Marchese Rosemary, Ilhan Emre, Pacey Verity
ScoliCare, Sydney 2217, Australia.
Department of Health Sciences, Macquarie University, Sydney 2109, Australia.
J Clin Med. 2023 Sep 19;12(18):6063. doi: 10.3390/jcm12186063.
(1) Background: Schroth is a type of physiotherapeutic scoliosis specific exercise (PSSE) prescribed to adolescents with idiopathic scoliosis (AIS). Studies have investigated the effectiveness of Schroth but are yet to elucidate how Schroth is applied clinically and the factors that influence their prescription. (2) Methods: A mixed methods design was used comprising an anonymous survey and semi-structured interviews of Schroth therapists who treated AIS and who were publicly listed on the Barcelona Scoliosis Physical Therapy School or the International Schroth 3-dimensional Scoliosis Therapy School websites. The survey included 64 questions covering demographics, session and treatment characteristics, and whether therapists included other treatment modalities in their clinical practice. A convenience sample of survey participants were invited to participate in a semi-structured interview to further explore the factors that influenced their prescription of Schroth for AIS. Results from the survey were analyzed descriptively (n, %), whereas inductive thematic analysis was used for the interviews. (3) Results: of the 173 survey respondents (18% response rate), most were from Europe and North America (64.0%), female (78.6%), physiotherapists (96.0%), and worked in private settings (72.3%). Fifty-two per cent of participants used other types of PSSE as an adjunct to Schroth, the Scientific Exercise Approach to Scoliosis (SEAS) being the most frequently used (37.9%). Non-PSSE methods were used 'at some point' as an adjunct by 98.8% of participants, including massage and other soft tissue techniques (80.9%), Pilates (46.6%), and Yoga (31.5%). The Schroth techniques used by all survey respondents included breathing and pelvic corrections. Seven participants were interviewed, but data saturation was achieved after only four interviews. Thematic analysis revealed four, inter-related broad themes describing the factors that influenced Schroth prescription for AIS: (1) the adolescent as a whole, including physical, emotional and mental characteristics, and patient goals, (2) family, including parent relationship with the adolescent and the motivation of parents in regard to Schroth, (3) the systems within which the treatment was being offered, such as vicinity to the clinic and the presence of financial insurance support, and (4) therapist characteristics, such as their training and experience. (4) Conclusions: Schroth therapists worldwide use a variety of adjunctive methods to treat AIS. Therapists prescribing Schroth exercises to AIS consider the complex interplay of intra-, inter- and extra-personal factors in clinical practice. These considerations move beyond the three components of evidence-based practice of research, patient preferences, and clinical expertise, towards a systems-based reflection on exercise prescription.
（1）背景：施罗斯疗法是一种针对青少年特发性脊柱侧弯（AIS）患者的物理治疗性脊柱侧弯特定运动（PSSE）。已有研究对施罗斯疗法的有效性进行了调查，但尚未阐明该疗法在临床上的应用方式以及影响其处方的因素。（2）方法：采用混合方法设计，包括对在巴塞罗那脊柱侧弯物理治疗学校或国际施罗斯三维脊柱侧弯治疗学校网站上公开列出的、治疗AIS的施罗斯治疗师进行匿名调查和半结构化访谈。该调查包含64个问题，涵盖人口统计学、治疗课程和治疗特征，以及治疗师在临床实践中是否纳入其他治疗方式。从参与调查的人员中选取一个便利样本，邀请他们参与半结构化访谈，以进一步探究影响他们为AIS患者开具施罗斯疗法处方的因素。对调查结果进行描述性分析（n，%），而对访谈则采用归纳主题分析。（3）结果：在173名调查受访者中（回复率为18%），大多数来自欧洲和北美（64.0%），为女性（78.6%），是物理治疗师（96.0%），且在私人机构工作（72.3%）。52%的参与者将其他类型的PSSE作为施罗斯疗法的辅助手段，其中脊柱侧弯科学运动疗法（SEAS）是最常用的（37.9%）。98.8%的参与者在“某些时候”将非PSSE方法作为辅助手段，包括按摩和其他软组织技术（80.9%）、普拉提（46.6%）和瑜伽（31.5%）。所有调查受访者使用的施罗斯技术包括呼吸和骨盆矫正。7名参与者接受了访谈，但仅4次访谈后就达到了数据饱和。主题分析揭示了四个相互关联的宽泛主题，描述了影响为AIS患者开具施罗斯疗法处方的因素：（1）青少年整体情况，包括身体、情感和心理特征以及患者目标；（2）家庭，包括父母与青少年的关系以及父母对施罗斯疗法的积极性；（3）提供治疗的系统，如诊所的位置和是否有医疗保险支持；（4）治疗师特征，如他们的培训和经验。（4）结论：全球范围内的施罗斯治疗师使用多种辅助方法治疗AIS。为AIS患者开具施罗斯运动处方的治疗师在临床实践中会考虑个体内、个体间和个体外因素的复杂相互作用。这些考虑超越了基于证据的实践的三个组成部分，即研究、患者偏好和临床专业知识，转向基于系统的运动处方反思。
