The effectiveness of Schroth exercises in adolescents with idiopathic scoliosis: A systematic review and meta-analysis

Abstract

Background Adolescent idiopathic scoliosis (AIS) is one of the most common structural spinal deformities in adolescents, becoming apparent around the time of puberty. Schroth scoliosis-specific exercises have demonstrated promising results in reducing the progression of AIS. Objectives The aim of this study was to identify, critically appraise and establish the best available evidence for the effectiveness of Schroth exercises in comparison to non-surgical management to reduce the progression of AIS. Methodology Seven databases were searched in April 2018. Main key search terms included AIS, Schroth exercises, physiotherapy, exercise, electrical stimulation, yoga, Pilates, tai chi and bracing . The quality of the trials was critically appraised according to the PEDro scale. Revman© Review Manager Software was used to pool the quality of life (QOL) results. Results Four randomised control trials with an average PEDro score of 6.75/10 were included in this study. Results indicated that Schroth exercises had a significant effect in decreasing the Cobb angle ( p < 0.05) in comparison to non-surgical management. The pooled effect on QOL showed a significant result in favour of Schroth exercises at 12 weeks ( p < 0.002) and at 24 weeks ( p < 0.0004). Conclusion Level II evidence suggests that Schroth exercises have a significant effect on reducing the Cobb angle and improving QOL in adolescents with idiopathic scoliosis. Clinical implications This review’s findings should be considered with caution for physiotherapy practice because of the limited number of identified articles and their methodologic limitations. Based on the current available and limited evidence, clinicians could combine supervised Schroth exercises with conventional physiotherapy care (observation, exercise, bracing and manual therapy) when treating adolescents with idiopathic scoliosis.

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

“…This review aimed to estimate the effect of SSE on scoliotic deformity improvement. Unlike the previous reviews [33,51,52], besides 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].…”

“…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].…”

“…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 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].…”

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

“…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).…”