O2125: The Role of Scoliosis Specific Exercises in the Non-Operative Treatment of Adolescent Idiopathic Scoliosis: A Prospective Matched Cohort Study

Background: The role of bracing and observation in the treatment of adolescent idiopathic scoliosis (AIS) is well documented. The role of physical therapy for decreasing the size of the curve or preventing progression remains controversial. Schroth therapy is the most commonly prescribed form of scoliosis specific exercise (SSE). A recent meta-analysis failed to show a clinically significant effect of SSE on curve magnitudes. Many studies on SSE fail to account for skeletal maturity and curve size, which are known predictors of curve progression. Our goal was to use a prospective multicenter database to match patients who received SSE with those who did not and assess curve progression while controlling for initial curve magnitude and skeletal maturity.

Methods: We utilized a multicenter database from several tertiary referral institutions to collect data on patients treated non-operatively for AIS. We identified 18 patients who were treated with SSE and matched them 1:1 with patients who did not receive SSE. Patients were matched by initial curve size as measured by the Cobb method and initial skeletal maturity as measured by the Sanders method. Patients were prospectively followed every 6 months until they required surgery or reached Sanders stage 7B of skeletal maturity. We compared patients at 6-month intervals to detect differences between patients who received SSE and those who did not. A difference in >/= 5 degrees was considered clinically significant.

Results: There were no significant differences in age, skeletal maturity, or initial curve sizes detected between groups, indicating that the groups were well-matched. We found no significant differences between groups at 6 months, 1 year, or 1.5 years in terms of curve size (all p >0.05). Only 28% of patients initially prescribed SSE were practicing those exercises at 1 year. Average brace wear was 14.2 hours for the SSE group for those who were prescribed braces (n=13) and 13.8 hours for the non-Schroth group (n=13). Brace wear was not significantly different between the two groups (p >0.05).

Conclusion: Although SSE are frequently prescribed for AIS, their role remains unclear. Our study failed to demonstrate any differences for SSE in altering the natural history of progression or improving compliance with bracing modalities. The majority of patients in our study no longer practice SSE at one year.