Review of scoliosis-specific exercise methods used to correct adolescent idiopathic scoliosis

Abstract

Background Adolescent idiopathic scoliosis (AIS) refers to a spinal curvature of an unknown origin diagnosed in otherwise healthy children. A conservative treatment approach includes physiotherapy scoliosis-specific exercises (PSSE) with or without corrective bracing in preventing further spinal column deviation. However, several PSSE types have been developed to facilitate a positive patient outcome and/or preclude surgical remediation. Based on other reviews, there has been insufficient evidence published on the efficacy of PSSEs. In addition, the superiority of PSSE over no intervention or compared to other exercise modes has yet to be determined. Methods A comprehensive search of AIS literature, inception through February 2018, was conducted to reveal relevant PSSE articles. Only studies using commonly reported PSSEs were included. Examined databases included PubMed, Scopus, CINAHL Complete, and Physiotherapy Evidence Database (PEDro). Google Scholar search engine was also examined. Article types included randomized or clinical control trials. All articles were published in English or were of English translation. Search parameters were collectively defined by the reviewers and subsequently used to determine included studies. Individual PSSE study methodology quality was determined by the PEDro scale. Effect sizes (Hedge’s g) and their 95% confidence intervals were calculated for Cobb angle between group changes. Results Of the initial 24 articles recovered only eight (33%) met the established search criteria. Patient ages from these sources ranged from 11.4–16.2 including both males and females. Examined papers included two Schroth method and six specifying the Scientific Exercise Approach to Scoliosis (SEAS) method. All articles demonstrated positive between group effect sizes for PSSEs. There were no studies that compared one PSSE to another. Determined PEDro scores indicated an overall moderate quality of these studies. Conclusions There is insufficient evidence to suggest that both Schroth and SEAS methods can effectively improve Cobb angles in patients with AIS compared to no intervention. There is limited evidence that the SEAS method is more effective at reducing Cobb angles compared to traditional exercises in treating AIS. Overall, this review revealed a noticeable lack of contemporary studies that could be used in answering our questions. Evidence-based medicine (EBM) supplies clinicians with verifiable results from well-designed and managed research studies. Consequently, more and varied studies of higher quality are needed before any definitive determination can be made as to the effectiveness of any PSSE let alone the one offering better patient outcomes.

Effectiveness of scoliosis-specific exercises for alleviating adolescent idiopathic scoliosis: a systematic review

“…Level II evidence (RCT) was considered the best methodology to answer intervention-related questions in a systematic review. However, considering the limited number of RCT in the most up-to-date reviews [33,49,51,52], prospective clinical control trials (CCT: Level III) were also analyzed in this study.…”

“…Thus, the quality of enrolled studies in that review was relatively poor [49]. Another three systematic reviews enrolled studies between 2005 and 2017 and found insufficient and low-quality clinical trials showing effects of SSE on improving the scoliotic deformity [33,51,52]. One review confirmed the promising effects of the Schroth method in curve regression but had analyzed only four studies [51]; one review analyzed nine articles of which three (33%) did not use SSE and one (11%) was an outdated article published 15 years ago [33].…”

“…One review confirmed the promising effects of the Schroth method in curve regression but had analyzed only four studies [51]; one review analyzed nine articles of which three (33%) did not use SSE and one (11%) was an outdated article published 15 years ago [33]. One study analyzed eight articles of which three (37.5%) were rated as being low quality (PEDro score: 3), one (12.5%) had a retrospective study design, and 50% (n = 4) were published 10 years ago [52]. A number of controlled trials have been published after 2017, which calls for an updated systematic review.…”

Effectiveness of Scoliosis-Specific Exercise for Alleviating Adolescent Idiopathic Scoliosis: A Systematic Review

“…The main limitation of the review is the lack of high-quality studies, which makes it di cult to extract adequate data to reach any rm conclusions. The previous systematic reviews (33,52), analyzed the same ve studies (35,37,41,45,48) included in our review, revealed a signi cant heterogeneity by statistical testing and concluded that no pooled effect sizes could be reliably reported. In addition, our review included ve more updated clinical trials that showed notable methodological heterogeneity: one CCT was conducted with a large sample size (n=99) but no comparative untreated controls (40); four studies, including one CCT (38) and three RCTs (36,46,47), were conducted with small sample sizes (n<50) which could mask variations and build up of systematic errors.…”

“…This review aimed to estimate the effect of SSE on scoliotic deformity improvement. Unlike the previous reviews (33,51,52), besides of reporting a reduction in Cobb angle, our review emphasized the true effect in terms of reductions beyond clinical measurement errors. The clinical standard for individual curve regression was reported to be >5° (55).…”