Effect of a 16-Week Physiotherapeutic Corrective Exercise Program on Spinal Deformities in Adolescent Idiopathic Scoliosis

Official title

The Effect of a 16-Week Structured Physiotherapeutic Corrective Exercise Program on Lateral Spinal Deviation, Vertebral Rotation, and Pelvic Position in Mild and Moderate Adolescent Idiopathic Scoliosis: A Randomized Controlled Trial

Overview

Brief Summary Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity that may progress during adolescence and lead to postural asymmetry, spinal rotation, pelvic imbalance, reduced spinal mobility, and decreased quality of life. This randomized controlled trial aims to evaluate the effectiveness of a 16-week structured physiotherapeutic corrective exercise program compared with standard physiotherapy care in adolescents with mild to moderate AIS (Cobb angle 10°-40°). Participants aged 10-18 years will be randomly assigned to either an experimental group or a control group using stratified block randomization based on age and baseline Cobb angle. The study will be conducted under the responsibility of the University of Prishtina- Faculty of Medicine and the University Clinical Center of Kosovo, with academic collaboration from Alma Mater Europaea. The experimental group will receive a structured physiotherapeutic corrective exercise program including core stabilization, stretching, spinal self-correction, and pelvic correction exercises. The control group will receive standard physiotherapy exercises used in routine clinical practice. Both groups will undergo supervised physiotherapy sessions three times per week for 16 weeks, with additional prescribed home exercises. Primary outcomes include individual spinal alignment parameters assessed using the DIERS Formetric 3D/4D system, including lateral deviation angle and vertebral rotation. Secondary outcomes include additional postural alignment parameters, spinal mobility measured using an inclinometer, and health-related quality of life assessed using the Scoliosis Research Society-22 Revised (SRS-22r) questionnaire. Assessments will be performed at baseline, 8 weeks, and 16 weeks. Each outcome parameter will be analyzed separately to evaluate changes over time and differences between groups. The study will provide evidence on whether a structured corrective physiotherapy program offers superior outcomes compared with standard physiotherapy care in adolescents with AIS.

Detailed description

Detailed Description

This randomized controlled trial evaluates the effectiveness of a structured physiotherapeutic corrective exercise program in adolescents with mild to moderate idiopathic scoliosis (Cobb angle 10°-40°), compared with standard physiotherapy care.

Adolescent idiopathic scoliosis is a structural spinal deformity characterized by lateral curvature, vertebral rotation, and postural imbalance. It may also be associated with pelvic asymmetry, altered sagittal spinal alignment, reduced spinal mobility, and impaired health-related quality of life.

Despite evidence supporting physiotherapeutic scoliosis-specific exercises, limited research has investigated comprehensive exercise programs addressing spinal alignment, postural control, and pelvic-related impairments simultaneously using advanced three-dimensional postural assessment systems.

Participants aged 10-18 years will be recruited from the Physical Medicine and Rehabilitation Clinic at the University Clinical Center of Kosovo and the University of Prishtina - Faculty of Medicine. The study is conducted under ethical approval from relevant institutional ethics committees. Alma Mater Europaea serves as an academic collaborating institution.

Participants will be randomly allocated to an experimental or control group using stratified block randomization based on age and baseline Cobb angle. Outcome assessors and statisticians will be blinded to group allocation.

The experimental group will follow a 16-week structured physiotherapeutic corrective exercise program including core stabilization, stretching, spinal self-correction, and pelvic correction exercises. The control group will receive standard physiotherapy exercises commonly used in clinical practice for adolescent idiopathic scoliosis.

Both groups will receive supervised physiotherapy sessions three times per week for 16 weeks, each lasting approximately 45 minutes, and will perform additional home-based exercises two days per week.

Primary outcome measures will include individual spinal alignment parameters assessed using the DIERS Formetric 3D/4D Spine \& Posture Analysis System, including change in lateral deviation angle and change in vertebral rotation. Each parameter will be analyzed as a separate outcome measure.

Secondary outcome measures will include individual postural and functional parameters assessed separately, including trunk imbalance, trunk inclination, pelvic obliquity, pelvic torsion, pelvic rotation, kyphotic angle, lordotic angle, spinal mobility measured using an inclinometer, and health-related quality of life assessed using the Scoliosis Research Society-22 Revised (SRS-22r) questionnaire.

Measurements will be performed at baseline, 8 weeks, and 16 weeks. Statistical analysis will compare within-group and between-group changes over time using appropriate parametric and non-parametric tests, with statistical significance set at p \< 0.05.

Additionally, agreement between angle of trunk rotation measured by scoliometer and vertebral rotation measured by the DIERS Formetric 3D/4D system will be evaluated as an exploratory analysis.

Interventions

• Behavioral Structured Physiotherapeutic Corrective Exercise Program
  A 16-week structured physiotherapeutic corrective exercise program including core stabilization, stretching, spine autocorrection, and pelvic stabilization and correction exercises. Participants will attend supervised sessions three times per week and perform home exercises two additional days per week.
• Behavioral Standard Physiotherapy Exercise Program
  The Standard Physiotherapy Exercise Program will last 16 weeks and consists of conventional therapeutic exercises aimed at improving spinal strength, flexibility, posture, and coordination in adolescents with idiopathic scoliosis.

Primary outcome measures

• Change in lateral spinal deviation [Time frame: Week 16]
• Change in vertebral rotation [Time frame: Week 16]

Secondary outcome measures (9)

• Change in trunk imbalance [Time frame: Week 16]
• Change in trunk inclination [Time frame: Week 16]
• Change in pelvic obliquity [Time frame: Week 16]
• Change in pelvic torsion [Time frame: Week 16]
• Change in pelvic rotation [Time frame: Week 16]
• Change in kyphotic angle [Time frame: Week 16]
• Change in lordotic angle [Time frame: Week 16]
• Change in spinal mobility [Time frame: Week 16]
• Change in health-related quality of life [Time frame: Week 16]

Eligibility criteria

Inclusion criteria

• Adolescents aged 10 to 18 years.
• Diagnosis of mild to moderate adolescent idiopathic scoliosis (AIS) with a Cobb angle between 10° and 40°.
• Referred for physiotherapy treatment at the Physical Medicine and Rehabilitation Clinic.
• Ability to participate in a 16-week exercise program.
• Written informed consent from a parent or legal guardian and assent from the participant.
• Agreement not to receive additional scoliosis-specific treatment during the study period.

Exclusion criteria

• Non-idiopathic scoliosis (congenital, neuromuscular, or syndromic scoliosis).
• Cervicothoracic scoliosis.
• Previous scoliosis surgery.
• Brace treatment during the study period.
• Previous scoliosis-specific physiotherapy during the study period.
• Neurological disorders affecting posture or gait.
• Congenital or structural spinal abnormalities.
• Lower extremity neuromuscular disorders.
• Leg length discrepancy.
• Cardiovascular or respiratory conditions contraindicating exercise.
• Inability to participate in the intervention or complete outcome assessments.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Single blind

Primary purpose

Treatment

Study locations

Kosovo · 1 center

• Physical Medicine and Rehabilitation Clinic, University Clinical Center of Kosovo (UCCK) — Pristina

Publications

• Akcay B, Colak TK, Apti A, Colak I. The Immediate Effect of Hanging Exercise and Muscle Cylinder Exercise on the Angle of Trunk Rotation in Adolescent Idiopathic Scoliosis. Healthcare (Basel). 2024 Jan 24;12(3):305. doi: 10.3390/healthcare12030305. PMID 38338189
• Schreiber S, Parent EC, Moez EK, et al. Schroth physiotherapeutic scoliosis-specific exercises for adolescent idiopathic scoliosis. PLoS ONE. 2016;11(6):e0158739.

Identifiers

NCT: NCT07736456 · UP-PT-2026-001 · UP-PT-2026-001

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗