Specific exercises reduce the need for bracing in adolescents with idiopathic scoliosis: A practical clinical trial

Ann Phys Rehabil Med. 2019 Mar;62(2):69-76. doi: 10.1016/j.rehab.2018.07.010. Epub 2018 Aug 24.


Background: In an ideal experimental setting, 2 randomized controlled trials recently showed the efficacy of physiotherapeutic scoliosis-specific exercises (PSSEs) for adolescents with idiopathic scoliosis (AIS). Now large observational studies are needed to check the generalizability of these results to everyday clinical life.

Objective: To explore the effectiveness of PSSEs for avoiding bracing or progression of AIS in everyday clinics.

Methods: This was a longitudinal comparative observational multicenter study, nested in a prospective database of outpatient tertiary referral clinics, including 327 consecutive patients. Inclusion criteria were AIS, age≥10 years old at first evaluation, Risser sign 0-2, and 11-20°Cobbangle. Exclusion criteria were consultations only and brace prescription at baseline. Groups performed PSSE according to the SEAS (Scientific Exercise Approach to Scoliosis) School, usual physiotherapy (UP) and no therapy (controls [CON]). End of treatment was medical discharge, Risser sign 3, or failure (defined by the need for bracing before the end of growth or Cobb angle>29°). The probability of failure was estimated by the risk ratio (RR) and 95% confidence interval (CI). The number needed to treat was estimated. Statistical analysis included intent-to-treat analysis, considering all participants (dropouts as failures), and efficacy analysis, considering only end-of-treatment participants. Propensity scores were used to reduce the potential effects of confounders related to the observational design.

Results: We included 293 eligible subjects after propensity score matching (SEAS, n=145; UP, n=95; controls, n=53). The risk of success was increased 1.7-fold (P=0.007) and 1.5-fold (P=0.006) with SEAS versus controls in the efficacy and intent-to-treat analyses, respectively, and the number needed to treat for testing SEAS versus controls was 3.5 (95% CI 3.2-3.7) and 1.8 (95% CI 1.5-2.0), respectively. The success rate was higher with SEAS than UP in the efficacy analysis.

Conclusions: SEAS reduced the bracing rate in AIS and was more effective than UP. PSSEs are additional tools that can be included in the therapeutic toolbox for AIS treatment.

Keywords: Adolescents; Exercise; Scoliosis.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Adolescent
  • Braces / statistics & numerical data*
  • Databases, Factual
  • Exercise Therapy / methods*
  • Female
  • Humans
  • Intention to Treat Analysis
  • Longitudinal Studies
  • Male
  • Propensity Score
  • Prospective Studies
  • Scoliosis / physiopathology
  • Scoliosis / therapy*
  • Tertiary Care Centers
  • Treatment Outcome