title: 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.
abstract: 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.
  
  
  OBJECTIVE
  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 10-18 years, with curves of 10°-45° and Risser grade 0-5 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 30-45 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°, 95% CI -1.1° to -5.9°, p = 0.006). Likewise, the between-group difference in the square root of the Sum of Curves was -0.40°, (95% CI -0.03° to -0.8°, p = 0.046), suggesting that an average patient with 51.2° at baseline, will have a 49.3° Sum of Curves at six months in the Schroth group, and 55.1° in the control group with the difference between groups increasing with severity. Per protocol analyses produced similar, but larger differences: Largest Curve = -4.1° (95% CI -1.7° to -6.5°, p = 0.002) and [Formula: see text] (95% CI -0.8 to 0.2, p = 0.006).
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  NCT01610908.
authors.affiliation: Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Sanja
authors.identifier: http://orcid.org/0000-0002-8231-5131
authors.initials: S
authors.lastname: Schreiber
authors.affiliation: Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Eric C
authors.initials: EC
authors.lastname: Parent
authors.affiliation: School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Elham
authors.initials: E
authors.lastname: Khodayari Moez
authors.affiliation: Department of Surgery, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada.|Alberta Health Services, Edmonton, Alberta, Canada.
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Hedden
authors.affiliation: Department of Surgery, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada.|Alberta Health Services, Edmonton, Alberta, Canada.
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Hill
authors.affiliation: Department of Surgery, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada.|Alberta Health Services, Edmonton, Alberta, Canada.
authors.forename: Marc
authors.initials: M
authors.lastname: Moreau
authors.affiliation: Department of Surgery, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada.|Glenrose Rehabilitation Research Centre, Alberta Health Services, Edmonton, Alberta, Canada.
authors.forename: Edmond
authors.initials: E
authors.lastname: Lou
authors.affiliation: Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Elise M
authors.initials: EM
authors.lastname: Watkins
authors.affiliation: Department of Surgery, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada.|Alberta Health Services, Edmonton, Alberta, Canada.
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Southon
mesh_terms: D000293:Adolescent; D002648:Child; D018450:Disease Progression; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D010352:Patient Dropouts; D012600:Scoliosis / Q000628:therapy*; D059039:Standard of Care; D016896:Treatment Outcome; D055815:Young Adult