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Research Article: Schroth Physiotherapeutic Scoliosis-Specific Exercise (PSSE) Trials—Systematic Review of Methods and Recommendations for Future Research

Date Published: 2023-05-27

Abstract:
The Schroth method is a non-operative treatment for scoliosis and kyphosis, used standalone or as an adjunct to bracing. While supporting evidence for its effectiveness is emerging, methodologic standardization and rigor are equivocal. Thus, we aimed to systematically review methods of published Schroth physiotherapeutic scoliosis-specific exercise (PSSE) trials and provide guidance for future research. We searched six databases for randomized controlled trials (RCT) and non-randomized studies of interventions (NRSIs) investigating the effect of Schroth in children and adults with scoliosis or kyphosis. General characteristics, methodological approaches, treatment protocols, and outcomes reporting were analyzed. Risk of bias (RoB) was assessed using an adapted Cochrane RoB2 tool for RCTs and ROBINS-I for NRSI. Eligible studies (n = 7) were conducted in six countries and included patients with Scheuermann’s kyphosis (n = 1) and adolescent idiopathic scoliosis (n = 6). Though all seven studies used the term Schroth to describe their interventions, the Schroth method was used in four of seven studies, of which only one used Schroth classification, three used Schroth therapists, and none prospectively registered the study protocol. Overall, methodological rigor was suboptimal, potentially invalidating evidence synthesis. Authors should follow minimum standards for reporting, including prospectively registering detailed protocols; using appropriate exercise labeling, Schroth classification and certified therapists; naming and describing exercises per classification; and providing therapy dosages, prescription methods, and adherence.

Introduction:
Scoliosis is an abnormal curvature of the spine that displaces the spine in all three planes of the body away from its natural position, creating morphological changes in the trunk and intervertebral discs, leading to structural changes in the vertebrae that can develop at any stage of life. Adolescent idiopathic scoliosis (AIS) has an unknown etiology [1,2,3,4], and is the most common type of scoliosis, accounting for 90% of scoliosis cases [5]. AIS is progressive, with onset typically during puberty in a healthy…

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