Schreiber Sanja, Parent Eric C, Moez Elham Khodayari, Hedden Douglas M, Hill Doug, Moreau Marc J, Lou Edmond, Watkins Elise M, Southon Sarah C
University of Alberta, Edmonton, Canada.
University of Alberta, Alberta Health Services, Edmonton, Canada.
Scoliosis. 2015 Sep 18;10:24. doi: 10.1186/s13013-015-0048-5. eCollection 2015.
In North America, care recommendations for adolescents with small idiopathic scoliosis (AIS) curves include observation or bracing. Schroth scoliosis-specific exercises have demonstrated promising results on various outcomes in uncontrolled studies. This randomized controlled trial (RCT) aimed to determine the effect of Schroth exercises combined with the standard of care on quality-of-life (QOL) outcomes and back muscle endurance (BME) compared to standard of care alone in patients with AIS.
Fifty patients with AIS, aged 10-18 years, with curves 10-45 °, recruited from a scoliosis clinic were randomized to receive standard of care or supervised Schroth exercises plus standard of care for 6 months. Schroth exercises were taught over five sessions in the first two weeks. A daily home program was adjusted during weekly supervised sessions. The assessor and the statistician were blinded. Outcomes included the Biering-Sorensen (BME) test, Scoliosis Research Society (SRS-22r) and Spinal Appearance Questionnaires (SAQ) scores. Intention-to-treat (ITT) and per protocol (PP) linear mixed effects models were analyzed. Because ITT and PP analyses produced similar results, only ITT is reported.
After 3 months, BME in the Schroth group improved by 32.3 s, and in the control by 4.8 s. This 27.5 s difference in change between groups was statically significant (95 % CI 1.1 to 53.8 s, p = 0.04). From 3 to 6 months, the self-image improved in the Schroth group by 0.13 and deteriorated in the control by 0.17 (0.3, 95 % CI 0.01 to 0.59, p = 0.049). A difference between groups for the change in the SRS-22r pain score transformed to its power of four was observed from 3 to 6 months (85.3, 95 % CI 8.1 to 162.5, p = 0.03), where (SRS-22 pain score)(4) increased by 65.3 in the Schroth and decreased by 20.0 in the control group. Covariates: age, self-efficacy, brace-wear, Schroth classification, and height had significant main effects on some outcomes. Baseline ceiling effects were high: SRS-22r (pain = 18.4 %, function = 28.6 %), and SAQ (prominence = 26.5 %, waist = 29.2 %, chest = 46.9 %, trunk shift = 12.2 % and shoulders = 18.4 %).
Supervised Schroth exercises provided added benefit to the standard of care by improving SRS-22r pain, self-image scores and BME. Given the high prevalence of ceiling effects on SRS-22r and SAQ questionnaires' domains, we hypothesize that in the AIS population receiving conservative treatments, different QOL questionnaires with adequate responsiveness are needed.
Schroth Exercise Trial for Scoliosis NCT01610908.
在北美，针对患有轻度特发性脊柱侧弯（AIS）的青少年的护理建议包括观察或支具治疗。在非对照研究中，施罗特脊柱侧弯特定运动已在各种结果上显示出有前景的效果。这项随机对照试验（RCT）旨在确定与仅接受标准护理相比，施罗特运动联合标准护理对AIS患者生活质量（QOL）结果和背部肌肉耐力（BME）的影响。
从一家脊柱侧弯诊所招募了50名年龄在10 - 18岁、侧弯角度为10 - 45°的AIS患者，随机分为两组，一组接受标准护理，另一组接受监督下的施罗特运动加标准护理，为期6个月。施罗特运动在前两周分五个疗程进行教授。在每周的监督疗程中调整每日家庭训练计划。评估者和统计人员均为盲法。结果包括比林 - 索伦森（BME）测试、脊柱侧弯研究学会（SRS - 22r）和脊柱外观问卷（SAQ）评分。分析了意向性治疗（ITT）和符合方案（PP）线性混合效应模型。由于ITT和PP分析产生了相似的结果，因此仅报告ITT结果。
3个月后，施罗特组的BME提高了32.3秒，对照组提高了4.8秒。两组之间这种27.5秒的变化差异具有统计学意义（95%置信区间1.1至53.8秒，p = 0.04）。从3个月到6个月，施罗特组的自我形象改善了0.13，对照组恶化了0.17（差异0.3，95%置信区间0.01至0.59，p = 0.049）。从3个月到6个月，观察到两组在SRS - 22r疼痛评分转换为四次幂后的变化存在差异（差异85.3，95%置信区间8.1至162.5，p = 0.03），其中（SRS - 22疼痛评分）⁴在施罗特组增加了65.3，在对照组减少了20.0。协变量：年龄、自我效能、支具佩戴、施罗特分类和身高对某些结果有显著的主要影响。基线天花板效应较高：SRS - 22r（疼痛=18.4%，功能=28.6%），以及SAQ（突出度=26.5%，腰部=29.2%，胸部=46.9%，躯干偏移=12.2%，肩部=18.4%）。
监督下的施罗特运动通过改善SRS - 22r疼痛、自我形象评分和BME，为标准护理提供了额外的益处。鉴于SRS - 22r和SAQ问卷领域的天花板效应普遍较高，我们假设在接受保守治疗的AIS人群中，需要不同的具有足够反应性的QOL问卷。
脊柱侧弯施罗特运动试验NCT01610908。
