Corrective exercise-based therapy for adolescent idiopathic scoliosis: Systematic review and meta-analysis

Abstract

Objective to analyze the efficacy of Corrective exercise-based therapy in the improvement of deformity and quality of life in adolescent idiopathic scoliosis. Data sources PubMed Medline, Scopus, Web of Science (WOS), Physiotherapy Evidence Database, CINAHL Complete and SciELO, until June 2021. Review methods Randomized controlled trials was selected, including participants diagnosed with adolescent idiopathic scoliosis, in which the experimental group received Corrective exercise-based therapy. Two authors independently searched the scientific literature in the data sources, extracted the data and assessed the risk of bias. A pairwise meta-analysis using the random-effects model was performed. Results Eight randomized controlled trials providing data from 279 adolescent idiopathic scoliosis patients were included. Seven randomized controlled trials including 236 patients showed moderate-quality evidence for a medium effect (SMD = −0.52, 95% CI −0.96 to −0.1), favoring corrective exercise-based therapy for spinal deformity reduction. Corrective exercise-based therapy was better than no intervention (SMD = −0.59, 95% CI −1.18 to −0.01) but similar to other intervention (SMD = −0.2, 95% CI −0.67 to 0.27), and a medium effect was found (SMD = −0.51, 95% CI −0.89 to −0.13) when corrective exercise-based therapy was used with other therapies. Four studies including 151 patients showed low-quality evidence of a large effect of Corrective exercise-based therapy on Scoliosis Research Society measurement (SRS-22) total score improvement (SMD = 1.16, 95% CI 0.36 to 1.95). Conclusion In mild and moderate adolescent idiopathic scoliosis patients, corrective exercise-based therapy could be used to reduce spinal deformity and to improve quality of life as isolated treatment or as coadjuvant treatment combined with other therapeutic resources.

Can physiotherapy alone reduce spinal curvature in patients with idiopathic scoliosis?

“…The consensus of these three systematic reviews is that following any specific regime of CEBT may be effective at reducing curvature of the spine in patients with AIS. Also, while results were statistically significantly, the absolute change in Cobb angle curvature in the systematic reviews was small (approximately −2.1°, consistent between Li et al and Gámiz-Bermudez et al ) 7 8. From this appraisal, it is not clear if any positive quality-of-life improvements following CEBT are due to the changes in spinal curvature, or a result of the more general physical and mental health benefits associated with frequent exercise 13…”

“…Only one case of minor adverse effects was reported in the subject groups analysed, so CEBTs appear the more comfortable non-surgical means to manage AIS, as it is well documented that braces are uncomfortable and poorly tolerated in AIS patients 10. Gámiz-Bermudez et al also compared the use of ‘corrective-based therapies’ with the current mainstay non-surgical treatment involving orthostatic management (bracing) and found no significant difference in effectiveness at reducing Cobb angle (p=0.41) 8. Therefore, ‘corrective-based therapies’ may be an effective, non-inferior, alternative to bracing for the non-surgical management of AIS.…”

“…The three systematic reviews each analysed a different type or combination of exercises that target spinal flexibility and musculature. Li et al looked at general core-based exercises; Gámiz-Bermudez et al combined different corrective-based therapies, including SREs, SEAS and core-based exercises; and Park et al focused specifically on SREs 7–9. Subsequent meta-analysis proved challenging due to the heterogeneity of cohorts and outcome measures used in different studies.…”

A Comparison of the Effects of Supervised versus Home Schroth Exercise Programs with Adolescent Idiopathic Scoliosis

“…Evidence is also growing regarding exercises, with former Cochrane Review results reporting that the currently very low-quality evidence for this treatment is expected to change. A recent systematic review reported that PSSEs can reduce spinal deformities and improve quality of life as an isolated treatment or when administered in addition to bracing [ 14 , 20 , 21 ].…”

Morphology and deformity of the shoulder and pelvis in the entire spine radiographs of adolescent idiopathic scoliosis

“…Adolescent idiopathic scoliosis (AIS) is the most common spinal deformity affecting the growth and development of adolescents, resulting in deformation of the 3-dimensional (3D) shape of the spine (1)(2)(3)(4). AIS affects not only the development of the spine, but also bone development in other parts of the body, organ function, and mental health to varying degrees, resulting in high and low shoulders, flat back, razor back, thoracic deformity, pelvic tilt, long and short legs, and in serious cases, abnormal cardiopulmonary function, which significantly damage the physical and mental health of teenagers (5)(6)(7).…”