“How should I apply this information?”
This is a follow-up study of an 8-visit, once a week supervised physical therapy (PT) intervention program that significantly improved pain and global rating of change outcomes compared with an unsupervised, 1 PT visit-only group. Nevertheless, both groups improved in all meaningful outcomes that exceeded the minimal clinically important difference.
The exercise protocols for both groups are pragmatic and may be easily applied by novice clinicians, patients, and their families. These may be tailored to patients who can or cannot afford to attend regular one-on-one PT sessions. Because no high-quality evidence currently exists for long-term scoliosis specific exercises,1 most therapists who have not undergone specialized training may opt for the simple stabilization program (with progression) applied in this study. Recently, even small scoliosis curves are shown to have significant long-term quality-of-life effect.2 Therefore, this study may help families, physicians, and therapists abandon the “wait and see” approach and instead address adolescent idiopathic scoliosis in early stages with the present study's approach.
“What should I be mindful about when applying this information?”
Several caveats may impact the quality of this study: (1) the risk of bias3 exists based on a lack of intention-to-treat analysis, the high dropout rate in the unsupervised group and the high differential dropout rate between both groups; (2) potential Hawthorne effect based on one group receiving 1 PT session whereas the other group received 8 sessions; (3) a statistically significant difference exists in the baseline age of both groups in the original study; (4) Scoliosis Research Society (SRS)-22r, a universally accepted scoliosis outcome measure was not used in this study, thereby precluding direct comparison with other exercise studies; and (5) the original sample size calculation required a total of 34 participants; however, the follow-up group only had 32 subjects.
Emmanuel Yung, PT, DPT, OCS, MA, FAAOMPT
Sacred Heart University
Fairfield, Connecticut
Michael S. Wong, PT, DPT, OCS, FAAOMPT
Azusa Pacific University
Azusa, California
REFERENCES
1. Romano M, Minozzi S, Zaina F, et al. Exercises for adolescent idiopathic scoliosis: a Cochrane systematic review. Spine. 2013;38(14):E883–E893.
2. Clark EM, Tobias JH, Fairbank J. The impact of small spinal curves in adolescents who have not presented to secondary care: a population-based cohort study. Spine. 2016;41(10):E611–E17.
3. National Institutes of Health. Quality Assessment of Controlled Intervention Studies.
http://www.nhlbi.nih.gov/health-pro/guidelines/in-develop/cardiovascular-risk-reduction/tools/rct. Accessed October 9, 2016.
