The effectiveness of Schroth method in Cobb angle, quality of life and trunk rotation angle in adolescent idiopathic scoliosis: a systematic review and meta-analysis

Abstract

Introduction: The Schroth method is one of the most common physiotherapeutic scoliosis-specific exercises intervention applied in adolescent idiopathic scoliosis (AIS). This method consists of three-dimensional correction of the specific curve pattern of the patient using a combination of sensorimotor, postural, and corrective breathing exercises. The aim of this systematic review and meta-analysis was to analyse the effects of the Schroth method in isolation on Cobb angle, quality of life, and trunk rotation angle compared to no intervention or other conservative treatments in patients with AIS.

Evidence acquisition: PubMed, Physiotherapy Evidence Database, Scopus, Cochrane Library, and Web of Science databases were searched. Studies were included if they were randomized controlled trials that compared the effects of the Schroth method in isolation to conservative interventions or no intervention. The quality of the studies was assessed with the PEDro Scale, and the risk of bias with the Cochrane Collaboration tool. Two independent assessors extracted data through a standardized form. Meta-analyses were conducted using fixed or random effects models according to the heterogeneity assessed with I² coefficient. Data on outcomes of interest were extracted by a researcher using RevMan 5.4 software.

Evidence synthesis: A total of 317 studies were screened. Six were included in the meta-analysis involving 144 patients with AIS. The methodological quality of the included studies ranged from high to low. Schroth method in isolation showed significant improvements in Cobb angle (mean difference [MD] =-3.18º; 95% CI: -4.30, -2.07; I²: 0%), quality of life (MD=0.28; 95% CI: 0.18, 0.38; I²: 0%) and trunk rotation angle (MD=-2.12º; 95% CI: -3.44, -0.80; I²: 71%) in the short-term.

Conclusions: The Schroth method in isolation is effective for reducing the Cobb angle and the trunk rotation angle and for improving the QoL in the short-term compared to no intervention or other conservative therapies in AIS, but the improvement in Cobb angle did not exceed the minimum clinically important difference.

Figure 1

—Flowchart diagram of the study.

Figure 2

—Risk of bias Cochrane tool.^{, -}

Figure 3

—A) Forest plot of Cobb angle; B) forest plot of QoL; C) forest plot of trunk rotation angle.^{, -}