Efficacy of Physiotherapeutic Scoliosis Specific Exercises in Adolescent Idiopathic Scoliosis
Efficacy of Physiotherapeutic Scoliosis Specific Exercises in Adolescent Idiopathic Scoliosis
Adolescent idiopathic scoliosis (AIS) has a relatively high prevalence in adolescents.
 Exercise is the most common conservative therapy for mild AIS patients. There are increasing
 evidences suggesting that physiotherapeutic scoliosis specific exercise (PSSE) can halt the
 curve progression. Nevertheless, the evidence concerning PSSE is inadequate and low quality.
 The aim of this study is to identify the efficacy of PSSE on Cobb's angle, rotation angle,
 fall index, pulmonary function, bone quality, and health related quality-of-life (HRQoL) for
 mild AIS patients, and to promote PSSE's application in Shanghai.

 Prior to inclusion, all subjects will be examined by the physiatrists. A parent of each
 subject will be asked to sign an informed consent form before the subject participate in the
 study.

 Eligible subjects will be randomized by a 1:1 allocation ratio by computer either to the
 intervention group, in which they will perform PSSEs; or the control group, in which they
 will perform generalised physiotherapy exercises. All subjects will be assessed at the
 initial visit and 6 months. A multidimensional, comprehensive evaluation including aesthetic
 appearance, radiographic measurement, static balance test, pulmonary function test, bone
 quality, and HRQoL will be used.
Adolescent idiopathic scoliosis (AIS) is a complex three-dimensional deformity of the spinal
 column, including scoliosis in the coronal plane, fixed rotation of the vertebral body and
 physiological curvature loss in the sagittal plane. AIS has a relatively high prevalence in
 adolescents. Exercise is the most common conservative therapy for mild AIS patients and has
 been widely used to reduce spinal deformity and halt curve progression. There are two kinds
 of exercises: generalised physiotherapy exercises and physiotherapeutic scoliosis specific
 exercise (PSSE). Little evidence is in favor of generalised physiotherapy exercises. There
 are increasing evidences suggesting that PSSE can halt the curve progression. Nevertheless,
 the evidence concerning PSSE is inadequate and low quality. Thus, the aim of this study is to
 identify the efficacy of PSSE on Cobb's angle, rotation angle, fall index, pulmonary
 function, bone quality, and health related quality-of-life (HRQoL) for mild AIS patients, and
 to promote PSSE's application in Shanghai.

 The AIS patients will be recruited from and investigated at the Xinhua Hospital, Xinhua
 Hospital Chongming Branch, Shanghai First Rehabilitation Hospital, Shanghai Yangzhi
 Rehabilitation Hospital, and Shanghai Yangpu Daqiao Community Health Service Centre. Prior to
 inclusion, all subjects will be examined by the physiatrists. The subjects' height, weight,
 shoulder, chest, back and pelvic asymmetries, and the Adams forward bend test will be
 evaluated and recorded. The following information will be obtained for all subjects,
 including demographic data (for example, age and sex), menarche status for the girls, and
 family history. A parent of each subject will be asked to sign an informed consent form
 before the subject participate in the study.

 Eligible subjects will be randomized by a 1:1 allocation ratio by computer either to the
 intervention group, in which they will perform PSSEs under the guidance of an experienced
 physiotherapist with expertise in scoliosis in an outpatient clinic; or the control group, in
 which they will perform generalised physiotherapy exercises. All subjects will receive the
 treatment as allocated and will be assessed at the initial visit and 6 months. A
 multidimensional, comprehensive evaluation including aesthetic appearance, radiographic
 measurement, static balance test, pulmonary function test, bone quality, and HRQoL will be
 used.
Inclusion Criteria:

 -  patients who are consistent with the diagnosis of adolescent idiopathic scoliosis
 suggested by Scoliosis Research Society

 -  the largest Cobb angle of less than 20 degrees on whole spine posterior-anterior X-ray
 radiographs in a standing position

 -  10 to 16 years old

 -  skeletal immaturity with Risser sign of <3

 Exclusion Criteria:

 -  previous exercises or brace treatment history

 -  previous operation history of spine or lower extremities

 -  scoliosis caused by neuromuscular disorder, vertebral malformation, trauma, tumor, or
 other diseases

 -  having contraindications to exercises