Schroth Physiotherapeutic Scoliosis-Specific Exercises Added to the Standard of Care Lead to Better Cobb Angle Outcomes in Adolescents with Idiopathic Scoliosis – an Assessor and Statistician Blinded Randomized Controlled Trial

Abstract

BackgroundThe North American non-surgical standard of care for adolescent idiopathic scoliosis (AIS) includes observation and bracing, but not exercises. Schroth physiotherapeutic scoliosis-specific exercises (PSSE) showed promise in several studies of suboptimal methodology. The Scoliosis Research Society calls for rigorous studies supporting the role of exercises before including it as a treatment recommendation for scoliosis.ObjectivesTo determine the effect of a six-month Schroth PSSE intervention added to standard of care (Experimental group) on the Cobb angle compared to standard of care alone (Control group) in patients with AIS.MethodsFifty patients with AIS aged 10–18 years, with curves of 10°-45° and Risser grade 0–5 were recruited from a single pediatric scoliosis clinic and randomized to the Experimental or Control group. Outcomes included the change in the Cobb angles of the Largest Curve and Sum of Curves from baseline to six months. The intervention consisted of a 30–45 minute daily home program and weekly supervised sessions. Intention-to-treat and per protocol linear mixed effects model analyses are reported.ResultsIn the intention-to-treat analysis, after six months, the Schroth group had significantly smaller Largest Curve than controls (-3.5°, 95% CI -1.1° to -5.9°, p = 0.006). Likewise, the between-group difference in the square root of the Sum of Curves was -0.40°, (95% CI -0.03° to -0.8°, p = 0.046), suggesting that an average patient with 51.2° at baseline, will have a 49.3° Sum of Curves at six months in the Schroth group, and 55.1° in the control group with the difference between groups increasing with severity. Per protocol analyses produced similar, but larger differences: Largest Curve = -4.1° (95% CI -1.7° to -6.5°, p = 0.002) and (95% CI -0.8 to 0.2, p = 0.006).ConclusionSchroth PSSE added to the standard of care were superior compared to standard of care alone for reducing the curve severity in patients with AIS.Trial RegistrationNCT01610908

Fusionless Correction of Moderate Adolescent Idiopathic Scoliosis with a New Minimally Invasive Dynamic Implant (ApiFix®) and Postoperative Schroth Scoliosis Specific Exercises-Case Series

“…It is, therefore, logical to combine the internal brace with scoliosis specific exercises. Schreiber et al in a randomized controlled study on nonoperative management of AIS reported that a combination of standard of care of AIS including bracing with Schroth scoliosis specific exercises gave a better curve correction than care without exercises [8]. Our novel concept and method also combine a brace, although internal, and exercises in the management protocol.…”

Effects of corrective, therapeutic exercise techniques on adolescent idiopathic scoliosis. A systematic review

“…[27][28][29][30][31][32][33][34][35] AIS symptoms are frequently associated with tumors, inflammation or visceral dysfunction; this would exclude solely conservative management. The studies encompassed by this review did not include that type of patients and, after the intervention, they showed a reduction in symptoms.…”

“…All included studies had corrective, therapeutic exercise as the independent outcome measure; 4 referred to it as Schroth exercises, [27][28][29][30] and the other 5 used different terms that covered therapeutic exercise based on self-correction and spinal stabilization. [31][32][33][34][35] The intervention period varied greatly: 3 studies included an intervention that lasted 8-12 weeks, 30,32,35 while 4 conducted interventions for 6 months, 27-29-33 and 2, for 1 year.…”

“…31,34 In relation to dependent outcome measures, 6 studies assessed symptoms using the following questionnaires: Scoliosis Research Society 22 (SRS-22), 28,34 Scoliosis Research Society 23 (SRS-23), 27 Numeric Pain Rating Scale (NPRS), 32,33 and Functional Rating Index (FRI). 35 Six studies assessed postural parameters, such as Cobb's angle, measured using anteriorposterior X-rays of the trunk with the patient standing, 27,[29][30][31]34 neck slope angle, measured using a sagittal photogrammetry with the patient sitting down, 35 angle of trunk rotation, measured using an inclinometry 27,34 and/or body asymmetries, measured using stereographic projections 35 Six studies assessed the functional capacity of included subjects using the following questionnaires: SRS-22, 28,34 SRS-23, 27 Oswestry Low Back Pain Disability Questionnaire (OSW), Patient-Specific Functional Scale (PSFS), 32,33 and FRI. 35 In relation to muscle endurance, 2 studies assessed back extensor muscle endurance using the Prone-Double-Leg-Raise Test (PDLRT) 32 and the Biering-Sorensen test (BME, back muscle endurance). 28 Two studies assessed the overall perception following the intervention using the Global Rating of Change (GROC).…”

Brace Treatment for Children and Adolescents with Scoliosis

“…Obviously, general exercises or sport activities also reduce the incidence of progression in small curvatures [28] or in patients with a low risk for progression [29]. However, there is only one relevant randomised controlled trial (RCT) with an untreated control group [5], whilst other RCTs involving PSE have major flaws (amongst other things not providing an uncontrolled control group) and therefore would not contribute to high quality evidence [30,31].…”