Effectiveness of scoliosis-specific exercises for adolescent idiopathic scoliosis compared with other non-surgical interventions: a systematic review and meta-analysis

Thompson, Jacqueline; Williamson, Esther; Williams, Mark A.; Heine, Peter J; Lamb, Sarah E

doi:10.1016/j.physio.2018.10.004

Cited by 41 publications

(50 citation statements)

References 41 publications

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“…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.…”

Section: Evidence Hierarchy and Methodological Appraisalmentioning

confidence: 99%

“…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only four studies [51]; one review analyzed nine articles of which three (33%) did not use SSE and one (11%) was an outdated article published 15 years ago [33].…”

Section: Introductionmentioning

confidence: 98%

“…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only four studies [51]; one review analyzed nine articles of which three (33%) did not use SSE and one (11%) was an outdated article published 15 years ago [33].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].…”

Section: Introductionmentioning

confidence: 99%

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

Fan

Ren

2020

BMC Musculoskelet Disord

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Background: Adolescent idiopathic scoliosis (AIS) is the most common pediatric spinal deformity with reported complications including pain, mental health concern and respiratory dysfunction. The scoliosis-specific exercise (SSE) is prescribed throughout pubertal growth to slow progression although effects are unclear. This review aims to establish the effectiveness of SSE for alleviating AIS in terms of reducing Cobb angle, improving trunk asymmetry and quality of life (QoL). Additionally, it aims to define the effects of age, skeletal maturity, curve magnitude and exercise compliance on the outcomes of SSE. Methods: A systematic reviewed was conducted to net SSE articles. Searched databases included PubMed, MEDL INE, Cochrane Library, Scopus, CINAHL and Google scholar. The quality of study was critically appraised according to the PEDro scale. Results: A total of ten trials with an average PEDro score of 6.9/10 were examined in this study. Two randomized controlled trials (RCTs) and two clinical controlled trials suggested that SSE alone and with bracing or traditional exercise had clinical significance in reducing Cobb angle more than 5°. One RCT specifically implicated no comparable effects between bracing and SSE in prevention of curve progression for moderate scoliosis. There was insufficient evidence to support the positive effects of SSE on improving truck asymmetry (n = 4) and QoL (n = 3). Five studies evaluated the interaction effects of age (n = 2), skeletal maturity (n = 1) and curve magnitude (n = 2) with SSE in reducing Cobb angle yet without drawing any firm conclusions. Conclusions: Insufficient evidence is available to prove that SSE with or without other conservative treatments can reduce Cobb angle, improve trunk balance and QoL. The interaction effects of age, skeletal maturity, curve magnitude, and exercise compliance with SSE in reducing Cobb angle are not proven. Future studies should investigate the relationship of influencing factors and SSE in treating AIS but not only testing its effectiveness. Trial registration: INPLASY202050100.

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Section: Evidence Hierarchy and Methodological Appraisalmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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

Fan

Ren

2020

BMC Musculoskelet Disord

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“…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.…”

Section: Discussionmentioning

confidence: 81%

“…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).…”

Section: Discussionmentioning

confidence: 96%

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

Fan

Ren

2020

Preprint

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Abstract Background: Adolescent idiopathic scoliosis (AIS) is the most common pediatric spinal deformity with reported complications including pain, mental health concern and respiratory dysfunction. The Scoliosis-specific exercise (SSE) is prescribed throughout pubertal growth to slow progression although effects are unclear. This review aims to establish the effectiveness of SSE in alleviating AIS in terms of reducing Cobb angle, improving trunk asymmetry and quality of life (QoL). Additionally, it aims to define the effects of age, skeletal maturity, curve magnitude and exercise compliance on the outcomes of SSE. Methods: A systematic reviewed was conducted to net SSE articles. Searched databases included PubMed, MEDLINE, Cochrane Library, Scopus, CINAHL and Google scholar. The quality of study was critically appraised according to the PEDro scale. Results: A total of ten trials with an average PEDro score of 6.9/10 were examined in this study. Two randomized controlled trials (RCTs) and two clinical controlled trials suggested that SSE alone and with bracing or traditional exercise had clinical significance in reducing Cobb angle more than 5°. One RCT specifically implicated no comparable effects between bracing and SSE in prevention of curve progression for moderate scoliosis. Insufficient evidence demonstrated the positive effects of SSE in improving truck asymmetry (n=4) and QoL (n=3). Five studies evaluated the interaction effects of age (n=2), skeletal maturity (n=1) and curve magnitude (n=2) with SSE in reducing Cobb angle yet without drawing any firm conclusions. Conclusions: Insufficient evidence is available to prove that SSE with or without other conservative treatments can reduce Cobb angle, improve trunk balance and QoL. The interaction effects of age, skeletal maturity, curve magnitude, and exercise compliance with SSE in reducing Cobb angle are not proven. Future studies should investigate the relationship of influencing factors and SSE in treating AIS but not only testing its effectiveness.

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Nighttime Bracing or Exercise in Moderate-Grade Adolescent Idiopathic Scoliosis

Charalampidis,

Diarbakerli,

Dufvenberg

et al. 2024

JAMA Netw Open

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ImportanceModerate-grade adolescent idiopathic scoliosis (AIS) may be treated with full-time bracing. For patients who reject full-time bracing, the effects of alternative, conservative interventions are unknown.ObjectiveTo determine whether self-mediated physical activity combined with either nighttime bracing (NB) or scoliosis-specific exercise (SSE) is superior to a control of physical activity alone (PA) in preventing Cobb angle progression in moderate-grade AIS.Design, Setting, and ParticipantsThe Conservative Treatment for Adolescent Idiopathic Scoliosis (CONTRAIS) randomized clinical trial was conducted from January 10, 2013, through October 23, 2018, in 6 public hospitals across Sweden. Male and female children and adolescents aged 9 to 17 years with an AIS primary curve Cobb angle of 25° to 40°, apex T7 or caudal, and skeletal immaturity based on estimated remaining growth of at least 1 year were included in the study. Dates of analysis were from October 25, 2021, to January 28, 2023.InterventionsInterventions included self-mediated physical activity in combination with either NB or SSE or PA (control). Patients with treatment failure were given the option to transition to a full-time brace until skeletal maturity.Main Outcomes and MeasuresThe primary outcome was curve progression of 6° or less (treatment success) or curve progression of more than 6° (treatment failure) seen on 2 consecutive posteroanterior standing radiographs compared with the inclusion radiograph before skeletal maturity. A secondary outcome of curve progression was the number of patients undergoing surgery up until 2 years after the primary outcome.ResultsThe CONTRAIS study included 135 patients (45 in each of the 3 groups) with a mean (SD) age of 12.7 (1.4) years; 111 (82%) were female. Treatment success was seen in 34 of 45 patients (76%) in the NB group and in 24 of 45 patients (53%) in the PA group (odds ratio [OR], 2.7; 95% CI, 1.1-6.6). The number needed to treat to prevent curve progression with NB was 4.5 (95% CI, 2.4-33.5). Treatment success occurred in 26 of 45 patients (58%) in the SSE group (OR for SE vs PA, 1.2; 95% CI, 0.5-2.8). Up to 2 years after the primary outcome time point, 9 patients in each of the 3 groups underwent surgery.Conclusions and RelevanceIn this randomized clinical trial, treatment with NB prevented curve progression of more than 6° to a significantly higher extent than did PA, while SSE did not; in addition, allowing transition to full-time bracing after treatment failure resulted in similar surgical frequencies independent of initial treatment. These results suggest that NB may be an effective alternative intervention in patients rejecting full-time bracing.Trial RegistrationClinicalTrials.gov Identifier: NCT01761305

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Effectiveness of scoliosis-specific exercises for adolescent idiopathic scoliosis compared with other non-surgical interventions: a systematic review and meta-analysis

Abstract: Effectiveness of scoliosis-specific exercises for adolescent idiopathic scoliosis compared with other non-surgical interventions: a systematic review and metaanalysis.Physiotherapy (2018),

Cited by 41 publications

References 41 publications

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

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

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

Nighttime Bracing or Exercise in Moderate-Grade Adolescent Idiopathic Scoliosis

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