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

• This systematic review analysed the effects of PSSE on AIS and conducted a meta-analysis to compare the targeted effectiveness of different non-surgical therapies.
• PSSE can reduce the Cobb angle compared to other non-surgical therapies, especially general exercise and conventional therapy, while reducing patients’ pain and improving their self-image and mental health compared to a brace.
• This review has included both randomised and non-randomised trials to enlarge the evidence bases. Although the heterogeneity is high, the high efficacy of PSSE in relieving AIS can also be demonstrated based on the results of the subgroup analysis.