump [26], and improving waist asymmetry [27]. Al-
though we cannot make a definite conclusion from our
results, a more reliable and valid measure of objective cos-
metic changes needs to be included in future studies.
The effect of the treatment on the SRS-22 scores shows
that Schroth exercises improve the overall QOL in AIS
patients during bracing. However, it is now increasingly
noted that the SRS-22 questionnaire was designed to
study the effects of surgery in AIS and suffers a ceiling
effect in conservative treatments [7, 28, 29]. The high
scores reported at the baseline therefore limit the ability
of this questionnaire to measure large improvements. Dif-
ferent tools, such as SRS-7, Trunk Appearance Perception
Scale (TAPS), Patient-Reported Outcomes Measurement
Information System (PROMIS), and computer adaptive
testing (CAT) instruments, may be administered together
in future studies to detect clinically significant differences
in their function and QOL. Currently, no alternative vali-
dated evaluating tools are available.
Our findings suggest that administering Schroth
exercise program as an outpatient is feasible and has a
reasonable compliance. These results are consistent with
earlier findings that a physiotherapist-supervised Schroth
exercise program is superior to a home-based program
or no treatment [25]. In their study, the supervised
program consisted of 18 sessions (1.5 h a day, 3 days a
week) for 6 weeks. However, this would be too deman-
ding for patients in this locality, and we predicted this
would have deleterious effects on the study enrolment,
the attendance, and compliance rate. We therefore
modified the protocol to four sessions (1 h per session
fortnightly) for 8 weeks. This was a compromise
between maintaining adequate supervision and minima-
lizing disruption to the patientsand their familieslives.
The study has several limitations. First, it was a his-
torical cohort comparison but every effort has been
made to ensure the two groups are compatible by
age, gender, and curve magnitude matching. However,
between the two groups. At the time of analysis, all
patients in the experimental group had a minimum of
12 months of follow-up, but some patients in the his-
torical cohort had already completed treatment.
Nonetheless, we felt this cohort provided a reasonable
control since the only difference in intervention
between the groups was the addition of Schroth train-
ing. Secondly, exercise compliance and adherence to
treatment could not be fully assured, although the pa-
tientsdiaries were checked, and full engagement of
the caregivers ensured accurate data collection.
Thirdly, although brace compliance between the two
groups was comparable, sub-analysis based on
exercise compliance found a difference in brace com-
pliance between the groups and historical control.
Hence, these results should be interpreted with
caution. Fourthly, the therapists could not be blinded
to the treatment group, although the analyses were
done by an independent assessor. Finally, the sample
size in the sub-analysis for compliance is small.
This is the first study to investigate the effects of Schroth
exercises during bracing in patients with a high risk of
curve progression. The findings from this preliminary
study suggest that Schroth exercises during bracing can
further improve the Cobb angle compared with bracing
alone and compliance is associated with greater benefit.
Based on the results of this study and using the current
protocol, appropriate sample size calculation and attrition
rate can be performed for a large-scale trial. Given the
promising findings, a prospective, randomized-controlled
trial to evaluate the effect of Schroth exercises during
brace treatment in AIS patients is now warranted.
Kwan et al. Scoliosis and Spinal Disorders (2017) 12:32 Page 5 of 7
AIS: Adolescent idiopathic scoliosis; ATR: Angle trunk rotation;
BRAIST: Bracing in Adolescent Idiopathic Scoliosis Trial; CAT: Computer
adaptive testing; PROMIS: Patient-Reported Outcomes Measurement
Information System; PSSE: Physiotherapy scoliosis-specific exercises;
QOL: Quality of life; SOSORT: Society on Scoliosis Orthopaedic and
Rehabilitation Treatment; SRS: Scoliosis Research Society; TAPS: Trunk
Appearance Perception Scale
Not applicable.
None declared.
Availability of data and materials
Please contact author for data requests.
KK conceived of the study, participated in the study design, and drafted the
manuscript. ACSC performed the study and statistical analysis. HYK collected
the data and participated in its design and coordination. AYYC participated
in the study design and coordination. KC supervised the study and helped
to draft the manuscript. All authors read and approved the final manuscript.
Ethics approval and consent to participate
This study was approved by the Institutional Review Board of the University of
Hong Kong/Hospital Authority Hong Kong West Cluster (HKU/HA HKW IRB)IRB
Reference Number: UW 17-136. Written informed consent was obtained from all
participants and/or their legal guardian.
Consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published
maps and institutional affiliations.
Author details
Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of
Medicine, The University of Hong Kong, Pokfulam, Hong Kong.
of Physiotherapy, Duchess of Kent Childrens Hospital, Sandy Bay, Hong
Received: 22 June 2017 Accepted: 30 August 2017
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Kwan et al. Scoliosis and Spinal Disorders (2017) 12:32 Page 7 of 7
... Tarptautinės skoliozės ortopedinio ir reabilitacinio gy- dymo asociacija (SOSORT) rekomenduoja skoliozės specifinę kineziterapiją kaip gydymo metodą taikyti atskirai, kartu su koreguojamaisiais įtvarais arba pooperaciniu laikotarpiu [9]. Konservatyvusis gydymas fiziniais pratimais apima įvairius metodus arba skirtingų metodų taikymą kartu. ...
... Vienas iš plačiausiai naudojamų ir daugiausiai mokslinių įrodymų turintis specifinės kineziterapijos metodas yra Schroth metodika [10]. Šį metodą sudaro trijų dimensijų gydymo principai, susidedantys iš korekcinių padėčių bei pratimų, stabilizacijos ir tinkamo kvėpavimo [9]. Taikant Schroth metodą, siekiama pacientus išmokyti korekcinių padėčių, kurias būtų galima taikyti kasdieniame gyvenime [6]. ...
... Analizuojant rezultatus tarp eksperimentinės ir kontrolinės grupių, 6 tyrimuose, kurių tiriamųjų Cobb kampo laipsnis yra 10 0 -45 0 , buvo gautas statistiškai reikšmingas gyvenimo kokybės rezultato padidėjimas eksperimentinėje grupėje. Du į sisteminę literatūros apžvalgą įtraukti straipsniai [9,13] vertino Schroth metodikos efektyvumą gyvenimo kokybei, kartu dėvint ortopedinį įtvarą. Y. Kwan Hong ir kt. ...
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Tyrimo tikslas. Įvertinti Schroth metodikos efektyvumą paauglių idiopatinės skoliozės gydymui. Sisteminė li­teratūros apžvalga buvo parašyta laikantis PRISMA (Prefered Reporting Item for Systematic Review and Meta-Analyses) sisteminės literatūros apžvalgos rengimo reikalavimų. Atlikus atranką pagal sisteminės literatūros apžvalgos įtraukimo ir atmetimo kriterijus, į sisteminę literatūros apžvalgą buvo įtrauktos 13 publikacijų. Efek­tyvumo įvertinimo tikslui pasiekti visų atrinktų mokslinių publikacijų duomenys buvo susisteminti į vieną tyrimų rezultatų lentelę, kurioje pateikiamas tyrimų eksperimen­tinės ir kontrolinės grupių skirtingų vertinimo rodiklių vidurkis ir standartinis nuokrypis prieš ir po Schroth ir ki­tos intervencijos taikymo. Paauglių idiopatinės skoliozės gydymui taikant Schroth metodiką, nustatytas statistiškai reikšmingas Cobb kampo sumažėjimas, liemens rotacijos kampo ir gyvenimo kokybės vertinimo rezultatų pagerė­jimas. Lyginant Schroth metodikos taikymą su pacientų stebėjimo metodu, kai Cobb kampas yra mažesnis nei 250, Schroth metodo taikymo atveju nustatytas statistiškai reikšmingas Cobb kampo sumažėjimas. Nustatytas statis­tiškai reikšmingas skoliozės vertinimo rodiklių pagerė­jimas paauglių idiopatinės skoliozės atveju pacientams, kurių Cobb kampas yra tarp 250 – 450, kai koreguojamieji įtvarai derinami kartu su Schroth metodikos taikymu.
... Understanding how Schroth is being applied to AIS worldwide once therapists have completed training and the key factors that influence the success of exercise treatment for AIS, has not been elucidated to date [8]. The Schroth method is one of the most frequently studied and used PSSE methods to date [12]. However, studies have generally focused on comparisons of the treatment against other conservative treatments rather than exploring the impact that a variation in Schroth prescription (e.g., exercise, intensity, repetitions) has for various amounts of curve deformity. ...
... However, adaptations were made to suit the patients and context [17,18] and included the use of more peripheral aspects of the treatment, and less often, other PSSE, such as SEAS, and non-PSSE, such as strength training, flexibility, and massage. These reports of large variations in approach by the Schroth therapists in this study are not replicated in the current research studies, with multiple studies focusing simply on exploring the benefits of one approach using Schroth compared with other treatments or no treatment [12,18,21,22]. There is also a lack of description in these studies regarding how the Schroth therapy prescription may vary according to the level of structural deformity in AIS. ...
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(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.
... The main objective of PSSE is to limit the magnitude of Cobb angle and progression of the curve [3]. The efficacy of PSSE following SoSoRT guidelines has been studied through several randomized controlled trials for managing the spinal deviation with varying degrees of Cobb angle, respiratory dysfunction, spinal pain, and for reducing the need for surgical intervention [7][8][9]. ...
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Актуальним завданням є вивчення сучасних підходів до використання фізичної терапії для лікування сколіотичної хвороби у підлітків з метою визначення ефективних методів, які мають належну наукову підтримку та доказову основу. Мета дослідження полягає в пошуку сучасних підходів до використання фізичної терапії у підлітків з сколіозом для визначення ефективних науково підтверджених методик консервативного лікування сколіозу та світових тенденцій у цьому напрямку. В статті проведений аналіз реабілітаційних підходів, які використовуються у пацієнтів з підлітковим ідіопатичним сколіозом (ПІС) у міжнародній медичній практиці. Розглянуті актуальні методи та стратегії, спрямовані на поліпшення фізичного стану, якість життя та зменшення деформації хребта у підлітків з сколіозом. Був проведений аналіз наукових статей, опублікованих в PubMed та Google Scholar з 2012 по 2022 рік, що стосувалися методів фізичної терапії для сколіотичної хвороби у підлітків. Згідно з Оксфордським центром доказової медицини, фізіотерапевтичні специфічні вправи для лікування сколіозу (Physiotherapeutic Scoliosis Specific Exircises (PSSE)) можуть бути рекомендовані як перші заходи для запобігання прогресуванню сколіозу. Якщо PSSE не допомагають запобігти прогресуванню, рекомендується застосовувати корегуюче ортезування (тривимірний корсет Шено). У випадках, коли консервативне лікування не зупиняє прогресування сколіозу, може бути прийняте рішення про проведення оперативного втручання. Всі науково обґрунтовані методики фізичної терапії для лікування сколіозу базуються на використанні фізіотерапевтичних специфічних вправ, які враховують зміни в трьох площинах. Виходячи з аналізу публікацій, зроблено висновки про важливість інтегрованого підходу до реабілітації підлітків з ідіопатичним сколіозом та необхідність подальших досліджень для вдосконалення методів та підтвердження їхньої ефективності. Ключові слова: підлітковий ідіопатичний сколіоз, фізична терапія, реабілітація
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Background and Aims Idiopathic scoliosis is a complex three-dimensional deformity affecting the spine and is more common in adolescents (10-18 years). Failure to pay attention to it can increase its severity and complications. Various exercise methods have been designed for preventing, managing, or correcting adolescent idiopathic scoliosis (AIS). Among them, the Schroth method has attracted the attention of therapists due to its promising results. However, there is still conflicting evidence of its effectiveness. Therefore, this review study aims to investigate the effectiveness of the Schroth method in improving the Cobb angle, trunk rotation angle, and quality of life (QoL) in adolescents with idiopathic scoliosis. Methods This is a systematic review study. A search was conducted in Cochrane, PubMed, Medline, Scopus and Google Scholar databases for finding studies that used Schroth method as an intervention and published from 2005 to December 2021 using the keywords related to AIS. The PEDro scale was used to evaluate the quality of papers. Results Initial search yielded 96 records of which 10 papers with PEDro scale score of 5.8 were selected for the review. Among them, the variables of Cobb angle, QoL, ATR were evaluated in nine, six and four papers, respectively. The outcomes obtained from the papers showed the significant effect of Schroth method on reducing the Cobb angle (>5°, using radiography), trunk rotation (>3°, using scoliometer) and improving the QoL (Using the scoliosis research society questionnaire). In only one paper, despite a significant improvement in QoL, no significant reduction in Cobb angle (<5°) was observed. Conclusion There is moderate evidence of the positive effects of the Schroth method on improving Cobb angle, trunk rotation angle and QoL in adolescents with idiopathic scoliosis. This method can used for preventing from the worsening of AIS. It can be used along with other methods such as core stability exercises and Pilates. Since the reviewed studies had moderate quality, high-quality studies are needed in this field.
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Introduction. Adolescent idiopathic scoliosis (AIS), described as a complex three-dimensional spinal deformity, is thought to affect neurophysiological processes that result in a loss of proprioceptive input. The main purpose of this case study is to investigate the effect of Proprioceptive Neuromuscular Facilitation (PNF) on spine joint reposition (JR) sense in a 20-year-old with AIS. Methods/ Case Description. The subject was a 20-year-old college student with moderate dextrothoracic and levolumbar scoliosis. She has structural scoliosis-related impaired posture, as evidenced by findings of impaired JR sensation in all directions, postural deviations, and patient-reported deformity perception using the Walter Reed Visual Assessment Scale. She was seen 4 times a week for 3 weeks. Results: The most recent radiographs analyzed by a radiologist revealed that the curvature of the thoracic spine had decreased from 38° to 32° and the curvature of the lumbar spine had decreased from 26° to 24°. There were also improvements noted in JR sensation, postural deviation, and deformity perception. Discussion: Incorporation of PNF in the patient’s plan of care may have positively contributed to improvement in JR sense of the spine, postural symmetry, and deformity perception. Future studies should examine the other components of proprioception, the effect of PNF in subjects with greater or more severe curvature, and information on joint position perception in healthy subjects.
Background: 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). Methods: 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. Results: 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. 7.3 h). 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%). Conclusions: 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 of evidence: Level II.
Aim: This perspective paper illustrates the usefulness of explicitly integrating motor learning terminology with evolving therapeutic approaches. Physiotherapy specific scoliosis exercises (PSSEs) include a growing number of approaches to scoliosis management and serve as an example of this integration. Methods: Three quintessential patient cases (a young hypermobile adolescent, a post-pubescent teen, and an adult with childhood diagnosis of scoliosis) serve to contrast the clinical decision-making process for a PSSE plan of care when organized within a motor learning framework. Conclusions and implications: As intervention approaches evolve, aligning the unique terminologies from different schools of thought with motor learning constructs would provide a common language for clinicians, academics and researchers to facilitate comparison of approaches and organize intervention care plans. Linking a motor learning framework and terminology to PSSE may facilitate comparison of PSSE treatment approaches by clinicians, academics, and researchers, as well as advance the global quality of care for patients with scoliosis.
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Purpose Adolescent idiopathic scoliosis (AIS) is the most common type of scoliosis that affects children aged 10–18 years old, manifesting in a three-dimensional spinal deformity. This study aimed to explore outcome measures used in defining AIS treatment success. Particularly, analyzing the extent of qualitative and quantitative (radiographic and quality of life domains) measures to evaluate AIS and whether AIS treatment approaches (surgical, bracing and physiotherapy) influences outcomes used as proxies of treatment success. Methods EMBASE and MEDLINE databases were used to conduct a systematic scoping review with 654 search queries. 158 papers met the inclusion criteria and were screened for data extraction. Extractable variables included: study characteristics, study participant characteristics, type of study, type of intervention approach and outcome measures. Results All 158 studies measured quantitative outcomes. 61.38% of papers used radiographic outcomes whilst 38.62% of papers used quantitative quality of life outcomes to evaluate treatment success. Irrespective of treatment intervention utilized, the type of quantitative outcome measure recorded were similar in proportion. Moreover, of the radiographic outcome measures, the subcategory Cobb angle was predominantly used across all intervention approaches. For quantitative quality of life measures, questionnaires investigating multiple domains such as SRS were primarily used as proxies of AIS treatment success across all intervention approaches. Conclusion This study identified that no articles employed qualitative measures of describing the psychosocial implications of AIS in defining treatment success. Although quantitative measures have merit in clinical diagnoses and management, there is increasing value in using qualitative methods such as thematic analysis in guiding clinicians to develop a biopsychosocial approach for patient care.
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Purpose Adolescent idiopathic scoliosis (AIS) is a common spinal deformity that affects millions of children worldwide. A variety of treatment algorithms exist for patients based on radiographic parameters such as the Cobb angle and the Risser stage. However, there has been a growing focus on nonradiographic outcomes such as back pain, which can cause functional disability and reduced quality of life for patients. In spite of this, back pain in AIS is poorly characterized in the literature. We aimed to summarize various factors that may influence back pain in AIS and the impact of different treatment methods on pain reduction. Methods A comprehensive systematic review was undertaken using the PubMed and Cochrane database. Keywords that were utilized and combined with “Adolescent Idiopathic Scoliosis” included, “back pain,” “treatment,” “biomechanics,” “biochemistry,” “epidemiology,” and “biopsychosocial.” The literature was subsequently evaluated and deemed relevant or not relevant for inclusion. Results A total of 93 articles were ultimately included in this review. A variety of contradictory literature was present for all sections related to epidemiology, underlying biomechanics and biochemistry, biopsychosocial factors, and treatment methodologies. Conclusion Back pain in AIS is common but remains difficult to predict and treat. The literature pertaining to causative factors and treatment options is heterogeneous and inconclusive. Longer-term prospective studies combining biopsychosocial intervention in conjunction with existing curve correction techniques would be meaningful.
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Abstract In recent decades, there has been a call for change among all stakeholders involved in scoliosis management. Parents of children with scoliosis have complained about the so-called “wait and see” approach that far too many doctors use when evaluating children’s scoliosis curves between 10° and 25°. Observation, Physiotherapy Scoliosis Specific Exercises (PSSE) and bracing for idiopathic scoliosis during growth are all therapeutic interventions accepted by the 2011 International Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT). The standard features of these interventions are: 1) 3-dimension self-correction; 2) Training activities of daily living (ADL); and 3) Stabilization of the corrected posture. PSSE is part of a scoliosis care model that includes scoliosis specific education, scoliosis specific physical therapy exercises, observation or surveillance, psychological support and intervention, bracing and surgery. The model is oriented to the patient. Diagnosis and patient evaluation is essential in this model looking at a patient-oriented decision according to clinical experience, scientific evidence and patient’s preference. Thus, specific exercises are not considered as an alternative to bracing or surgery but as a therapeutic intervention, which can be used alone or in combination with bracing or surgery according to individual indication. In the PSSE model it is recommended that the physical therapist work as part of a multidisciplinary team including the orthopeadic doctor, the orthotist, and the mental health care provider - all are according to the SOSORT guidelines and Scoliosis Research Society (SRS) philosophy. From clinical experiences, PSSE can temporarily stabilize progressive scoliosis curves during the secondary period of progression, more than a year after passing the peak of growth. In non-progressive scoliosis, the regular practice of PSSE could produce a temporary and significant reduction of the Cobb angle. PSSE can also produce benefits in subjects with scoliosis other than reducing the Cobb angle, like improving back asymmetry, based on 3D self-correction and stabilization of a stable 3D corrected posture, as well as the secondary muscle imbalance and related pain. In more severe cases of thoracic scoliosis, it can also improve breathing function. This paper will discuss in detail seven major scoliosis schools and their approaches to PSSE, including their bracing techniques and scientific evidence. The aim of this paper is to understand and learn about the different international treatment methods so that physical therapists can incorporate the best from each into their own practices, and in that way attempt to improve the conservative management of patients with idiopathic scoliosis. These schools are presented in the historical order in which they were developed. They include the Lyon approach from France, the Katharina Schroth Asklepios approach from Germany, the Scientific Exercise Approach to Scoliosis (SEAS) from Italy, the Barcelona Scoliosis Physical Therapy School approach (BSPTS) from Spain, the Dobomed approach from Poland, the Side Shift approach from the United Kingdom, and the Functional Individual Therapy of Scoliosis approach (FITS) from Poland.
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In North America, care recommendations for adolescents with small idiopathic scoliosis (AIS) curves include observation or bracing. Schroth scoliosis-specific exercises have demonstrated promising results on various outcomes in uncontrolled studies. This randomized controlled trial (RCT) aimed to determine the effect of Schroth exercises combined with the standard of care on quality-of-life (QOL) outcomes and back muscle endurance (BME) compared to standard of care alone in patients with AIS. Material and Methods Fifty patients with AIS, aged 10–18 years, with curves 10–45 °, recruited from a scoliosis clinic were randomized to receive standard of care or supervised Schroth exercises plus standard of care for 6 months. Schroth exercises were taught over five sessions in the first two weeks. A daily home program was adjusted during weekly supervised sessions. The assessor and the statistician were blinded. Outcomes included the Biering-Sorensen (BME) test, Scoliosis Research Society (SRS-22r) and Spinal Appearance Questionnaires (SAQ) scores. Intention-to-treat (ITT) and per protocol (PP) linear mixed effects models were analyzed. Because ITT and PP analyses produced similar results, only ITT is reported. After 3 months, BME in the Schroth group improved by 32.3 s, and in the control by 4.8 s. This 27.5 s difference in change between groups was statically significant (95 % CI 1.1 to 53.8 s, p = 0.04). From 3 to 6 months, the self-image improved in the Schroth group by 0.13 and deteriorated in the control by 0.17 (0.3, 95 % CI 0.01 to 0.59, p = 0.049). A difference between groups for the change in the SRS-22r pain score transformed to its power of four was observed from 3 to 6 months (85.3, 95 % CI 8.1 to 162.5, p = 0.03), where (SRS-22 pain score) 4 increased by 65.3 in the Schroth and decreased by 20.0 in the control group. Covariates: age, self-efficacy, brace-wear, Schroth classification, and height had significant main effects on some outcomes. Baseline ceiling effects were high: SRS-22r (pain = 18.4 %, function = 28.6 %), and SAQ (prominence = 26.5 %, waist = 29.2 %, chest = 46.9 %, trunk shift = 12.2 % and shoulders = 18.4 %). Supervised Schroth exercises provided added benefit to the standard of care by improving SRS-22r pain, self-image scores and BME. Given the high prevalence of ceiling effects on SRS-22r and SAQ questionnaires’ domains, we hypothesize that in the AIS population receiving conservative treatments, different QOL questionnaires with adequate responsiveness are needed. Trial registration Schroth Exercise Trial for Scoliosis NCT01610908.
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Objective: To determine the effectiveness of 3-dimensional therapy in the treatment of adolescent idiopathic scoliosis. Methods: We carried out this study with 50 patients whose average age was 14.15 +/-1.69 years at the Physical Therapy and Rehabilitation School, Hacettepe University, Ankara, Turkey, from 1999 to 2004. We treated them as outpatients, 5 days a week, in a 4-hour program for the first 6 weeks. After that, they continued with the same program at home. We evaluated the Cobb angle, vital capacity and muscle strength of the patients before treatment, and after 6 weeks, 6 months and one year, and compared all the results. Results: The average Cobb angle, which was 26.10 degrees on average before treatment, was 23.45 degrees after 6 weeks, 19.25 degrees after 6 months and 17.85 degrees after one year (p<0.01). The vital capacities, which were on average 2795 ml before treatment, reached 2956 ml after 6 weeks, 3125 ml after 6 months and 3215 ml after one year (p<0.01). Similarly, according to the results of evaluations after 6 weeks, 6 months and one year, we observed an increase in muscle strength and recovery of the postural defects in all patients (p<0.01). Conclusion: Schroth`s technique positively influenced the Cobb angle, vital capacity, strength and postural defects in outpatient adolescents.
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The two main societies clinically dealing with idiopathic scoliosis are the Scoliosis Research Society (SRS), founded in 1966, and the international Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT), started in 2004. Inside the SRS, the Non-Operative Management Committee (SRS-NOC) has the same clinical interest of SOSORT, that is the Orthopaedic and Rehabilitation (or Non-Operative, or conservative) Management of idiopathic scoliosis patients. The aim of this paper is to present the results of a Consensus among the best experts of non-operative treatment of Idiopathic Scoliosis, as represented by SOSORT and SRS, on the recommendation for research studies on treatment of Idiopathic Scoliosis. The goal of the consensus statement is to establish a framework for research with clearly delineated inclusion criteria, methodologies, and outcome measures so that future meta- analysis or comparative studies could occur. A Delphi method was used to generate a consensus to develop a set of recommendations for clinical studies on treatment of Idiopathic Scoliosis. It included the development of a reference scheme, which was judged during two Delphi Rounds; after this first phase, it was decided to develop the recommendations and 4 other Delphi Rounds followed. The process finished with a Consensus Meeting, that was held during the SOSORT Meeting in Wiesbaden, 8–10 May 2014, moderated by the Presidents of SOSORT (JP O’Brien) and SRS (SD Glassman) and by the Chairs of the involved Committees (SOSORT Consensus Committee: S Negrini; SRS Non-Operative Committee: MT Hresko). The Boards of the SRS and SOSORT formally accepted the final recommendations. The 18 Recommendations focused: Research needs (3), Clinically significant outcomes (4), Radiographic outcomes (3), Other key outcomes (Quality of Life, adherence to treatment) (2), Standardization of methods of non-operative research (6).
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To evaluate the effect of a programme of active self-correction and task-oriented exercises on spinal deformities and health-related quality of life (HRQL) in patients with mild adolescent idiopathic scoliosis (AIS) (Cobb angle <25°). This was a parallel-group, randomised, superiority-controlled study in which 110 patients were randomly assigned to a rehabilitation programme consisting of active self-correction, task-oriented spinal exercises and education (experimental group, 55 subjects) or traditional spinal exercises (control group, 55 subjects). Before treatment, at the end of treatment (analysis at skeletal maturity), and 12 months later (follow-up), all of the patients underwent radiological deformity (Cobb angle), surface deformity (angle of trunk rotation) and HRQL evaluations (SRS-22 questionnaire). A linear mixed model for repeated measures was used for each outcome measure. There were main effects of time (p < 0.001), group (p < 0.001) and time by group interaction (p < 0.001) on radiological deformity: training in the experimental group led to a significant improvement (decrease in Cobb angle of >5°), whereas the control group remained stable. Analysis of all of the secondary outcome measures revealed significant effects of time, group and time by group interaction in favour of the experimental group. The programme of active self-correction and task-oriented exercises was superior to traditional exercises in reducing spinal deformities and enhancing the HRQL in patients with mild AIS. The effects lasted for at least 1 year after the intervention ended.
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Background The role of bracing in patients with adolescent idiopathic scoliosis who are at risk for curve progression and eventual surgery is controversial. Methods We conducted a multicenter study that included patients with typical indications for bracing due to their age, skeletal immaturity, and degree of scoliosis. Both a randomized cohort and a preference cohort were enrolled. Of 242 patients included in the analysis, 116 were randomly assigned to bracing or observation, and 126 chose between bracing and observation. Patients in the bracing group were instructed to wear the brace at least 18 hours per day. The primary outcomes were curve progression to 50 degrees or more (treatment failure) and skeletal maturity without this degree of curve progression (treatment success). ResultsThe trial was stopped early owing to the efficacy of bracing. In an analysis that included both the randomized and preference cohorts, the rate of treatment success was 72% after bracing, as compared with 48% after observation (propensity-score-adjusted odds ratio for treatment success, 1.93; 95% confidence interval [CI], 1.08 to 3.46). In the intention-to-treat analysis, the rate of treatment success was 75% among patients randomly assigned to bracing, as compared with 42% among those randomly assigned to observation (odds ratio, 4.11; 95% CI, 1.85 to 9.16). There was a significant positive association between hours of brace wear and rate of treatment success (P<0.001). Conclusions Bracing significantly decreased the progression of high-risk curves to the threshold for surgery in patients with adolescent idiopathic scoliosis. The benefit increased with longer hours of brace wear. (Funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and others; BRAIST number, NCT00448448.)
Juvenile or adolescent idiopathic scoliosis is a relatively common spinal deformity, with an incidence of more than 1 %. Early diagnosis can lead to successful therapy. In the case of pathological clinical findings, the anteroposterior X‑ray of the whole spine leads the way to the correct grading, according to Cobb angle measurement. Depending on the individual risk of progression, brace treatment will be started with a Cobb angle range of 20–25°. Important predictors of therapeutic success are sufficient primary corrective power and patient compliance. COBB angles of 40–50° usually lead to the recommendation for surgery, which is performed as either anterior or posterior spinal fusion in skeletally mature adolescents, depending on the grade of the deformity according to Lenke’s classification. To achieve the best possible results, it is recommended that both conservative and surgical treatments are carried out by scoliosis specialists.
To compare the efficacy of three-dimensional (3D) Schroth exercises in patients with adolescent idiopathic scoliosis. A randomised-controlled study. An outpatient exercise-unit and in a home setting. Fifty-one patients with adolescent idiopathic scoliosis. Forty-five patients with adolescent idiopathic scoliosis meeting the inclusion criteria were divided into three groups. Schroth's 3D exercises were applied to the first group in the clinic and were given as a home program for the second group; the third group was the control. Scoliosis angle (Cobb method), angle of rotation (scoliometer), waist asymmetry (waist - elbow distance), maximum hump height of the patients and quality of life (QoL) (SRS-23) were assessed pre-treatment and, at the 6(th), 12(th) and 24(th) weeks. The Cobb (-2.53°; P=0.003) and rotation angles (-4.23°; P=0.000) significantly decreased, which indicated an improvement in the clinic exercise group compared to the other groups. The gibbosity (-68.66mm; P=0.000) and waist asymmetry improved only in the clinic exercise group, whereas the results of the other groups worsened. QoL did not change significantly in either group. According to the results of this study the Schroth exercise program applied in the clinic under physiotherapist supervision was superior to the home exercise and control groups; additionally, we observed that scoliosis progressed in the control group, which received no treatment. © The Author(s) 2015.
Scoliosis Research Society-22 (SRS-22) questionnaire was developed to evaluate health-related quality of life (HRQL) in adolescent idiopathic scoliosis (AIS) patients. Rasch analysis (RA) is a statistical procedure which turns questionnaire ordinal scores into interval measures. Measures from Rasch-compatible questionnaires can be used, similar to body temperature or blood pressure, to quantify disease severity progression and treatment efficacy. Purpose of the current work is to present Rasch analysis (RA) of the SRS-22 questionnaire and to develop an SRS-22 Rasch-approved short form. 300 SRS-22 were randomly collected from 2447 consecutive IS adolescents at their first evaluation (229 females; 13.9 ± 1.9 years; 26.9 ± 14.7 Cobb°) in a scoliosis outpatient clinic. RA showed both disordered thresholds and overall misfit of the SRS-22. Sixteen items were re-scored and two misfitting items (6 and 14) removed to obtain a Rasch-compatible questionnaire. Participants HRQL measured too high with the rearranged questionnaire, indicating a severe SRS-22 ceiling effect. RA also highlighted SRS-22 multidimensionality, with pain/function not merging with self-image/mental health items. Item 3 showed differential item functioning (DIF) for both curve and hump amplitude. A 7-item questionnaire (SRS-7) was prepared by selecting single items from the original SRS-22. SRS-7 showed fit to the model, unidimensionality and no DIF. Compared with the SRS-22, the short form scale shows better targeting of the participants’ population. RA shows that SRS-22 has poor clinimetric properties; moreover, when used with AIS at first evaluation, SRS-22 is affected by a severe ceiling effect. SRS-7, an SRS-22 7-item short form questionnaire, provides an HRQL interval measure better tailored to these participants.
Assessment of skeletal maturity in patients with adolescent idiopathic scoliosis (AIS) is important to guide clinical management. Understanding growth peak and cessation is crucial to determine clinical observational intervals, timing to initiate or end bracing therapy, and when to instrument and fuse. The commonly used clinical or radiological methods to assess skeletal maturity are still deficient in predicting the growth peak and cessation among adolescents, and bone age is too complicated to apply. To address these concerns, we describe a new distal radius and ulna (DRU) classification scheme to assess skeletal maturity. A prospective study. One hundred and fifty young, female AIS patients with hand x-rays and no previous history of spine surgery from a single institute were assessed. Radius and ulna plain radiographs, and various anthropomorphic parameters were assessed. We identified various stages of radius and ulna epiphysis maturity, which were graded as R1-R11 for the radius and U1-U9 for the ulna. The bone age, development of sexual characteristics, standing height, sitting height, arm span, radius length and tibia length were studied prospectively at each stage of these epiphysis changes. The standing height, sitting height and arm span growth were at their peak during stages R7 (mean: 11.4 years old) and U5 (mean: 11.0 years old). The long bone growths also demonstrated a common peak at R7 and U5. Cessation of height and arm span growth was noted after stages R10 (mean: 15.6 years old) and U9 (mean: 17.3 years old). The new DRU classification is a practical and easy-to-use scheme that can provide skeletal maturation status. This classification scheme provides close relationship with adolescent growth spurt and cessation of growth. This classification may have a tremendous utility in improving clinical-decision making in the conservative and operative management of scoliosis patients.