Objective: To investigate the effects of physiotherapeutic scoliosis-specific exercises (PSSE) on coronal, horizontal, and sagittal deformities of the spine in adolescent idiopathic scoliosis (AIS) as well as how curve severity, intervention duration, and intervention type could modify these effects.
Data sources: Data sources included the PubMed, Web of Science, Embase, Cochrane Library, and Scopus databases, searched from their inception to September 5, 2023.
Study selection: Clinical controlled trials reporting the effects of PSSE on the Cobb angle, angle of trunk rotation (ATR), thoracic kyphosis (TK), or lumbar lordosis (LL) in AIS patients aged 10 to 18 years. The experimental groups received PSSE; the control groups received standard care (observation or bracing) or conventional exercise such as core stabilization exercise, pilates, PNF, and other non-specific exercise.
Data extraction: Two researchers independently extracted key information from eligible studies. The quality of the studies was assessed using the Cochrane Handbook version 5.1.0 risk of bias assessment and the JBI Center for Evidence-Based Health Care (2016) of quasi-experimental research authenticity assessment tool. The level and certainty of evidence was rated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The protocol for this study was registered in PROSPERO (CRD42023404996).
Data synthesis: Twelve randomized controlled trials (RCTs) and five non-RCTs (NRCTs) were meta-analyzed separately. The results indicated that compared with other non-surgical management, PSSE significantly improved the Cobb angle, ATR, and TK, whereas the LL improvement was not statistically significant. Additionally, the efficacy of PSSE on Cobb angle was not significant in patients with curve severity ≥30° compared with controls. Nevertheless, the pooled effect of PSSE on Cobb angle was not significantly modified by intervention duration and intervention type, and on ATR was not significantly modified by intervention duration. The overall quality of evidence according to GRADE was moderate to low for RCT and very low for NRCT.
Conclusions: PSSE exhibited positive benefits on the Cobb angle, ATR, and TK in patients with AIS compared to other non-surgical therapies. In addition, the effectiveness of PSSE may be independent of intervention duration and intervention type, but may be influenced by the initial Cobb angle. However, more RCTs are needed in the future to validate the efficacy of PSSE in moderate AIS with a mean Cobb ≥30°. Current evidence is limited by inconsistent control group interventions and small sample size of the studies.
Keywords: Adolescent; Exercise Therapy; Meta-analysis; Scoliosis; Systematic review.
Copyright © 2024. Published by Elsevier Inc.