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Exercises for Adolescent Idiopathic Scoliosis: A Cochrane Systematic Review

Romano, Michele PT*; Minozzi, Silvia MD; Zaina, Fabio MD*; Saltikov, Josette Bettany PhD; Chockalingam, Nachiappan PhD§; Kotwicki, Tomasz MD, PhD; Hennes, Axel Maier PT; Negrini, Stefano MD**

doi: 10.1097/BRS.0b013e31829459f8
Cochrane Collaboration

Study Design. Systematic review of interventions.

Objective. To evaluate the efficacy of scoliosis-specific exercise (SSE) in adolescent patients with adolescent idiopathic scoliosis (AIS).

Summary of Background Data. AIS is a 3-dimensional deformity of the spine. Although AIS can progress during growth and cause a surface deformity, it is usually not symptomatic. However, in adulthood, if the final spinal curvature surpasses a certain critical threshold, the risk of health problems and curve progression is increased. The use of SSEs to reduce progression of AIS and postpone or avoid other more invasive treatments is controversial.

Methods. Search methods: The following databases (up to March 30, 2011) were searched with no language limitations: CENTRAL (The Cochrane Library 2011, issue 2), MEDLINE (from January 1966), EMBASE (from January 1980), CINHAL (from January 1982), SPORTDiscus (from January 1975), PsycINFO (from January 1887), and PEDro (from January 1929). We screened reference lists of articles and conducted an extensive hand search of gray literature. Selection criteria: randomized controlled trials and prospective cohort studies with a control group comparing exercises with no treatment, other treatment, surgery, and different types of exercises. Data collection and analysis: Two review authors independently selected studies, assessed risk of bias and extracted data.

Results. Two studies (154 participants) were included. There is low-quality evidence from 1 randomized controlled study that exercises as an adjunctive to other conservative treatments to increase the efficacy of these treatments (thoracic curve reduced: mean difference 9.00, [95% confidence interval, 5.47–12.53]; lumbar curve reduced: mean difference 8.00, [95% confidence interval, 5.08–10.92]). There is very low-quality evidence from a prospective controlled cohort study that SSEs structured within an exercise program can reduce brace prescription (risk ratio, 0.24; [95% confidence interval, 0.06–1.04]) as compared with “usual physiotherapy” [many different kinds of general exercises according to the preferences of the single therapists within different facilities]).

Conclusion. There is a lack of high-quality evidence to recommend the use of SSE for AIS. One very low-quality study suggested that these exercises may be more effective than electrostimulation, traction, and postural training to avoid scoliosis progression, but better quality research needs to be conducted before the use of SSE can be recommended in clinical practice.

Level of Evidence: 2

We assessed the effects of scoliosis-specific exercises (SSE) in adolescent patients with AIS using a systematic review. Two studies (154 participants) were included. There is low quality evidence from the two studies. Better quality research needs to be conducted before the use of SSE can be recommended in clinical practice.

*ISICO (Italian Scientific Spine Institute), Milan, Italy

Department of Epidemiology, Lazio Regional Health Service, Rome, Italy

School of Health and Social Care, University of Teeside, Middlesbrough, UK

§Faculty of Health, Staffordshire University, Stoke on Trent, UK

Department of Pediatric Orthopedics and Traumatology, University of Medical Sciences, Poznan, Poland

Scoliosis Rehabilitation Centre, Bad Sobernheim, Germany; and

**Physical and Rehabilitation Medicine, University of Brescia - Don Gnocchi Foundation Milan, Brescia, Italy.

Address correspondence and reprint requests to Michele Romano, PT, ISICO (Italian Scientific Spine Institute), Via Roberto Bellarmino 13/1, 20141 Milan, Italy; E-mail:

Acknowledgment date: March 27, 2013. Acceptance date: March 27, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: stocks.

© 2013 Lippincott Williams & Wilkins, Inc.