Exercises for adolescent idiopathic scoliosis.
BACKGROUND
Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine . While 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 scoliosis-specific exercises (SSE) to reduce progression of AIS and postpone or avoid other more invasive treatments is controversial.


OBJECTIVE
To evaluate the efficacy of SSE in adolescent patients with AIS.


METHODS
The following databases (up to 30 March 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), PEDro (from January 1929). We screened reference lists of articles and also conducted an extensive handsearch of grey literature.


METHODS
Randomised controlled trials and prospective cohort studies with a control group comparing exercises with no treatment, other treatment, surgery, and different types of exercises.


METHODS
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 one randomised controlled study that exercises as an adjunctive to other conservative treatments increase the efficacy of these treatments (thoracic curve reduced: mean difference (MD) 9.00, (95% confidence interval (CI) 5.47 to 12.53); lumbar curve reduced:MD 8.00, (95% CI 5.08 to 10.92)). There is very low quality evidence from a prospective controlled cohort study that scoliosis-specific exercises structured within an exercise programme can reduce brace prescription (risk ratio (RR) 0.24, (95% CI 0.06 to1.04) as compared to usual physiotherapy (many different kinds of general exercises according to the preferences of the single therapists within different facilities).


CONCLUSIONS
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.
ISICO (Italian Scientific Spine Institute), Milan, Italy. michele.romano@isico.it.
Michele
M
Romano
Silvia
S
Minozzi
Josette
J
Bettany-Saltikov
Fabio
F
Zaina
Nachiappan
N
Chockalingam
Tomasz
T
Kotwicki
Axel
A
Maier-Hennes
Stefano
S
Negrini
D000293:Adolescent; D018450:Disease Progression; D004599:Electric Stimulation Therapy / Q000379:methods; D005081:Exercise Therapy / Q000379:methods; D006801:Humans; D026741:Physical Therapy Modalities; D011187:Posture; D016032:Randomized Controlled Trials as Topic; D012600:Scoliosis / Q000628:therapy*; D014143:Traction / Q000379:methods