![](https://csdnimg.cn/release/download_crawler_static/18501216/bg3.jpg)
measured at skeletal maturity by the SRS-22r questionnair e
(by 0.75 to 0.89/5) while the traditional spinal exercises
were associated with stable outcomes [34]. The study in-
cluded 110 skeletally immature patients with AIS and
curves <25 ° at baseline. In a third recent RCT, preoperative
aerobic training improved the QOL in 40 surgical candi-
dates with AIS [35].
Among all scoliosis-specific exercise approaches, the
Schroth method is among the most studied and widely
used. The Schroth method consists of scoliosis-specific
sensorimotor, postural and breathing exercises [36].
Auto-corre ction defined as the patient’s ability to reduce
the spinal deformity through active postural realignment
of the spine in three dimensions [29] is a fundamental
component of the Schroth method. Auto-correction is
achieved through self-elongation and postural corrections
that are specific for each curve pattern, and is eventually
integrated in daily activities. In several cohort studies, the
Schroth method demonstrated positive outcomes on back
muscle strength [31], breathing function [31], slowing
curve progression [37], improving Cobb angles [31, 37]
and decreasing the prevalence of surgery [38].
The results from a large case–control study [39] sug-
gest that the back muscle endurance of scoliosis patients
is significantly lower than in people without scoliosis.
Paraspinal muscles are needed to maintain spinal align-
ment throughout the day. To our knowledge this out-
come has not been investigated in a Schroth exercise
study.
To our knowledge no RCT or prospective controlled
studies have been conducted on the effect of Schroth exer-
cises. Moreover, most exercise studies did not blind the
assessors, report on compliance, intention-to-treat ana-
lyses, or on recruitment strategies. The promising effect of
Schroth exercises on QOL should be confirmed in a RCT
conducted by independent researchers, not involved in
the development and promotion of or profiting from the
approach, to limit investigator bias, and to address the
methodological limitations of prior studies.
Therefore, the objective of this RCT on Schroth exercises
was to determine the effect of a 6-month Schroth exercise
intervention in conjunction with standard of care (observa-
tion and bracing) on QOL, perceived appearance and back
muscle endurance, compared to the standard of care alone
in patients with AIS.
Methods
Study design
This was a phase II assessor- and statistician-blinded,
randomized controlled clinical trial. The full protocol for
this study has been published [40]. The CONSORT flow
chart for this RCT has been reported in Additional file 1.
Participants and therapists
We consecutively enrolled patients with AIS from the
scoliosis clinic at our institution. Inclusion criteria were:
10–18 years old, both genders, curves 10–45 °, Risser 0–5
(all skeletal maturities) and ability to travel to weekly
visits. Exclusion criteria were: diagnosis other than AIS,
planning surgery, having had surgery, previously weaned
from brace, being scheduled for clinical follow-up later
than in 6 ± 2 months or being discharged from the clinic
when approached to participate. We obtained assent from
the patients and informed parental consent prior to the
enrolment. This study was approved by the University of
Alberta Health Research Ethics Board (Pro00011552).
The main Schroth-cert ified therapist had 3 years of
Schroth therapy experience and provided 95 % of the
therapy sessions. Another certified therapist filled in as
needed.
Randomization and masking
A research coordinator invited eligible patients attending
regular scoliosis clinic visits to participate in the study.
Within 2 weeks from the visit, a researcher contacted
interested patients to obtain consent and book a baseline
evaluation. After an initial exam confirming eligibility and
collecting baseline data, participants were randomized
using a computer-generated sequence in pre-sealed enve-
lopes into the Schroth exercises or the control group. We
used random size (4–8) blocked randomization stratified
for the four Schroth curve types [41] to ensure allocation
of a balanced number of participants in both arms of the
study (25 per group) for each curve type.
Therapists and patients could not be blinded when
offering or receiving the Schroth treatment. However,
participants were asked not to reveal their group alloca-
tion to ensure blinding of the evaluator. The statistician
was not aware of the data coding.
Intervention
Schroth exercises added to standard care (experimental)
group
The 6-months supervised Schroth exercise intervention
included five initial 1-h long private training sessions deliv-
ered during the first two weeks after baseline, followed by
weekly 1-h long group classes combined with a 30–45 min
dailyhomeexerciseprogram.Exercisesarepresentedin
Additional file 2 with a description of the corrective move-
ments required, the curve type for which they are recom-
mended, the level of passive support involved, whether they
offer a static or dynamic challenge and the dosages recom-
mended. A Schroth curve type classification algorithm [41]
and algorithms to guide the exercise prescription and
progression for each of the four Schroth curve types [42]
Schreiber et al. Scoliosis (2015) 10:24 Page 3 of 12