青少年特发性脊柱侧弯：施罗瑟运动疗法改善生活质量与肌肉耐力的随机对照试验

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本研究论文"schreiber2015.pdf"主要探讨了施罗瑟(Schroth)运动疗法在青少年特发性脊柱侧弯(AIS)患者生活质量与肌肉耐力改善方面的效果。该研究是基于一项双盲随机对照试验（RCT），旨在评估施罗瑟锻炼是否能作为一种补充标准治疗手段，显著提升此类患者的健康状况。背景：在北美，对于轻度特发性脊柱侧弯的青少年，通常建议观察或采用脊柱矫形器。然而，未经控制的研究已经显示出施罗瑟专门针对脊柱侧弯的锻炼具有积极的影响，可能涉及各种临床结果。因此，这项研究设计了一个实验，目的是通过对比接受施罗瑟锻炼加上标准护理与单纯接受标准护理的患者，来确定施罗瑟锻炼对生活质量（QOL）和背部肌肉耐力（BME）的具体作用。参与者和方法：研究纳入了来自脊柱侧弯诊所的50名年龄在10至18岁之间，脊柱侧弯角度在10°至45°之间的青少年。这些患者被随机分配到两组，一组接受监督下的施罗瑟锻炼结合标准护理，另一组仅接受标准护理作为对照。实验过程包括定期进行施罗瑟锻炼，这是一种结合了呼吸技巧、身体意识和特定脊柱矫正动作的训练方法。研究者和统计分析员被双盲，以减少偏见并确保数据的客观性。研究期间，对患者的生活质量通过标准化量表进行评估，如脊柱侧弯特定的QOL问卷，同时通过肌电图或体力测试测量背部肌肉力量和耐力的变化。预期结果：研究的核心关注点在于探究施罗瑟锻炼是否能提高患者的生活质量得分，以及是否能显著增强他们的背肌功能，从而可能降低手术干预的需求。这将有助于临床医生制定更全面的治疗策略，以促进青少年特发性脊柱侧弯患者的康复和生活质量的提高。总结，schreiber2015.pdf的研究提供了对施罗瑟运动疗法在特发性脊柱侧弯青少年患者中实施的重要证据，其结果对于评估该疗法的临床效益具有重要意义，并可能对未来相关治疗方法的发展产生影响。

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

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