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Schroth physiotherapeutic scoliosis-specific exercises added to the standard of care lead to better Cobb angle outcomes in adolescents with idiopathic scoliosis -- an assessor and statistician blinded randomized controlled trial
Schreiber S, Parent EC, Khodayari Moez E, Hedden DM, Hill DL, Moreau M, Lou E, Watkins EM, Southon SC
PLoS ONE 2016 Dec;11(12):e0168746
clinical trial
8/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: The North American non-surgical standard of care for adolescent idiopathic scoliosis (AIS) includes observation and bracing, but not exercises. Schroth physiotherapeutic scoliosis-specific exercises (PSSE) showed promise in several studies of suboptimal methodology. The Scoliosis Research Society calls for rigorous studies supporting the role of exercises before including it as a treatment recommendation for scoliosis. OBJECTIVES: To determine the effect of a six-month Schroth PSSE intervention added to standard of care (experimental group) on the Cobb angle compared to standard of care alone (control group) in patients with AIS. METHODS: Fifty patients with AIS aged 10 to 18 years, with curves of 10 degrees to 45 degrees and Risser grade 0 to 5 were recruited from a single pediatric scoliosis clinic and randomized to the experimental or control group. Outcomes included the change in the Cobb angles of the largest curve and sum of curves from baseline to six months. The intervention consisted of a 30 to 45 minute daily home program and weekly supervised sessions. Intention-to-treat and per protocol linear mixed effects model analyses are reported. RESULTS: In the intention-to-treat analysis, after six months, the Schroth group had significantly smaller largest curve than controls (-3.5 degrees, 95% CI -1.1 degrees to -5.9 degrees, p = 0.006). Likewise, the between-group difference in the square root of the sum of curves was -0.40 degrees (95% CI -0.03 degrees to -0.8 degrees, p = 0.046), suggesting that an average patient with 51.2 degrees at baseline, will have a 49.3 degrees sum of curves at six months in the Schroth group, and 55.1 degrees in the control group with the difference between groups increasing with severity. Per protocol analyses produced similar, but larger differences: largest curve -4.1 degrees (95% CI -1.7 degrees to -6.5 degrees, p = 0.002) and square root of sum of curves -0.5 degrees (95% CI -0.8 to 0.2, p = 0.006). CONCLUSION: Schroth PSSE added to the standard of care were superior compared to standard of care alone for reducing the curve severity in patients with AIS. TRIAL REGISTRATION: NCT01610908.

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