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Romano M1, Negrini S2, Donzelli S1, Negrini A3, Parzini S3, Zaina F1
1ISICO (Italian Scientific Spine Institute), Milan, Italy, 2Brescia University, Brescia, Italy, 3ISICO (Italian Scientific Spine Institute), Vigevano, Italy
Background: In many countries the typical treatment of the AIS (Adolescent Idiopathic Scoliosis) is the wait and see procedure and surgery in case of curves worsening.
Until today the conservative treatment and the specific exercises are not recommended in these countries due to the lack of strong scientific evidence.
Some recent randomized control trial, performed in ideal experimental setting, described the efficacy of therapeutic exercises for adolescent scoliosis patients. A large observational study was needed to check the same results in everyday clinical setting.
Purpose: To explore the effectiveness of PSSEs (Physiotherapic-Scoliosis-Specific-Exercises) to avoid bracing or progression of AIS in everyday clinics.
Methods: The study design is a longitudinal comparative observational multicenter study, nested in a prospective database of outpatient tertiary referral clinics, including 327 consecutive patients.
Inclusion criteria were AIS, Risser sign 0-2, Cobb Angle 11-20°, age≥10 years old at first evaluation.
Exclusion criteria were consultations only and brace prescription at baseline.
Groups performed PSSE according to the SEAS (Scientific Exercise Approach to Scoliosis) School, usual physiotherapy (UP) and no therapy (controls [CON]). End of treatment was medical discharge, Risser sign 3, or failure (defined by the need for bracing before the end of growth or Cobb angle>29°). The probability of failure was estimated by the risk ratio (RR) and 95% confidence interval (CI). The number needed to treat was estimated. Statistical analysis included intent-to-treat analysis, considering all participants (dropouts as failures), and efficacy analysis, considering only end-of-treatment participants. Propensity scores were used to reduce the potential effects of confounders related to the observational design.
Results: We included 293 eligible subjects after propensity score matching (SEAS, n=145; UP, n=95; controls, n=53). The risk of success was increased 1.7-fold (P=0.007) and 1.5-fold (P=0.006) with SEAS versus controls in the efficacy and intent-to-treat analyses, respectively, and the number needed to treat for testing SEAS versus controls was 3.5 (95% CI 3.2-3.7) and 1.8 (95% CI 1.5-2.0), respectively. The success rate was higher with SEAS than UP in the efficacy analysis.
Conclusion(s): Respect the Control group, SEAS reduced the bracing rate in AIS and was more effective than UP
Implications: PSSEs are effective tools that can be included in the therapeutic toolbox for AIS conservative treatment.
Keywords: Adolescents, Exercise, Scoliosis
Funding acknowledgements: The study was unfonded
Until today the conservative treatment and the specific exercises are not recommended in these countries due to the lack of strong scientific evidence.
Some recent randomized control trial, performed in ideal experimental setting, described the efficacy of therapeutic exercises for adolescent scoliosis patients. A large observational study was needed to check the same results in everyday clinical setting.
Purpose: To explore the effectiveness of PSSEs (Physiotherapic-Scoliosis-Specific-Exercises) to avoid bracing or progression of AIS in everyday clinics.
Methods: The study design is a longitudinal comparative observational multicenter study, nested in a prospective database of outpatient tertiary referral clinics, including 327 consecutive patients.
Inclusion criteria were AIS, Risser sign 0-2, Cobb Angle 11-20°, age≥10 years old at first evaluation.
Exclusion criteria were consultations only and brace prescription at baseline.
Groups performed PSSE according to the SEAS (Scientific Exercise Approach to Scoliosis) School, usual physiotherapy (UP) and no therapy (controls [CON]). End of treatment was medical discharge, Risser sign 3, or failure (defined by the need for bracing before the end of growth or Cobb angle>29°). The probability of failure was estimated by the risk ratio (RR) and 95% confidence interval (CI). The number needed to treat was estimated. Statistical analysis included intent-to-treat analysis, considering all participants (dropouts as failures), and efficacy analysis, considering only end-of-treatment participants. Propensity scores were used to reduce the potential effects of confounders related to the observational design.
Results: We included 293 eligible subjects after propensity score matching (SEAS, n=145; UP, n=95; controls, n=53). The risk of success was increased 1.7-fold (P=0.007) and 1.5-fold (P=0.006) with SEAS versus controls in the efficacy and intent-to-treat analyses, respectively, and the number needed to treat for testing SEAS versus controls was 3.5 (95% CI 3.2-3.7) and 1.8 (95% CI 1.5-2.0), respectively. The success rate was higher with SEAS than UP in the efficacy analysis.
Conclusion(s): Respect the Control group, SEAS reduced the bracing rate in AIS and was more effective than UP
Implications: PSSEs are effective tools that can be included in the therapeutic toolbox for AIS conservative treatment.
Keywords: Adolescents, Exercise, Scoliosis
Funding acknowledgements: The study was unfonded
Topic: Musculoskeletal: spine
Ethics approval required: Yes
Institution: Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
Ethics committee: Comitato Etico Milano Area B
Ethics number: Protocol n° 202016_bis
All authors, affiliations and abstracts have been published as submitted.
