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Old 26-06-2014, 11:07 AM
LB33 LB33 is offline
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Default New high quality evidence - Scoliosis specific exercise helps Cobb

Hi,

I’m a final year physiotherapy student who has just finished an assessment task looking at scoliosis and the effects of scoliosis specific exercises (such as Schroth). Of interest to people on this forum may be the results of a very recent high quality study which compares the effect of traditional exercises versus the scoliosis specific exercise principles of active self-correction and task-oriented exercises on Cobb angle and Quality of Life.

This study specifically looked at adolescents (>10years old) with mild idiopathic scoliosis (cobb angles <25°) with still a lot of growth remaining and therefore at a high risk of progression.

It found that scoliosis specific exercises improved Cobb angle by 5.3° while the traditional exercises did not improve Cobb. There was minimal improvement in the quality of life with the traditional exercises while scoliosis specific exercises made significant improvements. The positive outcomes of scoliosis specific exercises were still present at follow-up 1 year after the conclusion of the treatment.

The study is a randomised controlled trial (RCT) meaning it is of a high quality. Its design helps eliminate biases, so that confidence may be had in its results. RCT’s are additionally assessed for their level of quality. Commonly the Pedro scale (a rating out of 10) is used for this. Things that the Pedro scale assesses include whether the patient knows if the treatment they are receiving is the standard or experimental one, so as not to influence the results. Trials are commonly considered of good quality if they are above >6/10. This trial scored 9/10. The research was conducted at a large European hospital and did not have any conflict of interest. The research team is highly credentialed with studies in a wide range of areas from chronic pain to hips.

The study had 110 patients split into 2 groups who underwent either a “control” treatment of traditional exercises ( such as balance exercises, spinal mobilisation and spinal strengthening and stretching) or an “experimental” treatment of active self-correction and task-oriented exercises (a primary principle of Scoliosis specific methods, such as Schroth). Participants were measured before the treatment period, at the completion of the treatment period and 1 year afterwards. Having this number of patients meant that the study had sufficient “power” to detect that changes measured were due to the treatment and not likely due to an error.

Changes in Cobb Angle were measured by one trained assessor (to ensure consistency) who importantly was unaware of which treatment group the patient was in (so to avoid personal bias in reporting the results). After the training period, they found 69% of the active self-correction “experimental” group patients had improved their Cobb angle, 8% worsened and 23% remained stable. By comparison in the traditional exercise “control” group only 6% improved, 39% worsened and 55 % remained stable. The average change in Cobb angle from pre-training to after training was an improvement of 5.3° in the active self-correction and task-oriented exercises group versus a deterioration of 1.7°in the control group.

To rate the patient’s Quality of Life they used the Scoliosis Research Society-22 Patient Questionnaire (SRS-22) which assesses function, pain, mental health, self-perceived image and satisfaction with management. The Questionnaire has been extensively studied and justified for its use in this population. Analysis of the results showed negligible improvement in the “traditional’ exercise group, whilst the scoliosis specific exercise group showed a significant improvement in their quality of life.

The study’s title is, “Active self-correction and task-oriented exercises reduce spinal deformity and improve quality of life in subjects with mild adolescent idiopathic scoliosis. Results of a randomised controlled trial”.

It can be found in the European Spine Journal. This is the official publication of the European Spine Society, The European Spinal Deformity Society and the European Section of the Cervical Spinal Research Society.

See below link for the article summary (where the secondary outcome measures refer to the quality of life results)
http://www.ncbi.nlm.nih.gov/pubmed/24682356

As it has been quite correctly pointed out in this forum, there is a general lack of high quality evidence available on the topic.
To my knowledge there are 2 more randomised controlled trials currently in progress investigating scoliosis specific exercises further.

Yes this is but one trial, but it is an important one.
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Old 08-08-2014, 09:15 PM
sabbie sabbie is offline
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Default Re: New high quality evidence - Scoliosis specific exercise helps Cobb

Thanks for the article LB33. I love hearing about any new research that’s happening. Having a hunt myself I came across this article published in May in the New York Times, that might also be of interest.

It mentions that a Children’s Hospital in Boston and a Manhattan hospital for special surgery now actually have Schroth therapists on staff.
Further on it mentions that a surgeon from the Scoliosis Research Society and a professor of surgery at Harvard thinks it makes bracing more successful.

Anyhow, here’s a link to the article as there’s a bit more stuff about Schroth in it

http://well.blogs.nytimes.com/2014/0...ype=blogs&_r=0
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