Annotated bibliography for PSSEs

Chwała W, Płaszewski M, Kowalski P. Variations in bioelectric activity during symmetric loading and asymmetric stretching of paraspinal extensors in young adult women with mild single curve scoliosis. Stud Health Technol Inform (2012); 176: 129-132

  • “16yr follow up on SSE Thirty five females, aged 30.6±2.7 years, with body weight of 56.8±4.4 kgs and height 1.64±0.05 m with single curve thoracic scoliosis, 11-36° Cobb, who in adolescence had attended a scoliosis-specific physiotherapy program, participated. Braced and/or surgically treated subjects were excluded. Characteristics of the integrated EMG were collected and analysed. The measurements were conducted on a subject in prone position at rest, during 20 second static symmetrical erectors’ contractions while sustaining elevated trunk and during the same effort, while stretching trunk erectors on the concave side of the curve by extending and reaching the corresponding arm forward.”
  • “RESULTS: The biopotentials measured on both sides of the spine differed significantly (p<.001) during asymmetrical stretching of the erector muscles on the concave side while extending the trunk. We did not observe such differences in measurements obtained while at rest and during symmetrical contractions without stretching.
  • CONCLUSIONS: We observed a beneficial scheme of muscle activity during trunk extension and stretching of the erector muscles on the concave side of the curvature in lying prone position, while extending and reaching forward an arm on the convex side. Significance. These findings could provide a useful remark for exercise prescription for adult patients with single thoracic scoliosis. However, the assumptions need wider studies”

Dos Santos, Alves VL, Alves da Silva RJAL, et al. Effect of a preoperative protocol of aerobic physical therapy on the quality of life of patients with adolescent idiopathic scoliosis: a randomized clinical study. Am J Orthop (Belle Mead NJ) (2014) 43 (6): E112-6

  • Evaluate preoperative aerobic exercise protocol can improve quality of life (Qol) before and after training // Randomized to receive or not receive 4 months preop course of aerobic physical training// Evaluated with SF 36// QoL scores improved for study group but not for control group// Study group QoL score increase significantly between baseline and 4 months// Prospective randomized clinical trial in Brazil 2011-2012 // Inclusion: AIS thoracic curve > 45, age 10-18// Exclusion: hx pulmonary, cardiac, myo-articular/neurological disease, curve < 45// N = 40, 20 in group I: AIS submitted to physical rehab protocol; Group II – IAS not submitted to rehab protocol// SF36 baseline and after 4 months of therapy; protocol included warm up aerobic exercise, treadmill, cool down
  • Preop physical therapy protocol increase AIS pateint’s quality of life in all SF 36 domains // Aerobic exercises, no scoliosis specific exercise

Dos Santos Alves VL, Stirbulov R, Avanzi O. Long-term impact of pre-operative physical rehabilitation protocol on the 6-min walk test of patients with adolescent idiopathic scoliosis: A randomized clinical trial. Rev Port Pneumol (2015). 21(3): 138-143

  • Prospective randomized clinical trial 2008-2009// Inclusion: AIS thoracic curve > 45, age 10-18// Exclusion: hx pulmonary, cardiac, myo-articular/neurological disease// N = 50, 25 in group I: AIS submitted to physical rehab protocol; Group II – IAS not submitted to rehab protocol// Preop physical rehab program (Bouchard, Shepard, Covey et al) for 4 months// Evaluate long term result of 6MWT after rehab protocol employed before surgical correction(preop, postop at 3, 6, and 12 months)
  • Post-surgical recovery was better in patient who underwent 4 months preop physical rehab protocol // Aerobic exercises, no scoliosis specific exercise

Kuru T, Yeldan İ, Dereli EE, Özdinçler AR, Dikici F, Çolak İ. The efficacy of three-dimensional Schroth exercises in adolescent idiopathic scoliosis: A randomised controlled clinical trial. Clinical Rehabilitation. (March 2015)

  • Evaluate efficacy of 3D Schroth exercise in patients with AIS//Randomized controlled study //Outpatient exercise-unit and home setting//N = 45 patients with AIS. 3 groups: Schroth exercise in clinic, Schroth exercise home program, and control//Measure scoliosis Cobb angle, angle of rotation, waist asymmetry, maximum hump height of patient and quality of life (QoL) pretreatment, 6th, 12th, and 24th week.//2010-2011, AIS age 10-18, cobb angle 10-60 degrees, Risser sign 0-3//Exclusion: neuromuscular, RA, mental problem, contraindication to exercise
  • Cobb angle and rotation angle significantly decreased in Schroth clinical group in comparison to other group. // Qol did not significantly change in either group.  // Patients are not blinded in study, large range of Cobb angle/rotation, patient selection bias via follow through

Lee SG. Improvements of curvature and deformity in a sample of patients with idiopathic scoliosis with specific exercises. OA Musculoskeletal Medicine (2014) 2(1):6

  • Investigate amount of spinal curvature/trunk deformity correction with scoliologic best practice physiotherapy// Prospective cohort study 2013 in Korea // N = 60, idiopathic scoliosis, age 11=19, Cobb 6-56 thoracic, 6-52 lumbar. ATR 3-18 thoracic, 2-17n lumbar.  //Fu 2, 9 months.  Measure curvature.
  • Curvature exceeding 30 degrees show better results than smaller curvature after scoliologic best practice program. //Outpatient scoliologic best practice program provide better results than intensive in-patient Schroth standard.  // Short term follow-up.  Non-randomized // Patients are not blinded in study, large range of Cobb angle/rotation

Lewis C, Diaz R, Lopez G, et al. A preliminary study to evaluate postural improvement in subjects with scoliosis: active therapeutic movement version 2 device and home exercises using the Mulligan’s mobilization-with-movement concept. Journal of Manipulative Physiol Ther (2014) 37 (7); 502-509

  • 43 subjects between the ages of 12 to 75 years were recruited for the study. Each subject underwent a low back evaluation along with specific measurements for their scoliosis. Subjects participated in a 4-week intervention, 2 times a week consisting of treatment utilizing the ATM2 and were also given a home exercise program to mimic the specific movement(s) they performed on the ATM2. Photographic assessment of posture was taken before and after the intervention. Subjects were surveyed during the initial assessment and again at the final intervention using the following outcome measures: Fear Avoidance Belief Questionnaire, Short-Form Health Survey-36, Oswestry Disability Index, and a Numeric Pain Rating Scale.
  • Results were significant for most of the variables measured. Subjects gained improvement in spinal ranges of motion for all directions except for flexion and extension. Most subjects had improved pelvic alignment after the intervention. Before and after photographs demonstrated improved posture. Subjective measurements of pain, disability, and quality of life improved.// Results of this preliminary study showed improvement for selected variables. The use of ATM2 and home exercises using the Mulligan’s mobilization-with-movement concept by subjects with scoliosis appears to be a potentially viable conservative treatment alternative to address various findings associated with scoliosis, including posture improvement.

Monticone, Marco; Ambrosini, Emilia; Cazzaniga Daniele et al. 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 randomized controlled trial. Eur Spine J (2014) 23: 1204-1214

  • Evaluate effect of programme of active self-correction and task-oriented exercises on spinal deformities and health-related quality of life (HRQL) in patients with mild AIS (COBB angle < 25)// Parallel-group randomized superiority-controlled study with 110 randomly assigned to rehabilitation program includes active self-correction, task-oriented spinal exercises and education, or traditional spinal exercises. // Evaluate before treatment, end of treatment (skeletal maturity) and 12 months later with radiographic measures, surface deformity, and HRQL evaluation // Linear mixed model used to evaluate each outcome
  • Experimental group lead to significant improvement (decrease in Cobb angle of greater than 5 degrees) than control group. // Control group remained stable// Effect lasted at least 1 year after intervention // Assessor and statician blinded// Cobb angle change of 5 degree difference may be small and skew by rater reliability // Short term follow-up (1 yr only)

Negrini A, Negrini MG, Donzelli S, et al. Scoliosis-Specific exercises can reduce the progression of severe curves in adult idiopathic scoliosis: a long-term cohort study. Scoliosis. (2015) 10:20

  • 34 ADIS patients (age~38), INTERVENTION- SEAS, OUTCOME: radiographic progression
  • After an average period of 2 years of treatment (range 1-18y), 68 % of the patients experienced an improvement in their scoliosis. However in one patient (3 %) the scoliosis worsened by 5 ° in 18 years (progression rate reduced from 0.5 ° to 0.27 ° per year). Patients improved 4.6 ± 5.0 ° Cobb (P < 0.05), with no differences based on the localization of the curve, gender, age, length of treatment, Cobb degrees at the start of observation or treatment.

Płaszewski M, Cieśliński I, Nowobilski R et al. Mental health of adults treated in adolescence with scoliosis-specific exercise program or observed for idiopathic scoliosis. The Scientific World Journal. (2014), Article ID 932827

  • Registry-based, cross-sectional study with retrospective data collection.// Sixty-eight subjects (43 women) aged 30.10 (25-39) years, with mild or moderate scoliosis (11-36° Cobb angle), and 76 (38 women) nonscoliotic subjects, aged 30.11 (24-38) years, participated. The time period since the end of the exercise or observation regimes was 16.5 (12-26) years. Beck Depression Inventory (BDI) and General Health Questionnaire (GHQ-28) scores were analyzed with the χ(2) and U tests. Multiple regression analyses for confounders were also performed.
  • Intergroup differences of demographic characteristics were nonsignificant. Scoliosis, gender, participation in the exercise program, employment, and marital status were associated with BDI scores. The presence of scoliosis and participation in the exercise program manifested association with the symptoms. Higher GHQ-28 “somatic symptoms” subscale scores interacted with the education level.//Our findings correspond to the reports of a negative impact of the diagnosis of scoliosis and treatment on mental health. The decision to introduce a therapeutic program in children with mild deformities should be made with judgment of potential benefits, risks, and harm.

Pugacheva N. Corrective exercises in multimodality therapy of idiopathic scoliosis in children-analysis of six weeks efficiency- pilot study. Stud Health Technology Inform. (2012); 176: 365-71

  • Evaluate efficacy of Schroth method in 21 patients treated with 6 weeks of physiotherapy program// N = 21 female 13-15 age with scoliosis, Cobb angle 28-50 included. //Evaluated with computer optical topography for asymmetric angle, surface rotation angle
  • Schroth therapy after 6 weeks is correlated with decreasing lateral asymmetry angle, surface rotation angle, and trunkal tilt. // No control group.  Pilot small study.  Use of non-standardized measuring techniques for “surface symmetry”.

Rivett L, Stewart A, Potterton J. The effect of compliance to a Rigo System Cheneau brace and a specific exercise programme on idiopathicscoliosis curvature: a comparative study: SOSORT 2014 award winner.Scoliosis (2014); 9:5

  • A pre/post test study design was used with a post study comparison between subjects who complied with the management and those who did not. Fifty one subjects, girls aged 12-16 years, Cobb angles 20-50 degrees participated in the study. Subjects were divided into two groups, according to their compliance, at the end of the study. The compliant group wore the brace 20 or more hours a day and exercised three or more times per week. The non-compliant group wore the brace less than 20 hours a day and exercised less than three times per week. Cobb angles, vertebral rotation, scoliometer readings, peak flow, quality of life and personality traits were compared between groups, using the student’s two sample t-test and an analysis of covariance.
  • The compliant group, wore the brace 21.5 hours per day and exercised four times a week, and significantly improved in all measures compared to non compliant subjects, who wore the brace 12 hours per day, exercised 1.7 times a week and significantly deteriorated (p < 0.0001). The major Cobb angles in the compliant group improved 10.19°(±5.5) and deteriorated 5.52°(±4.3) in the non compliant group (p < 0.0001). Compliant subjects had a significantly better QoL than the non compliant subjects (p = 0.001). The compliant group were significantly more emotionally mature, stable and realistic than the non compliant group (p = 0.03).//Good compliance of the RSC brace and a specific exercise regime resulted in a significant improvement in curvatures, poor compliance resulted in progression/deterioration. A poorer QoL in the non compliant group possibly was caused by personality traits of the group, being more emotionally immature and unstable.//South Africa

Romano M, Negrini A, Parzini S, et al. SEAS (Scientific Exercises Approach to Scoliosis): a modern and effective evidence based approach to physiotherapic specific scoliosis exercises. Scoliosis. (2015) 10:3

  • “Systematic Lit Review: Even if SEAS appears simple by requiring less physiotherapist supervision and by using fewer home exercises prescribed at a lower dose than some of the other scoliosisspecific exercise approaches, real expertise in scoliosis, exercises, and patient and family management is required.”
  • Different papers, including a randomized controlled trial (2014), published over the past several years, documented the efficacy of the SEAS approach applied in the various phases of scoliosis treatment in reducing Cobb angle progression and the need to wear a brace. ——>>> study breakdowns——>

Benjamin D. Roye, Matthew E. Simhon, Hiroko Matsumoto, Prachi Bakarania, Hagit Berdishevsky, Lori A. Dolan, Kelly Grimes, Theodoros B. Grivas, Michael T. Hresko, Lori A. Karol, Baron S. Lonner, Michael Mendelow, Stefano Negrini, Peter O. Newton, Eric C. Parent, Manuel Rigo, Luke Strikeleather, John Tunney, Stuart L. Weinstein, Grant Wood. Establishing consensus on the best practice guidelines for the use of bracing in adolescent idiopathic scoliosis. Spinal Deformity. 2020 Feb 8(4):597-604

  • Consensus developed on best practice guidelines regarding brace wear in the non-operative treatment of patients with adolescent idiopathic scoliosis.
  • We utilized the Delphi process and the nominal group technique to establish consensus among a multidisciplinary group of bracing experts.

Schmid AB, Dyer L, Böni T, Held U, Brunner F. Paraspinal muscle activity during symmetrical and asymmetrical weight training in idiopathic scoliosis. Journal for Sport Rehabilitation. (2010) Aug 19(3); 315-327

  • “ABSTRACT ONLY: cross sectional study of 16 AIS patients INTERVENTIONS:
  • Patients performed 4 back-strengthening exercises (front press, lat pull-down, roman chair, bent-over barbell row) during 1 test session. Each exercise was performed in a symmetrical and asymmetrical variant and repeated 3 times.
  • MAIN OUTCOME MEASURE: EMG amplitudes of the paraspinal muscles were recorded in the thoracic and lumbar apexes of the scoliotic curve during each exercise. Ratios of convex- to concave-side EMG activity were calculated.”
  • “RESULTS: Statistical analysis revealed that the asymmetrical variants of front press at the lumbar level (P=.002) and roman chair and bent-over barbell row at the thoracic level (P<.0001, .001 respectively) were superior in increasing EMG amplitudes in the concavity of the scoliotic curve.
  • CONCLUSIONS: Specific asymmetrical exercises increase EMG amplitudes of paraspinal muscles in the concavity. If confirmed in longitudinal studies measuring improvements of postural deficits, these exercises may advance care of patients with scoliosis.”

Schreiber S, Parent EC, Hedden DM, et al. Effect of Schroth exercises on curve characteristics and clinical outcomes in adolescent idiopathic scoliosis: protocol for a multicentre randomised controlled trial. Journal of Physiotherapy; (Dec 2014) 60:4. 234

  • RCT, assessor blinded, statistician blinded– 258 AIS patients 10-16yo–10-45 deg Cobb–INTERVENTION: 5 Schroth session +weekly group classes +HEP x6months
  • Study to be completed in Sept 2016 – awaiting results

Schreiber Sanja; Parent E; Moez, Elham Khodayari et al.  The effect of Schroth exercises added to the standard of care on the quality of life and muscle endurance in adolescents with idiopathic scoliosis – an assessor and statistician blinded randomized controlled trial: “SOSORT 2015 Award Winner”. Scoliosis Journal. (2015) 10:24

  • Randomized controlled trial // N = 50 AIS, 10-18 curve 10-45; randomized to standard of care or supervised Schroth exercises for 6 months// Outcome include Biering Sorensen (BME) test, scoliosis research society SRS 22r, SAW score
  • Supervised Schroth exercises provided added benefit to the standard of care by improving SRS 22r pain, self-image scores, and BME.


Chwała W, Koziana A, Kasperczyk T, et al. Electromyographic assessment of functional symmetry of paraspinal muscles during static exercises in adolescents with idiopathic scoliosis. BioMed Research International (2014), Article ID 573276

  • N=82 girls, age=12.4 w single/double curves, Cobb angle 24 ± 9.4°. The functional biopotentials during isometric work of paraspinal muscles in “at rest” position and during two symmetric and four asymmetric exercises were measured with the use of the Muscle Tester ME 6000 electromyograph.
  • During symmetric and asymmetric exercises, muscle tension patterns differed significantly in both groups, in comparison with the examination at rest, in most cases generating positive corrective patterns. Asymmetric exercises generated divergent muscle tension patterns on the convex and concave sides of the deformity.

Weiss HR, Klein R. Improving excellence in scoliosis rehabilitation: a controlled study of matched pairs. Pediatric Rehabilitation. (2006) 9(3): 190-200

  • ABSTRACT ONLY: Prospective controlled trial of pairs of patients with idiopathic scoliosis matched by sex, age, Cobb angle and curve pattern. There were 18 patients in the treatment group (SIR + physio-logic exercises) and 18 patients in the control group (SIR only). Average Cobb angle in the treatment group was 34.5 degrees, Cobb angle in the control group was 31.6 degrees. Age in the treatment group was at average 15.3 years and in the control group 14.7 years. 13/18 patients in either group had a brace. Outcome parameter: average lateral deviation (mm), average surface rotation ( degrees ) and maximum Kyphosis angle ( degrees ) as evaluated with the help of surface topography
  • Lateral deviation (mm) decreased significantly after the performance of the physio-logic programme and highly significantly in the physio-logic ADL posture; however, it was not significant after completion of the whole rehabilitation programme (2.3 vs 0.3 mm in the controls). Surface rotation improved at average 1.2 degrees in the treatment group and 0.8 degrees in the controls while Kyphosis angle did not improve in both groups

Zapata KA, Wang-Price SS, Sucato DJ, et al. Spinal Stabilization Exercise Effectiveness for Low Back Pain in Adolescent Idiopathic Scoliosis: A Randomized Trial. Pediatric Physical Therapy.  (2015); 27(4): 396-402

  • Randomized controlled trial // 34 participants randomly assigned to supervised or unsupervised group AIS// Supervised group receive weekly physical therapy // FU with Numeric pain rating scale, patient specific functional scale scores after 8 weeks// 8 weeks followup
  • Supervised spinal stabilization exercises for lower back has more pain reduction and functional improvement than unsupervised group// No difference between back muscle endurance, revised Oswestry Back Pain Disability Questionnaire scores, or Global Rating of Change scores. //Short turn study, 8 weeks