Improving Home-Based Scoliosis Therapy: Findings From a Web-Based Survey

Abstract

Background: Conservative scoliosis therapy in the form of assisted physiotherapeutic scoliosis exercises is supplemented by self-contained training at home, depending on the approach (eg, Schroth, the Scientific Exercises Approach to Scoliosis). Complex exercises, lack of awareness of the importance of training, and missing supervision by therapists often lead to uncertainty and reduced motivation, which in turn reduces the success of home-based therapy. Increasing digitalization in the health care sector offers opportunities to close this gap. However, research is needed to analyze the requirements and translate the potential of digital tools into concrete solution concepts.

Objective: The aim of this study is to evaluate the potential for optimizing home-based scoliosis therapy in terms of motivation, assistive devices, and digital tools.

Methods: In collaboration with the Institute of Physiotherapy at the Jena University Hospital, a survey was initiated to address patients with scoliosis and physical therapists. A digital questionnaire was created for each target group and distributed via physiotherapies, scoliosis forums, the Bundesverband für Skoliose Selbsthilfe e. V. newsletter via a link, and a quick response code. The survey collected data on demographics, therapy, exercise habits, motivation, assistive devices, and digital tools. Descriptive statistics were used for evaluation.

Results: Of 141 survey participants, 72 (51.1%; n=62, 86.1%, female; n=10, 13.9%, male) patients with scoliosis with an average age of 40 (SD 17.08) years and 30 scoliosis therapists completed the respective questionnaires. The analysis of home-based therapy showed that patients with scoliosis exercise less per week (2 times or less; 45/72, 62.5%) than they are recommended to do by therapists (at least 3 times; 53/72, 73.6%). Patients indicated that their motivation could be increased by practicing together with friends and acquaintances (54/72, 75%), a supporting therapy device (48/72, 66.7%), or a digital profile (46/72, 63.9%). The most important assistive devices, which are comparatively rarely used in home-based therapy, included balance boards (20/72, 27.8%), wall bars (23/72, 31.9%), mirrors (36/72, 50%), and long bars (40/72, 55.6%). Therapists saw the greatest benefit of digital tools for scoliosis therapy in increasing motivation (26/30, 87%), improving home therapy (25/30, 83%), monitoring therapy progress (25/30, 83%), and demonstrating exercise instructions (24/30, 80%).

Conclusions: In this study, we investigated whether there is any potential for improvement in home-based scoliosis therapy. For this purpose, using online questionnaires, we asked patients with scoliosis and therapists questions about the following topics: exercise habits, outpatient and home-based therapy, motivation, supportive devices, and digital tools. The results showed that a lack of motivation, suitable training equipment, and tools for self-control leads to a low training workload. From the perspective of the patients surveyed, this problem can be addressed through community training with friends or acquaintances, a supportive therapy device, and digital elements, such as apps, with training instructions and user profiles.

Keywords: Schroth therapy; adherence; assistive devices; digital tools; eHealth; exercise system; home program; home-based exercise; physiotherapeutic scoliosis-specific exercises (PSSE); scoliosis therapy.

Figure 1

Comparison of weekly training sessions performed by patients with scoliosis at home and recommendations of therapists in this regard. To create the figure, the results of 2 questions from PQ (“How often do you do additional therapy exercises at home for your scoliosis?” [PB02; black] and “How often did your therapist recommend you to do exercises at home?” [PB03; dark gray]) and 1 question from TQ (“How often do you usually recommend additional home exercise sessions to your patients for physical therapy?” [TC01; light gray]) were used. PB02: PQ, topic 2, question 2; PB03: PQ, topic 2, question 3; PQ: questionnaire for patients with scoliosis; TC01: TQ, topic 3, question 1; TQ: questionnaire for scoliosis therapists.

Figure 2

How motivated are patients with scoliosis to perform their exercises, broken down by age group? The figure is based on the results of 1 question from PQ: “How motivated are you in general to do your exercises?” [PC01]. The disagreement items (“not motivated at all” and “rather not motivated”) are visualized in black and dark gray, respectively, while the agreement items (“rather motivated” and “very motivated”) are visualized in light gray and white, respectively, each stacked. PC01: PQ, topic 3, question 1; PQ: questionnaire for patients with scoliosis.

Figure 3

What would motivate patients with scoliosis to perform their exercises? The content of the graph is based on the results of voting from the PQ: “Please indicate how motivating you would find the following features for your scoliosis exercises” [PC02]. Here, the disagreement items (“not motivating at all” and “rather not motivating”) are visualized in black and dark gray, respectively, while the agreement items (“rather motivating” and “very motivating”) are visualized in light gray and white, respectively, each stacked. PC02: PQ, topic 3, question 2; PQ: questionnaire for patients with scoliosis.

Figure 4

Which assistive devices do patients with scoliosis use for training at home, and which do patients and therapists rate as helpful for scoliosis therapy? For the creation of the figure, the results of 2 questions from PQ (“Where do you use, or where would you like to use, which of the predefined tools?” [PE01; black lines] and “How helpful do you find the mentioned devices?” [PE02; light gray]) and 1 voting from TQ (“Please rate how helpful the mentioned assistive devices are for scoliosis therapy” [TE03; gray]) were used. The Likert distribution was calculated excluding the answer “I do not use.” PE01: PQ, topic 5, question 1; PE02: PQ, topic 5, question 2; PQ: questionnaire for patients with scoliosis; TE03: TQ, topic 5, question 3; TQ: questionnaire for scoliosis therapists.

Figure 5

Evaluation of digital tools with regard to their usefulness in supporting scoliosis therapy. The results of the question “How helpful do you find, or would you find, the following digital tools in your exercises?” [PF02] from PQ were evaluated for the creation of the graph. The evaluation was carried out using a 5-point Likert scale, divided into 2 age groups. PF02: PQ, topic 6, question 2; PQ: questionnaire for patients with scoliosis.