Effects of Specific Exercise Therapy on Adolescent Patients With Idiopathic Scoliosis

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Abstract

To explore the interventional effect of exercise therapy on idiopathic scoliosis and identify an optimal intervention window, we did a prospective controlled cohort study. The results shows the efficacy of our exercise protocol, and younger patients with a lower Risser grade are most likely to respond.

Study Design.

A prospective controlled cohort study.

Objective.

The aim of this study was to explore the interventional effect of exercise therapy on idiopathic scoliosis (IS) and identify an optimal intervention window.

Summary of Background Data.

Early conservative treatment is helpful for IS. In addition to bracing, current evidence suggests that exercise can play an important role.

Methods.

We included 99 patients with IS who were treated at the Guangdong Xinmiao Scoliosis Center from August 2013 to September 2017. The inclusion criteria were: new IS diagnosis, Cobb angle 10° to 25°, Risser 0 to 3 grade, only treated with the Xinmiao treatment system (XTS; >3 days/week, >1 h/day), and follow-up >1 year. Patients were divided into three age groups: A, <10 years (n = 29); B, 10 to 12 years (n = 24); and C, 13 to 15 years (n = 46). The percentages of curve improvement (Cobb angle decrease ≥5°), stability (Cobb angle change × ±5°), and progression (Cobb angle increase ≥5°) were compared.

Results.

The groups showed significant differences for major curve correction, Risser sign, first referral, and final follow-up of the main curve (all P < 0.05). The major curve in group A decreased significantly by 6.8° (44% correction), compared to 3.1° (18% correction) and 1.5° (9% correction) in groups B and C, respectively. In group A, 69.0% (20/29) had curve improvement, 27.6% (8/29) stabilized and 3.4% (1/29) progressed. In group B, 45.8% (11/24) improved, 50% (12/24) stabilized, and 4.2% (1/24) progressed. In group C, 26.1% (12/46) improved, 63.0% (29/46) stabilized, and 10.9% (5/46) progressed. There was also a significant difference in final Risser grade among the groups ( P < 0.05).

Conclusion.

For IS patients with Cobb angles between 10° and 25°, our exercise protocol can effectively control or improve curve progression. Younger patients with a lower Risser grade are most likely to respond.

Level of Evidence: 2

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Most cited references 28

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Adolescent idiopathic scoliosis.

Stuart L. Weinstein, Lori Dolan, Jack Cheng … (2008)

Adolescent idiopathic scoliosis (AIS) affects 1-3% of children in the at-risk population of those aged 10-16 years. The aetiopathogensis of this disorder remains unknown, with misinformation about its natural history. Non-surgical treatments are aimed to reduce the number of operations by preventing curve progression. Although bracing and physiotherapy are common treatments in much of the world, their effectiveness has never been rigorously assessed. Technological advances have much improved the ability of surgeons to safely correct the deformity while maintaining sagittal and coronal balance. However, we do not have long-term results of these changing surgical treatments. Much has yet to be learned about the general health, quality of life, and self-image of both treated and untreated patients with AIS.

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2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth

Stefano Negrini, Sabrina Donzelli, Angelo Gabriele Aulisa … (2018)

Background The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) produced its first guidelines in 2005 and renewed them in 2011. Recently published high-quality clinical trials on the effect of conservative treatment approaches (braces and exercises) for idiopathic scoliosis prompted us to update the last guidelines’ version. The objective was to align the guidelines with the new scientific evidence to assure faster knowledge transfer into clinical practice of conservative treatment for idiopathic scoliosis (CTIS). Methods Physicians, researchers and allied health practitioners working in the area of CTIS were involved in the development of the 2016 guidelines. Multiple literature reviews reviewing the evidence on CTIS (assessment, bracing, physiotherapy, physiotherapeutic scoliosis-specific exercises (PSSE) and other CTIS) were conducted. Documents, recommendations and practical approach flow charts were developed using a Delphi procedure. The process was completed with the Consensus Session held during the first combined SOSORT/IRSSD Meeting held in Banff, Canada, in May 2016. Results The contents of the new 2016 guidelines include the following: background on idiopathic scoliosis, description of CTIS approaches for various populations with flow-charts for clinical practice, as well as literature reviews and recommendations on assessment, bracing, PSSE and other CTIS. The present guidelines include a total of 68 recommendations divided into following topics: bracing (n = 25), PSSE to prevent scoliosis progression during growth (n = 12), PSSE during brace treatment and surgical therapy (n = 6), other conservative treatments (n = 2), respiratory function and exercises (n = 3), general sport activities (n = 6); and assessment (n = 14). According to the agreed strength and level of evidence rating scale, there were 2 recommendations on bracing and 1 recommendation on PSSE that reached level of recommendation “I” and level of evidence “II”. Three recommendations reached strength of recommendation A based on the level of evidence I (2 for bracing and one for assessment); 39 recommendations reached strength of recommendation B (20 for bracing, 13 for PSSE, and 6 for assessment).The number of paper for each level of evidence for each treatment is shown in Table 8. Conclusion The 2016 SOSORT guidelines were developed based on the current evidence on CTIS. Over the last 5 years, high-quality evidence has started to emerge, particularly in the areas of efficacy of bracing (one large multicentre trial) and PSSE (three single-centre randomized controlled trials). Several grade A recommendations were presented. Despite the growing high-quality evidence, the heterogeneity of the study protocols limits generalizability of the recommendations. There is a need for standardization of research methods of conservative treatment effectiveness, as recognized by SOSORT and the Scoliosis Research Society (SRS) non-operative management Committee. Electronic supplementary material The online version of this article (10.1186/s13013-017-0145-8) contains supplementary material, which is available to authorized users.

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The prediction of curve progression in untreated idiopathic scoliosis during growth.

Eric Carlson, J W Lonstein (1984)

We reviewed the cases of 727 patients with idiopathic scoliosis in whom the initial curve measured from 5 to 29 degrees. The patients were followed either to the end of skeletal growth or until the curve progressed. One hundred and sixty-nine patients (23.2 per cent) showed progression of the curve. The incidence of curve progression was found to be related to the pattern and magnitude of the curve, the patient's age at presentation, the Risser sign, and the patient's menarchal status. We found no correlation between progression of the curve and the patient's sex, Harrington factor, rotational prominence, family history, or radiographic measurements. A progression factor was calculated using the three strongest correlations available at initial examination: the magnitude of the curve, the Risser sign, and the patient's chronological age. A graph and nomogram are presented that can serve as a guide for advising patients' families and for planning continuing care.

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Author and article information

Journal

Journal ID (nlm-ta): Spine (Phila Pa 1976)

Journal ID (iso-abbrev): Spine

Journal ID (publisher-id): BRS

Title: Spine

Publisher: Lippincott Williams & Wilkins

ISSN (Print): 0362-2436

ISSN (Electronic): 1528-1159

Publication date (Print): 1 August 2020

Publication date (Electronic): 24 February 2020

Volume: 45

Issue: 15

Pages: 1039-1046

Affiliations

[a ]Department of Spine Surgery, the 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China

[b ]Physical Education Institute, Chengdu University of Technology, Chengdu, China

[c ]Department of sports and Arts, Guangzhou Sport University, Guangzhou, Guangdong, China

[d ]Spine Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China

[e ]Xinmiao Scoliosis Prevention Center of Guangdong Province, Guangzhou, Guangdong, China.

Author notes

Address correspondence and reprint requests to Junlin Yang, MD, PhD, Spine Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China; E-mail: yjunlin@ 123456126.com ; Zifang Huang, MD, PhD, Department of Spine Surgery, the 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510120, China; E-mail: laughten@ 123456126.com .

Article

Publisher ID: SPINE159898 Accession ID: 00010

DOI: 10.1097/BRS.0000000000003451

PMC ID: 7373466

PubMed ID: 32675606

SO-VID: e29870e9-0d55-4439-a073-f0179d06179b

License:

This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0

History

Date received : 20 September 2019

Date revision received : 09 December 2019

Date accepted : 20 January 2020

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Keywords: age,curve progression,efficacy,idiopathic scoliosis,intervention window,prospective controlled cohort study,risser sign,specific exercise

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Keywords: age, curve progression, efficacy, idiopathic scoliosis, intervention window, prospective controlled cohort study, risser sign, specific exercise

Effects of Specific Exercise Therapy on Adolescent Patients With Idiopathic Scoliosis : A Prospective Controlled Cohort Study

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Abstract

Study Design.

Objective.

Summary of Background Data.

Methods.

Results.

Conclusion.

Related collections

Efficacy of Communicating Science

Most cited references 28

Adolescent idiopathic scoliosis.

2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth

The prediction of curve progression in untreated idiopathic scoliosis during growth.

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