Efficacy of exercise intervention in adolescents with mild to moderate idiopathic scoliosis: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

ZHANG Wei ^1,2 ,  BO Shumin ¹ , WANG Tao ^1,3 , WANG Pukui ¹

1. Capital University of Physical Education and Sports, Beijing 100191, P. R. China;
2. College of Basic Medicine, Jining Medical University, Jining 272067, P. R. China;
3. School of Physical Education, Liaocheng University, Liaocheng 252059, P. R. China;

Corresponding author：

BO Shumin, Email: boshumin@163.com

Keywords：

Exercise intervention; Adolescent; Idiopathic scoliosis; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.202202039

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Objective To systematically review the efficacy of exercise intervention in adolescents with mild to moderate idiopathic scoliosis (AIS). Methods PubMed, Web of Science, The Cochrane Library, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy of exercise intervention in adolescents with mild to moderate AIS from inception to November 2021. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed using Stata 16.0 software. Results A total of 11 RCTs involving 638 patients were included. The results of meta-analysis showed that exercise intervention significantly improved the Cobb angle of the spine in patients with AIS (MD=−1.65, 95%CI −2.63 to −0.68, P<0.01), reduced the angle of trunk rotation (ATR) (MD=−0.68, 95%CI −0.96 to −0.40, P<0.01), and increased their forced vital capacity (FVC) (MD=0.63, 95%CI 0.10 to 1.15, P=0.02). However, there was no statistically significant improvement in the forced expiratory volume in the first second (FEV₁) or the ratio of FEV₁/FVC between the two groups. Conclusion Current evidence shows that the exercise intervention could improve the Cobb angle of the spine, reduce ATR and enhance FVC. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.

Citation： ZHANG Wei, BO Shumin, WANG Tao, WANG Pukui. Efficacy of exercise intervention in adolescents with mild to moderate idiopathic scoliosis: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2022, 22(8): 896-900. doi: 10.7507/1672-2531.202202039 Copy

1.	Normand E, Franco A, Marcil V. Nutrition and physical activity level of adolescents with idiopathic scoliosis: a narrative review. Spine J, 2020, 20(5): 785-799.
2.	Negrini S, Minozzi S, Bettany-Saltikov J, et al. Braces for idiopathic scoliosis in adolescents. Cochrane Database Syst Rev, 2015, (6): CD006850.
3.	Théroux J, Stomski N, Hodgetts CJ, et al. Prevalence of low back pain in adolescents with idiopathic scoliosis: a systematic review. Chiropr Man Therap, 2017, 25: 10.
4.	Ceballos LL, Tejedor CC, Mingo GT, et al. Effects of corrective, therapeutic exercise techniques on adolescent idiopathic scoliosis: a systematic review. Arch Argent Pediatr, 2018, 116(4): e582-e589.
5.	Bettany-Saltikov J, Weiss HR, Chockalingam N, et al. Surgical versus non-surgical interventions in people with adolescent idiopathic scoliosis. Cochrane Database Syst Rev, 2015, (4): CD010663.
6.	Weinstein SL. The natural history of adolescent idiopathic scoliosis. J Pediatr Orthop, 2019, 39(Suppl 1): S44-S46.
7.	Plaszewski M, Kotwicki T, Chwala W, et al. Study protocol and overview of the literature on long-term health and quality of life outcomes in patients treated in adolescence for scoliosis with therapeutic exercises. J Back Musculoskelet Rehabil, 2015, 28(3): 453-462.
8.	杨红杰, 乔文菲, 董胜利. 功能性康复训练结合矫形器对青少年特发性脊柱侧弯患者Cobb角, 腰部活动范围的影响. 内蒙古医学杂志, 2021, 53(10): 1163-1166.
9.	刘潇. 观察分析牵引下运动疗法对青少年脊柱侧弯Cobb角恢复价值. 中国伤残医学, 2020, 28(1): 50-51.
10.	陈俊泽, 廖八根, 韩晓峰, 等. 青少年特发性脊柱侧弯应用特定运动疗法的临床效果分析. 华夏医学, 2020, 33(5): 105-108.
11.	苏锡文. 体操锻炼配合俯卧位下肢悬吊牵引治疗青少年特发性脊柱侧凸的临床疗效观察. 福州: 福建中医药大学, 2020.
12.	张泽, 王春南. 支具矫正联合姿态训练治疗青少年特发性脊柱侧弯的效果. 中国民康医学, 2021, 33(12): 59-61.
13.	冯国栋. 支具联合BSPTS疗法对中度青少年特发性脊柱侧凸的影响. 天津: 天津体育学院, 2021.
14.	叶勇智. 轻度特发性脊柱侧凸患者应用脊柱侧凸特定运动疗法的可行性. 中外医学研究, 2018, 16(28): 19-21.
15.	Schreiber S, Parent EC, Khodayari ME, et al. 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. PLoS One, 2016, 11(12): e0168746.
16.	Kumar A, Kumar S, Sharma V, et al. Efficacy of task oriented exercise program based on ergonomics on Cobb's angle and pulmonary function improvement in adolescent idiopathic scoliosis- a randomized control trial. J Clin Diagn Res, 2017, 11(8): YC01-YC04.
17.	Kuru T, Yeldan İ, Dereli EE, et al. The efficacy of three-dimensional Schroth exercises in adolescent idiopathic scoliosis: a randomised controlled clinical trial. Clin Rehabil, 2016, 30(2): 181-190.
18.	Gao C, Zheng Y, Fan C, et al. Could the clinical effectiveness be improved under the integration of orthotic intervention and scoliosis-specific exercise in managing adolescent idiopathic scoliosis. A randomized controlled trial study. Am J Phys Med Rehabil, 2019, 98(8): 642-648.
19.	Yen TC, Weinstein SL. Evaluation of predictors and outcomes of bracing with emphasis on the immediate effects of in-brace correction in adolescent idiopathic scoliosis. Iowa Orthop J, 2019, 39(2): 62-65.
20.	Bettany-Saltikov J, Parent E, Romano M, et al. Physiotherapeutic scoliosis-specific exercises for adolescents with idiopathic scoliosis. Eur J Phys Rehabil Med, 2014, 50(1): 111-121.
21.	Karol LA, Virostek D, Felton K, et al. Effect of compliance counseling on brace use and success in patients with adolescent idiopathic scoliosis. J Bone Joint Surg Am, 2016, 98(1): 9-14.
22.	Cheung PWH, Wong CKH, Lau ST, et al. Responsiveness of the EuroQoL 5-dimension (EQ-5D) in adolescent idiopathic scoliosis. Eur Spine J, 2018, 27(2): 278-285.
23.	Wong CKH, Cheung PWH, Samartzis D, et al. Mapping the SRS-22r questionnaire onto the EQ-5D-5L utility score in patients with adolescent idiopathic scoliosis. PLoS One, 2017, 12(4): e0175847.
24.	Cheung JPY, Chong CHW, Cheung PWH. Underarm bracing for adolescent idiopathic scoliosis leads to flatback deformity: the role of sagittal spinopelvic parameters. Bone Joint J, 2019, 101-B(11): 1370-1378.
25.	Park JH, Jeon HS, Park HW. Effects of the Schroth exercise on idiopathic scoliosis: a meta-analysis. Eur J Phys Rehabil Med, 2018, 54(3): 440-449.
26.	Zheng Y, Dang Y, Yang Y, et al. Whether orthotic management and exercise are equally effective to the patients with adolescent idiopathic scoliosis in mainland china. A randomized controlled trial study. Spine, 2018, 43(9): E494-E503.
27.	Li K, Miao J, Zhang J. Network meta-analysis of short-term effects of different strategies in the conservative treatment of AIS. Eur J Med Res, 2021, 26(1): 54.
28.	倪国新, 邓晓琴, 徐玥, 等. 体医融合的历史推进与发展路径研究. 北京体育大学学报, 2020, 43(12): 22-34.
29.	Tolo VT, Herring JA. Scoliosis-specific exercises: a state of the art review. Spine Deform, 2020, 8(2): 149-155.

1. Normand E, Franco A, Marcil V. Nutrition and physical activity level of adolescents with idiopathic scoliosis: a narrative review. Spine J, 2020, 20(5): 785-799.
2. Negrini S, Minozzi S, Bettany-Saltikov J, et al. Braces for idiopathic scoliosis in adolescents. Cochrane Database Syst Rev, 2015, (6): CD006850.
3. Théroux J, Stomski N, Hodgetts CJ, et al. Prevalence of low back pain in adolescents with idiopathic scoliosis: a systematic review. Chiropr Man Therap, 2017, 25: 10.
4. Ceballos LL, Tejedor CC, Mingo GT, et al. Effects of corrective, therapeutic exercise techniques on adolescent idiopathic scoliosis: a systematic review. Arch Argent Pediatr, 2018, 116(4): e582-e589.
5. Bettany-Saltikov J, Weiss HR, Chockalingam N, et al. Surgical versus non-surgical interventions in people with adolescent idiopathic scoliosis. Cochrane Database Syst Rev, 2015, (4): CD010663.
6. Weinstein SL. The natural history of adolescent idiopathic scoliosis. J Pediatr Orthop, 2019, 39(Suppl 1): S44-S46.
7. Plaszewski M, Kotwicki T, Chwala W, et al. Study protocol and overview of the literature on long-term health and quality of life outcomes in patients treated in adolescence for scoliosis with therapeutic exercises. J Back Musculoskelet Rehabil, 2015, 28(3): 453-462.
8. 杨红杰, 乔文菲, 董胜利. 功能性康复训练结合矫形器对青少年特发性脊柱侧弯患者Cobb角, 腰部活动范围的影响. 内蒙古医学杂志, 2021, 53(10): 1163-1166.
9. 刘潇. 观察分析牵引下运动疗法对青少年脊柱侧弯Cobb角恢复价值. 中国伤残医学, 2020, 28(1): 50-51.
10. 陈俊泽, 廖八根, 韩晓峰, 等. 青少年特发性脊柱侧弯应用特定运动疗法的临床效果分析. 华夏医学, 2020, 33(5): 105-108.
11. 苏锡文. 体操锻炼配合俯卧位下肢悬吊牵引治疗青少年特发性脊柱侧凸的临床疗效观察. 福州: 福建中医药大学, 2020.
12. 张泽, 王春南. 支具矫正联合姿态训练治疗青少年特发性脊柱侧弯的效果. 中国民康医学, 2021, 33(12): 59-61.
13. 冯国栋. 支具联合BSPTS疗法对中度青少年特发性脊柱侧凸的影响. 天津: 天津体育学院, 2021.
14. 叶勇智. 轻度特发性脊柱侧凸患者应用脊柱侧凸特定运动疗法的可行性. 中外医学研究, 2018, 16(28): 19-21.
15. Schreiber S, Parent EC, Khodayari ME, et al. 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. PLoS One, 2016, 11(12): e0168746.
16. Kumar A, Kumar S, Sharma V, et al. Efficacy of task oriented exercise program based on ergonomics on Cobb's angle and pulmonary function improvement in adolescent idiopathic scoliosis- a randomized control trial. J Clin Diagn Res, 2017, 11(8): YC01-YC04.
17. Kuru T, Yeldan İ, Dereli EE, et al. The efficacy of three-dimensional Schroth exercises in adolescent idiopathic scoliosis: a randomised controlled clinical trial. Clin Rehabil, 2016, 30(2): 181-190.
18. Gao C, Zheng Y, Fan C, et al. Could the clinical effectiveness be improved under the integration of orthotic intervention and scoliosis-specific exercise in managing adolescent idiopathic scoliosis. A randomized controlled trial study. Am J Phys Med Rehabil, 2019, 98(8): 642-648.
19. Yen TC, Weinstein SL. Evaluation of predictors and outcomes of bracing with emphasis on the immediate effects of in-brace correction in adolescent idiopathic scoliosis. Iowa Orthop J, 2019, 39(2): 62-65.
20. Bettany-Saltikov J, Parent E, Romano M, et al. Physiotherapeutic scoliosis-specific exercises for adolescents with idiopathic scoliosis. Eur J Phys Rehabil Med, 2014, 50(1): 111-121.
21. Karol LA, Virostek D, Felton K, et al. Effect of compliance counseling on brace use and success in patients with adolescent idiopathic scoliosis. J Bone Joint Surg Am, 2016, 98(1): 9-14.
22. Cheung PWH, Wong CKH, Lau ST, et al. Responsiveness of the EuroQoL 5-dimension (EQ-5D) in adolescent idiopathic scoliosis. Eur Spine J, 2018, 27(2): 278-285.
23. Wong CKH, Cheung PWH, Samartzis D, et al. Mapping the SRS-22r questionnaire onto the EQ-5D-5L utility score in patients with adolescent idiopathic scoliosis. PLoS One, 2017, 12(4): e0175847.
24. Cheung JPY, Chong CHW, Cheung PWH. Underarm bracing for adolescent idiopathic scoliosis leads to flatback deformity: the role of sagittal spinopelvic parameters. Bone Joint J, 2019, 101-B(11): 1370-1378.
25. Park JH, Jeon HS, Park HW. Effects of the Schroth exercise on idiopathic scoliosis: a meta-analysis. Eur J Phys Rehabil Med, 2018, 54(3): 440-449.
26. Zheng Y, Dang Y, Yang Y, et al. Whether orthotic management and exercise are equally effective to the patients with adolescent idiopathic scoliosis in mainland china. A randomized controlled trial study. Spine, 2018, 43(9): E494-E503.
27. Li K, Miao J, Zhang J. Network meta-analysis of short-term effects of different strategies in the conservative treatment of AIS. Eur J Med Res, 2021, 26(1): 54.
28. 倪国新, 邓晓琴, 徐玥, 等. 体医融合的历史推进与发展路径研究. 北京体育大学学报, 2020, 43(12): 22-34.
29. Tolo VT, Herring JA. Scoliosis-specific exercises: a state of the art review. Spine Deform, 2020, 8(2): 149-155.

Chinese Journal of Evidence-Based Medicine

Efficacy of exercise intervention in adolescents with mild to moderate idiopathic scoliosis: a meta-analysis

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