The Impact of Patient Specific Scoliosis Exercises on Outcomes for Adolescent Idiopathic Scoliosis: A Systematic Review with Meta-Analysis

Objective(s): To investigate the impact of patient specific scoliosis exercises (PSSE) on outcomes in patients with adolescent idiopathic scoliosis (AIS) to improve patient care.

Data Sources: A systematic review with meta-analysis was performed using PubMed, CINAHL, MEDLINE, Cochrane, and ScienceDirect with search terms “adolescent idiopathic scoliosis” AND “schroth” OR “scoliosis specific exercise” from October 2022 to database inception

Study Selection: Inclusion criteria included use of PSSE, patient population of AIS, patient outcomes, and English full text. Multiple reviewers participated in article screening and final selection. A total of 628 articles were retrieved from the initial search with 26 articles meeting final inclusion criteria (10 Level I articles,16 Level IV articles).

Data Extraction: Data extraction was performed by multiple authors. Article bias and quality was assessed via the Physiotherapy Evidence Database (PEDro) for randomized controlled trials and the Methodological Index for Non-Randomized Studies (MINORS) for observational studies.

Data Synthesis: A total of 18 articles (n=1927 total patients) were used for Cobb angle assessment with 3.20 degrees of improvement in Cobb angle in patients receiving PSSE at 18 months follow up as compared to 1.4 degrees of worsening in controls (p < 0.001). Meta analysis of eight randomized controlled trials revealed a statistically significant difference of Cobb angle delta between treatment (n=644 patients) and control groups (n=782 patients) with an overall mean improvement of 2.6 degrees (0.91,4.30; p=0.018). For subgroup analysis, there was significant improvement in small curves (less than 30 degrees)(p < 0.001) with no significant improvement in larger curves (greater than 30 degrees)(p=0.565) in patients treated with PSSE. No significant improvement was seen in ATR (p=0.07) or SRS-22 scores (p=0.16) after PSSE.

Conclusions: PSSE demonstrates a small but statistically significant improvement in Cobb angle in patients with AIS. When stratified based on curve size, improvement was seen for smaller curves, but not for larger curves.

Author(s) Disclosures: Patrick Cahill has affiliations with Dynamic Lung MRI and Pediatric Deformity System. John Flynn has affiliations with Biomet and Wolters Kluwer. No other authors have any disclosures.