Application of passive transverse forces in the rehabilitation of spinal deformities: a randomized controlled study.

In our centre, physiotherapy and braces are the main approaches in the management of scoliosis and kyphosis as well. If a surgical intervention is necessary patients are guided to the appropriate centre for spine surgery. In order to avoid surgery, we are looking for possibilities to improve the conservative facilities of spinal deformities management. The aim of our study was to find out whether the use of passive transverse forces (PTF) applied on the deformed body is useful in the rehabilitation process of patients with spinal deformities. A randomized controlled study was undertaken including 126 patients with scoliosis treated with our intensive rehabilitation programme and 4 to 6 PTF treatments lasting 20 minutes per treatment. This group had a curvature angle of 38,7 degrees (SD 16,8) thoracic and 32 degrees (SD15,1) lumbar. Average age was 14,8 years (SD2,7). The control group of 126 patients had a curvature angle of 33,1 degrees (SD 16,1) thoracic and 26,9 degrees (SD12,7) lumbar. Average age was 15,2 years (SD2,3). The patients were randomized by the third author in order to have inpatient rehabilitation and PTF or intensive inpatient rehabilitation alone. For the result evaluation we carried out an investigation before and after the intensive inpatient rehabilitation phase of 4-6 weeks long with the surface measuring system (Formetric system). We evaluated the average lateral deviation value, measured in mm, as given out by the system. The value of average lateral deviation in the treatment group decreased highly significantly (p=.00157) with an average improvement of 1.27 mm. The controls also improved comparing the value for the average lateral deviation before and after rehabilitation with an average difference of 0.94 mm, which was not significant in the T-test (p=0.10032). When comparing the treatment group (PTF) without additional braces (n=52) the difference was even bigger with 1.50 mm (p=.0307). The control group without brace showed similar results as the entire control group. Only uncorrected posture can be measured with the Formetric system. When trying to show the possible postural corrections with the help of the Formetric system, more than 50% of the scans show artefacts resulting from the fact that the points necessary for calculating the spinal deviation can no longer be automatically recognized. For this reason also the changes after an intensive inpatient rehabilitation are very moderate, even if they show a significant tendency to postural correction in larger groups. In smaller groups however, we generally only find the nonsignificant tendency to postural correction. Significant values were obtained with additional application of the PTF treatment. This proves the efficacy of passive forces combined with intensive physiotherapy aiming at an active stabilization of the passively mobilized spine. The uncorrected posture is improved significantly by inpatient rehabilitation and PTF, thus the treatment of scoliotic patients with the described methods is superior to inpatient rehabilitation alone.