The effects of exercise therapy on adolescent idiopathic scoliosis: An overview of systematic reviews and meta-analyses

Self-management in patients with adult spinal deformity: a best practice implementation project

INTRODUCTION

The prevalence of adult spinal deformity (ASD) has increased in recent years. Patients often have to live for a prolonged period from the onset of the condition, up until the need for surgical treatment. Self-management plays a crucial role in disease progression and prognosis.

OBJECTIVES

This project aimed to promote evidence-based practices for the self-management of patients with ASD.

METHODS

This project was guided by the JBI Evidence Implementation Framework project and was conducted in the orthopedic department of a tertiary care hospital in China. A baseline audit was conducted to evaluate current practice against best practice recommendations. Barriers were identified and, after the implementation of improvement strategies, a follow-up audit was conducted to assess project effectiveness.

RESULTS

A comparison between the baseline and follow-up audits revealed a significant increase in nurses' compliance with best practices (rising from 0%-64% to 97.7%-100%) in the following areas: improved health promotion behaviors by nurses in self-management of ASD patients; acquisition and application of communication skills with patients; increased availability of educational materials in the ward; and establishment of conservative treatment follow-up instructions for patients. For patients, the Visual Analog Scale of pain decreased from (2.72 ± 1.67) to (1.90 ± 1.14), the Oswestry Disability Index decreased from (49.96 ± 16.49) to (39.83 ± 18.97), self-management behaviors improved from (10.84 ± 4.31) to (19.52 ± 6.31), and maximum isometric muscle strength in the standing position increased from (179.48 ± 91.18)N to (250.03 ± 91.50)N, all with statistically significant improvements ( p <0.05). For nurses, the knowledge questionnaire score improved from (34.83 ± 24.16) to (82.00 ± 11.11) ( p <0.05).

CONCLUSIONS

This project helped ASD patients improve self-management, alleviated their clinical symptoms, and improved nurses' knowledge of best practices. Future audits will be conducted to review long-term project outcomes.

SPANISH ABSTRACT

http://links.lww.com/IJEBH/A193.

The impact of patient scoliosis-specific exercises for adolescent idiopathic scoliosis: a systematic review and meta-analysis of randomized controlled trials with subgroup analysis using observational studies

PURPOSE

Adolescent idiopathic scoliosis (AIS) is a common pediatric spinal deformity frequently treated with patient scoliosis-specific exercises (PSSE). The purpose of this study is to perform a systematic review and meta-analysis of randomized controlled trials and sensitivity analysis of observational studies to determine the impact of PSSE on outcomes for AIS.

METHODS

A systematic review and meta-analysis on impact of PSSE for patients with AIS was performed. Databases used included PubMed, CINAHL, MEDLINE, Cochrane, and ScienceDirect database inception to October 2022. Inclusion criteria included use of PSSE, patient population of AIS, and full text.

RESULTS

A total of 26 articles out of 628 initial retrieved met final inclusion criteria (10 randomized controlled trials (RCTs), 16 observational studies). Total included patients (n = 2083) had a frequency weighted mean age of 13.2 ± 0.9 years and a frequency weighted mean follow-up of 14.5 ± 20.0 months. Based on only data from RCTs with direct comparison groups (n = 7 articles), there was a statistically significant but clinically insignificant improvement in Cobb angle of 2.5 degrees in the PSSE group (n = 152) as compared to the control group (n = 148; p = 0.017). There was no statistically significant improvement in Cobb angle when stratified by small curve (< 30 degrees) or large curve (> 30 degrees) with PSSE (p = 0.140 and p = 0.142, respectively). There was no statistically significant improvement in ATR (p = 0.326) or SRS-22 score (p = 0.370).

CONCLUSION

PSSE may not provide any clinically significant improvements in Cobb angle, ATR, or SRS-22 scores in patients with AIS. PSSE did not significantly improve Cobb angle when stratified by curve size.

LEVEL OF EVIDENCE

Level I.

The role of the paraspinal muscles in the development of adolescent idiopathic scoliosis based on surface electromyography and radiographic analysis

BACKGROUND

Patients with idiopathic scoliosis commonly present with an imbalance of the paraspinal muscles. However, it is unclear whether this muscle imbalance is an underlying cause or a result of idiopathic scoliosis. This study aimed to investigate the role of paraspinal muscles in the development of idiopathic scoliosis based on surface electromyography (sEMG) and radiographic analyses.

METHODS

This was a single-center prospective study of 27 patients with single-curve idiopathic scoliosis. Posteroanterior whole-spine radiographs and sEMG activity of the erector spinae muscles were obtained for all patients in the habitual standing position (HSP), relaxed prone position (RPP), and prone extension position (PEP). The Cobb angle, symmetrical index (SI) of the sEMG activity (convex/concave), and correlation between the two factors were analyzed.

RESULTS

In the total cohort, the mean Cobb angle in the HSP was significantly greater than the mean Cobb angle in the RPP (RPP-Cobb) (p < 0.001), whereas the mean Cobb angle in the PEP (PEP-Cobb) did not differ from the RPP-Cobb. Thirteen patients had a PEP-Cobb that was significantly smaller than their RPP-Cobb (p = 0.007), while 14 patients had a PEP-Cobb that was significantly larger than their RPP-Cobb (p < 0.001). In the total cohort and two subgroups, the SI of sEMG activity at the apex vertebra (AVSI) in the PEP was significantly greater than 1, revealing significant asymmetry, and was also significantly larger than the AVSI in the RPP. In the RPP, the AVSI was close to 1 in the total cohort and two subgroups, revealing no significant asymmetry.

CONCLUSION

The coronal Cobb angle and the SI of paraspinal muscle activity in AIS patients vary with posture changes. Asymmetrical sEMG activity of the paraspinal muscles may be not an inherent feature of AIS patients, but is evident in the challenging tasks. The potential significance of asymmetric paraspinal muscle activity need to be explored in further research.

Physiotherapeutic Scoliosis-Specific Exercises (PSSE-Schroth) can reduce the risk for progression during early growth in curves below 25°: prospective control study

BACKGROUND

The main treatment aim in mild scoliosis is to prevent progression and if possible, to avoid bracing. Physiotherapeutic Scoliosis Specific Exercises (PSSE) are curve pattern specific exercises, based on 3D self-correction and activities of daily living training.

AIM

The objective of this study was to evaluate the efficacy of PSSE - Schroth, as an exclusive treatment, during the riskiest period of rapid growth.

DESIGN

Prospective control study.

SETTING

Outpatient treatment.

POPULATION

Adolescents with scoliosis.

METHODS

One hundred and sixty-three patients (148 girls,15 boys; mean age 12.6 years, Risser sign 1.1, thoracic (Th) Cobb angle 20.8° and lumbar/thoracolumbar (L/TL) Cobb angle 20.7°) performed PSSE - Schroth exercises in our clinic. They were asked to regularly attend supervised sessions and to follow a home-program at least 5 times per week. Our inclusion criteria were Cobb angle 15°-25°, Risser 0-2 and angle trunk rotation (ATR) >5°, measured by scoliometer. The outcome parameters were the Cobb angle before and after the intervention (improvement or progression were defined as angle difference more than 5°) and the number of patients that finally needed a brace. Average follow-up time was 29.4 months. Control group was consisted of 58 patients (54 girls, 4 boys; mean age 13.1 years, Risser sign 0-2, Th Cobb 19.4°, L/TL Cobb 19.2°), that were retrospectively analyzed and performed general or no exercises. Compliance was self-reported. Statistical analysis was performed by paired t-test.

RESULTS

For PSSE - Schroth group, 103 patients (63.2%) remained stable, 39 (23.9%) improved and 21 (12.9%) worsened. The success rate (87.1%) was significantly higher compared to Control group (P=0.002), where 15 subjects (25.9%) were stable and 43 (74.1%) worsened. Similarly, 16 patients (9.8%) from PSSE - Schroth group finally needed a brace, while 39 (67.2%) from control group (P=0.01).

CONCLUSIONS

PSSE - Schroth reduced the risk of progression in Adolescent Idiopathic Scoliosis (AIS) patients, during early growth. Our results are in accordance with the recently published literature, showing the effectiveness of PSSE and their superiority compared to general exercises or natural history.

CLINICAL REHABILITATION IMPACT

Scoliosis specific exercises can be the first step of scoliosis treatment in mild curves, to avoid progression and bracing.

The effects of physiotherapeutic scoliosis-specific exercise on idiopathic scoliosis in children and adolescents: a systematic review and meta-analysis

BACKGROUND

Physiotherapeutic scoliosis-specific exercise (PSSE) is recommended by SOSORT as the first step in the treatment of adolescent idiopathic scoliosis (AIS). However, a thorough summary and meta-analysis of the evidence for the effectiveness of PSSE is lacking.

OBJECTIVE

To summarise the up-to-date evidence on the efficacy of PSSE in AIS compared with the other non-surgical therapies.

DATA SOURCES

The PubMed, Web of Science, Cochrane, Scopus, Embase and CNKI databases were systematically searched from 1 January 2012 to 1 November 2022.

STUDY SELECTION

Controlled trials comparing the effects of PSSE and other non-surgical therapies on improving Cobb angle and quality of life in young people aged 6-18 years were included.

DATA SYNTHESIS

Three researchers independently extracted data and evaluated methodological quality. Meta-analysis was performed where possible; otherwise, descriptive syntheses were reported.

RESULTS

Seventeen studies with a total of 930 participants (76% female) were included. Among them, ten studies were RCTs. Six studies were of excellent quality. Thirteen studies were included in the meta-analysis. PSSE corrected the Cobb angle in patients better than other non-surgical therapies (I2 = 82%, MD = -2.82, 95%CI = -4.17 to -1.48, P < 0.01). PSSE was more effective than brace in improving patients' pain, self-image and mental health. Patients with a Risser grade of 0-3 or who had never received brace therapy had better outcomes.

CONCLUSION

Evidence from higher quality studies suggests that PSSE was superior to general exercise and conventional therapy for correcting the Cobb angle in AIS.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO ID CRD42022345157 CONTRIBUTION OF THE PAPER.

The Addition of Daytime Physiotherapeutic Scoliosis-specific Exercises to Adolescent Idiopathic Scoliosis Nighttime Bracing Reduces Curve Progression

BACKGROUND

The effectiveness of physiotherapeutic scoliosis-specific exercises (PSSE) in addition to nighttime bracing compared with nighttime bracing alone is unknown. The purpose of this prospective comparative study was to evaluate the effectiveness of PSSE in skeletally immature patients with adolescent idiopathic scoliosis treated with nighttime bracing (PSSE group) compared with the standard of care of nighttime bracing alone (control group).

METHODS

Patients with adolescent idiopathic scoliosis thoracolumbar or lumbar primary curves <35 degrees at Risser stage 0 who wore a Providence brace were prospectively enrolled into the PSSE or control group. A temperature sensor recorded the number of hours of brace wear. The PSSE group was instructed in the Schroth-based physical therapy method and a home exercise program for at least 15 minutes per day, 5 days per week, for 1 year.

RESULTS

Seventy-four patients (37 PSSE, 37 controls) were followed until the final visit of skeletal maturity or surgery. The PSSE and control groups had similar baseline Cobb angles (24 vs. 25 degrees) and average hours of brace wear (8.0 vs. 7.3 h). The PSSE group had no change in curve magnitude at the final visit compared with curve progression in the control group (1 vs. 7 degrees, P <0.01). Furthermore, the PSSE group had a lower rate of curve progression >5 degrees at the final visit (14% vs. 43%, P <0.01). The PSSE group also had less conversion to full-time bracing after 1 year (5% vs. 24%, P =0.046), but differences were no longer significant at the final visit (14% vs. 27%).

CONCLUSIONS

In this prospective series of patients in nighttime Providence braces, the addition of Schroth-based physical therapy reduced curve progression after 1 year and at skeletal maturity. These findings can educate motivated families interested in PSSE.

LEVEL OF EVIDENCE

Level II.

Prediction of future curve angle using prior radiographs in previously untreated idiopathic scoliosis: natural history from age 6 to after the end of growth (SOSORT 2022 award winner)

PURPOSE

Treatment selection for idiopathic scoliosis is informed by the risk of curve progression. Previous models predicting curve progression lacked validation, did not include the full growth/severity spectrum or included treated patients. The objective was to develop and validate models to predict future curve angles using clinical data collected only at, or both at and prior to, an initial specialist consultation in idiopathic scoliosis.

METHODS

This is an analysis of 2317 patients with idiopathic scoliosis between 6 and 25 years old. Patients were previously untreated and provided at least one prior radiograph prospectively collected at first consult. Radiographs were re-measured blinded to the predicted outcome: the maximum Cobb angle on the last radiograph while untreated. Linear mixed-effect models were used to examine the effect of data from the first available visit (age, sex, maximum Cobb angle, Risser, and curve type) and from other visits while untreated (maximum Cobb angle) and time (from the first available radiograph to prediction) on the Cobb angle outcome. Interactions of the first available angle with time, of time with sex, and time with Risser were also tested.

RESULTS

We included 2317 patients (83% of females) with 3255 prior X-rays where 71% had 1, 21.1% had 2, and 7.5% had 3 or more. Mean age was 13.9 ± 2.2yrs and 81% had AIS. Curve types were: 50% double, 26% lumbar/thoracolumbar-lumbar, 16% thoracic, and 8% other. Cobb angle at the first available X-ray was 20 ± 10° (0-80) vs 29 ± 13° (6-122) at the outcome visit separated by 28 ± 22mths. In the model using data at and prior to the specialist consult, larger values of the following variables predicted larger future curves: first available Cobb angle, Cobb angle on other previous X-ray, and time (with Time2 and Time3) to the target prediction. Larger values on the following variables predicted a smaller future Cobb angle: Risser and age at the first available X-ray, time*Risser and time*female sex interactions. Cross-validation found a median error of 4.5o with 84% predicted within 10°. Similarly, the model using only data from the first specialist consult had a median error of 5.5o with 80% of cases within 10° and included: maximum Cobb angle at first specialist consult, Time, Time2, age, curve type, and both interactions.

CONCLUSIONS

The models can help clinicians predict how much curves would progress without treatment at future timepoints of their choice using simple variables. Predictions can inform treatment prescription or show families why no treatment is recommended. The nonlinear effects of time account for the rapid increase in curve angle at the beginning of growth and the slowed progression after maturity. These validated models predicted future Cobb angle with good accuracy in untreated idiopathic scoliosis over the full growth spectrum.

Barriers and facilitators of physical function, activity, sports and exercise in children and adolescents with spinal pain: a protocol for a systematic review and meta-ethnography

INTRODUCTION

Spinal pain is one of the leading causes of disability, with the incidence of adolescent back pain estimated at 20%. Multiple barriers influence exercise participation in adolescents. However, there remains a lack of literature surrounding patients' choice to exercise, perceived barriers and facilitators of exercise, and their relationship to participant demographics. The aim of this systematic review with meta-ethnography will be to identify the barriers and facilitators of exercise participation among adolescents with thoracic or lower back pain (LBP). The secondary aim will be to identify any trends in barriers and facilitators of exercise between different demographic groups within children or adolescents under 18 years.

METHODS AND ANALYSIS

The seven-phase process identified by Noblit and Hare's meta-ethnography approach will be used. A comprehensive electronic search of databases (AMED, CINAHLplus, EMBASE, MEDLINE, SCOPUS, Nursing & Allied Health, PubMed, PsycINFO, SPORTDiscus, Social Science Database) will be completed during April 2022. Grey literature using reference lists, websites and search engines will also be searched in accordance with Peer Review of Electronic Search Strategies (PRESS) guidelines. Inclusion criteria include: (A) qualitative studies, (B) participants under 18 years experiencing thoracic or LBP, (C) identification of barriers and facilitators of exercise participation in exercise, sports or physical activity and (D) primary research. This systematic review with meta-ethnography review aims to generate theories of behaviours and interpret significance across multiple studies. This process aims to develop future physiotherapeutic behavioural interventions, inform service provision and identify possible future research questions.

ETHICS AND DISSEMINATION

No ethical approval was required due to the nature of using previously published work to form a systematic review paper. This systematic review and meta-ethnography will be disseminated through both conference presentations and journal publications. No funding was received for this review.

PROSPERO REGISTRATION NUMBER

CRD42022314796.

Algorithm for Schroth-Curve-Type Classification of Adolescent Idiopathic Scoliosis: An Intra- and Inter-Rater Reliability Study

Schroth exercises for scoliosis are prescribed based on curve types. This study aimed to determine the reliability of an algorithm for classifying Schroth curve types. Forty-four consecutive volunteers with adolescent idiopathic scoliosis, 10 to 18 years old, with curves 10° to 50°, were recruited from a scoliosis clinic. Their standing posture and Adam’s bending test were videotaped. Ten consecutive Schroth therapist volunteers from an international registry independently classified the curve types using the proposed classification algorithm. Videos were rated twice at least seven days apart. Reliability was calculated using the Gwet’s AC1 agreement coefficient for all the raters and for subgroups reporting full understanding (well-trained) and with prior algorithm experience. The intra-rater and weighted agreement coefficients for all the raters were 0.64 (95% CI: 0.53–0.73) and 0.75 (0.63–0.84), respectively. For the well-trained raters, they were 0.70 (0.60–0.78) and 0.82 (0.73–0.88), respectively; for the experienced raters, they were 0.81 (0.77–0.85) and 0.89 (0.80–0.94), respectively. The inter-rater versus weighted agreement coefficients for all the raters were 0.43 (0.28–0.58) versus 0.48 (0.29–0.67). For the well-trained raters, they were 0.50 (0.38–0.61) versus 0.61 (0.49–0.72), and for the experienced raters, they were 0.67 (0.50–0.85) versus 0.79 (0.64–0.94). Full understanding and experience led to higher reliability. Use of the algorithm can help standardize Schroth exercise treatment.

Effectiveness of psychosocial interventions for pediatric patients with scoliosis: a systematic review

Background

Pediatric patients affected by scoliosis have complex psychological and social care needs, and may benefit from psychosocial interventions. We therefore aimed to summarize evidence of the efficacy of psychosocial interventions for this patient population.

Methods

Literature was identified by searching Medline, PsycINFO, Embase, EBSCO Cumulated Index to Nursing and Allied Health Literature (CINAHL), and Cochrane Central Register of Controlled Trials (CENTRAL) from database inception to 20 March 2022. Articles that evaluated the effectiveness of psychosocial interventions for pediatric patients diagnosed with scoliosis and reported at least one quantitative outcome were included. Article eligibility, data extraction, and quality assessment (using the Cochrane Collaboration's Risk of Bias Tool and Methodological Index for Non-Randomized Studies) were performed by two independent researchers. Findings are presented using narrative synthesis.

Results

We identified ten studies, all of which focused on adolescent idiopathic scoliosis. Studies included a total of 1007 participants, most of whom were female. Three studies focused on patients undergoing bracing, six on patients undergoing spinal surgery, and one on patients broadly. Brace compliance monitoring and counseling were found to significantly improve brace compliance quality and quantity. Proactive mental healthcare delivery by nurses after spinal surgery was similarly found to improve outcomes. Several studies examined the efficacy of brief educational interventions; most did not report clear evidence of their efficacy. The methodological quality of studies was often unclear due to limitations in articles' reporting quality.

Conclusions

Research on the efficacy of psychosocial interventions for pediatric patients with scoliosis is limited, with interventions involving frequent patient-provider interactions showing the most promise. Future clinical and research efforts should focus on developing and testing psychosocial interventions for this patient population, with emphasis on multidisciplinary teams delivering holistic care.

Trial registration number

PROSPERO number CRD42022326957.

Left-Right Differential Erector Spinae Muscles Activation in Prone and Quadruped Positions

Left-right differential erector spinae (ES) muscle strengthening is required to correct ES muscle imbalances. The objective was to test the effect of 6 body positions on the differential activation of the ES muscles. In 14 able-bodied young women, using a surface electromyography system, the bilateral ES muscles activity at the third lumbar (ESL3) and the 10th (EST10) and 6th (EST6) thoracic vertebral levels was measured with the contralateral arm and leg lifted in the prone and quadruped conditions and with a single arm lifted in the quadruped position. Results showed that the activity of the ESL3 was symmetrical (P > .05) and significantly smaller than that of the thoracic ES muscles in all body positions (P < .01). The EST10 and EST6 were differentially activated in all tests (P < .001). Besides, the differential activation was higher in the contralateral-arm and -leg lift in the quadruped position than in the other positions. In conclusion, contralateral-arm and -leg lift and single-arm lift in the quadruped and prone positions are capable of differentially activating the ES muscles on one side more than the other side. Further studies are recommended to examine the effectiveness of these exercises on the correction of ES muscle imbalances in clinical populations.

The Impact of Training Time on Understanding the Treatment of Adolescent Idiopathic Scoliosis According to SOSORT International Guidelines: An Online Survey Study

The lack of knowledge by health professionals in the management of scoliosis can lead to an erroneous diagnosis. The aim of the current study was to understand the influence of length of professional experience on the knowledge of Brazilian physical therapists regarding international guidelines for the treatment of adolescent idiopathic scoliosis. The study was conducted using an online questionnaire consisting of 23 questions, divided into 8 questions on sociodemographic data and 15 questions based on information provided by the guidelines in the SOSORT 2016. In total, 506 physiotherapists were interviewed, and they comprised the study sample. The results showed that professionals who have been working for more than 6 years in the field have greater knowledge of AIS, seek to become more professional, and with that, have an understanding of AIS that is more aligned with the SOSORT. Length of experience made a difference when considering knowledge of the treatment of idiopathic scoliosis. The present study showed that a time since graduation of 6 years or more was satisfactory.

Efficacy of conservative treatment on exacerbation of adolescent idiopathic scoliosis

Scoliosis is defined as a deviation from the normal vertical line of the spine and consists of a lateral curvature in which the spine rotates within the curvature. Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis and the cause is unknown. In this study, it was investigated whether conservative treatment for adolescent idiopathic scoliosis (CONTRAIS) reduced the patient’s Cobb angle, and the effect of CONTRAIS according to the severity of idiopathic scoliosis and the efficacy of CONTRAIS by spinal region were also verified. Idiopathic scoliosis patients with a Cobb angle of 10° or more were recruited and classified into mild, moderate, and severe groups according to the Cobb angle (°). Cobb angle was measured radiographically before and after 10 weeks of treatment. A combination of CONTRAIS, including physical therapy, exercise therapy, manual therapy, and home exercise was prescribed for all patients. The patients visited the hospital 3 times a week for 10 weeks for treatment, and exercised at home for 20 min every day. In this study, the effect of reducing Cobb angle of CONTRAIS did not differ according to the spinal region. Also, the Cobb angle reduction effect of CONTRAIS was more effective in severe group. This study may suggest that early detection and treatment through CONTRAIS enables successful correction of AIS.

Physiotherapeutic Scoliosis-Specific Exercise Methodologies Used for Conservative Treatment of Adolescent Idiopathic Scoliosis, and Their Effectiveness: An Extended Literature Review of Current Research and Practice

Due to the multifactorial etiology of scoliosis, a comprehensive treatment plan is essential for conservative management. Physiotherapeutic scoliosis-specific exercise (PSSE) methods have lately gained popularity for the conservative treatment of scoliosis. The aim of this study was to analyze the PSSE methodologies used for conservative treatment of adolescent idiopathic scoliosis (AIS), as well as their effectiveness. The study was based on an extended literature search conducted in the PubMed, Google Scholar, PEDro, eLABA, and BioMed Central databases. A total of 123 articles were selected for this study (including articles overviewed in systematic reviews and meta-analyses) after applying the inclusion criteria. The study revealed that inappropriate management of AIS could result in serious health problems. Conservative interventions that aid in stabilizing spine curvature and improving esthetics are preferred for scoliosis treatment. Bracing has traditionally been the mainstay of treatment, but growing evidence suggests that PSSE physiotherapy allows effective management of idiopathic adolescent scoliosis. Currently, there are the following PSSE physiotherapy schools in Europe: Schroth, SEAS, BSPTS, FED, FITS, Lyon, Side Shift, and DoboMed. The methodologies of these schools are similar, in that they focus on applying corrective exercises in three planes, developing stability and balance, breathing exercises, and posture awareness. Although high-quality research supporting the effectiveness of PSSE physiotherapy in the treatment of AIS is lacking, existing evidence indicates that PSSE physiotherapy helps to stabilize spinal deformity and improve patients’ quality of life. Among the abovementioned methodologies, Schroth is the most widely studied and has been proven to be effective. However, both SEAS and BSPTS effectively stabilize and even reduce the Cobb angle of scoliosis. Data supporting the validity of other methodologies are very limited. Only the Schroth method significantly reduces the angle of trunk rotation, while both SEAS and Schroth methods greatly improve the quality of life indicators. In any case, the available evidence is insufficient to confirm the advantage of one specific physiotherapy technique over others.

Does exercise therapy improve pulmonary function in patients with Adolescent Idiopathic Scoliosis?

INTRODUCTION

Exercise therapy is frequently used for treating patients with Adolescent Idiopathic Scoliosis (AIS) however no previous review has evaluated the effect of exercise therapy on pulmonary function in this population.

OBJECTIVE

To systematically analyze the literature on the effect of exercise therapy on pulmonary function in patients with AIS.

METHODS

A systematic electronic database search (CINAHL, Embase, Medline, Web of Science) was conducted. Manual searches of key reviews and studies were also conducted. Studies that included exercise-based interventions to improve pulmonary function in patients with AIS and reported pre- and post-intervention pulmonary function test scores were included. Test scores were compared using standardized mean difference (SMD) between intervention and control groups in randomized control trials (RCT) and mean ± SD between pre- and post-intervention in prospective intervention studies (PI). Methodological quality was assessed using a modified Downs and Black checklist.

RESULTS

Fifteen studies met the inclusion criteria (six RCTs and nine PIs). Results indicated the positive effect of exercise-based therapy on lung volumes (FVC/VC) and FEV₁ in patients with AIS.

CONCLUSION

Exercise therapy has a positive effect on lung volumes in patients with AIS. The quality of many studies was only 'fair,' therefore more suitably powered higher level clinical trials are required.