Studies investigating the outcome of conservative scoliosis treatment differ widely with respect to the inclusion criteria used. This study has been performed to investigate the possibility to find useful inclusion criteria for future prospective studies on physiotherapy (PT).
Materials and methods
A PubMed search for outcome papers on PT was performed in order to detect study designs and inclusion criteria used.
Real outcome papers (start of treatment in immature samples/end results after the end of growth; controlled studies in adults with scoliosis with a follow-up of more than 5 years) have not been found. Some papers investigated mid-term effects of exercises, most were retrospective, few prospective and many included patient samples with questionable treatment indications.
There is no outcome paper on PT in scoliosis with a patient sample at risk for being progressive in adults or in adolescents followed from premenarchial status until skeletal maturity. However, papers on bracing are more frequently found and bracing can be regarded as evidence-based in the conservative management and rehabilitation of idiopathic scoliosis in adolescents.
BackgroundWhile children grow until they have fully matured, there are certain times with more or less growth during childhood and adolescence and curvature progression is more or less probable during different phases of growth (Figure 1). The ‚baby spurt' ends at the age of five and a half to six years followed by a ‚flat phase,' which lasts until the first signs of maturation. With the first signs of breast development or pubic hair, the pubertal growth spurt begins (P1) and in its ascending phase 2/3 of progression may occur. Shortly after the growth peak (P3) menarche in girls/voice change in boys appears to indicate the onset of the descending phase of growth up to its cessation (P5).
Scoliosis is a three dimensional deformity of the spine and trunk, which may deteriorate quickly during periods of rapid growth. Although scoliosis may be the expression or a symptom of certain diseases, eg. neuromuscular, congenital, due to certain syndromes or tumors, the majority of the patients with scoliosis (80-90%) are called ‚Idiopathic' because a certain underlying cause still has not been found. The treatment of the symptomatic scoliosis may primarily be determined by the underlying cause. The treatment of the so-called idiopathic scoliosis is determined by the deformity itself. As most of the scoliosis progress during growth, some also in later life, the main aim of any intervention is to stop curvature progression.
View the whole study and images at ScoliosisJournal