施罗特物理治疗特定脊柱侧弯运动加入标准护理可使特发性脊柱侧弯青少年的Cobb角改善效果更佳——一项评估者和统计学家双盲随机对照试验
Schroth Physiotherapeutic Scoliosis-Specific Exercises Added to the Standard of Care Lead to Better Cobb Angle Outcomes in Adolescents with Idiopathic Scoliosis - an Assessor and Statistician Blinded Randomized Controlled Trial.
作者信息
Schreiber Sanja, Parent Eric C, Khodayari Moez Elham, Hedden Douglas M, Hill Douglas L, Moreau Marc, Lou Edmond, Watkins Elise M, Southon Sarah C
机构信息
Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada.
Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada.
出版信息
PLoS One. 2016 Dec 29;11(12):e0168746. doi: 10.1371/journal.pone.0168746. eCollection 2016.
BACKGROUND
The North American non-surgical standard of care for adolescent idiopathic scoliosis (AIS) includes observation and bracing, but not exercises. Schroth physiotherapeutic scoliosis-specific exercises (PSSE) showed promise in several studies of suboptimal methodology. The Scoliosis Research Society calls for rigorous studies supporting the role of exercises before including it as a treatment recommendation for scoliosis.
OBJECTIVES
To determine the effect of a six-month Schroth PSSE intervention added to standard of care (Experimental group) on the Cobb angle compared to standard of care alone (Control group) in patients with AIS.
METHODS
Fifty patients with AIS aged 10-18 years, with curves of 10°-45° and Risser grade 0-5 were recruited from a single pediatric scoliosis clinic and randomized to the Experimental or Control group. Outcomes included the change in the Cobb angles of the Largest Curve and Sum of Curves from baseline to six months. The intervention consisted of a 30-45 minute daily home program and weekly supervised sessions. Intention-to-treat and per protocol linear mixed effects model analyses are reported.
RESULTS
In the intention-to-treat analysis, after six months, the Schroth group had significantly smaller Largest Curve than controls (-3.5°, 95% CI -1.1° to -5.9°, p = 0.006). Likewise, the between-group difference in the square root of the Sum of Curves was -0.40°, (95% CI -0.03° to -0.8°, p = 0.046), suggesting that an average patient with 51.2° at baseline, will have a 49.3° Sum of Curves at six months in the Schroth group, and 55.1° in the control group with the difference between groups increasing with severity. Per protocol analyses produced similar, but larger differences: Largest Curve = -4.1° (95% CI -1.7° to -6.5°, p = 0.002) and [Formula: see text] (95% CI -0.8 to 0.2, p = 0.006).
CONCLUSION
Schroth PSSE added to the standard of care were superior compared to standard of care alone for reducing the curve severity in patients with AIS.
TRIAL REGISTRATION
NCT01610908.
背景
北美青少年特发性脊柱侧凸（AIS）的非手术标准治疗方案包括观察和支具治疗，但不包括运动疗法。施罗斯物理治疗脊柱侧凸特定运动疗法（PSSE）在几项方法欠佳的研究中显示出前景。脊柱侧凸研究协会呼吁进行严格研究，以支持运动疗法在脊柱侧凸治疗推荐中的作用，然后再将其纳入其中。
目的
确定在AIS患者中，与单纯标准治疗（对照组）相比，在标准治疗基础上增加为期6个月的施罗斯PSSE干预（试验组）对Cobb角的影响。
方法
从一家儿科脊柱侧凸诊所招募了50例年龄在10 - 18岁、侧弯角度为10° - 45°且Risser分级为0 - 5级的AIS患者，并随机分为试验组或对照组。结果包括从基线到6个月时最大弯度的Cobb角变化以及弯度总和的变化。干预措施包括每天30 - 45分钟的家庭训练计划和每周的监督训练课程。报告了意向性分析和符合方案的线性混合效应模型分析结果。
结果
在意向性分析中，6个月后，施罗斯组的最大弯度明显小于对照组（-3.5°，95%置信区间-1.1°至-5.9°，p = 0.006）。同样，弯度总和平方根的组间差异为-0.40°（95%置信区间-0.03°至-0.8°，p = 0.046），这表明基线时平均弯度为51.2°的患者，在施罗斯组6个月时弯度总和为49.3°，而对照组为55.1°，且组间差异随严重程度增加。符合方案分析产生了类似但更大的差异：最大弯度=-4.1°（95%置信区间-1.7°至-6.5°，p = 0.002）和[公式：见原文]（95%置信区间-0.8至0.2，p = 0.006）。
结论
在标准治疗基础上增加施罗斯PSSE，在降低AIS患者的侧弯严重程度方面优于单纯标准治疗。
试验注册
NCT01610908。
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