1. Introduction
Scoliosis is defined as a three-dimensional deformity of the spine. Clinically, the most common type of scoliosis is adolescent idiopathic scoliosis (AIS). Although scoliosis is a three-dimensional deformity, the diagnostic criterion is a Cobb angle of more than 10 degrees, which is evaluated in two dimensions in the frontal plane on standing AP orthorontographs [1,2].
Although the Cobb angle was defined in 1948, it is still used as the gold standard evaluation method in diagnosing scoliosis, determining treatment options and effects, and evaluating progression [3,4]. While the Cobb angle is a widely used parameter to assess the severity of scoliosis, its direct impact on patients’ quality of life remains a topic of discussion. Although the Cobb angle is frequently used, there is insufficient data to conclude that better radiological results are associated with long-term improvements in scoliosis patients’ function, quality of life, self-image, and pain [5]. According to published reports, adults with AIS who have not received treatment are highly functional and productive at a 20th, 28th, and 50th-year follow-up even though they have a large Cobb angle. Back pain and cosmetic concerns are the only physical impairments caused by untreated AIS [6,7]. Additionally, the overall quality of life and the Cobb angle have a weak relationship [8].
According to SOSORT and SRS criteria, a decrease of more than 5 degrees in the Cobb angle is considered an improvement, and an increase of more than 5 degrees is considered progression [9,10]. Although Cobb angle measurements are still very important for professionals working in the specialty of scoliosis, it should be kept in mind that there may be differences even between the Cobb measurements of the same person. It has been reported that there can be a difference of 3.5–7.1 degrees between two measurements when measured manually and 3.2–6.1 degrees when measured using computer systems [11]. A measurement error of 5 degrees is very important as it will change the patient’s treatment program [10].
Another important point is the radiation exposure of patients due to X-rays taken to evaluate the Cobb angle. Up to 40 to 50 X-rays may be required for certain patients, particularly those who are diagnosed at a younger age and are receiving early and continuous treatment [12]. After evaluating 13 females who had 22 X-rays over a 3-year period, Nash et al. calculated an increase in breast cancer of 140 to 290 per million and an increase in organ cancer of 3.4 to 15 per million [13] Levy et al. assessed 2039 patients referred to a large pediatric hospital between 1925 and 1965 who received an average of 12 and 10 X-rays, respectively, and calculated an excess cancer risk of 42 to 238 cases per 100,000 for women and 14 to 79 cases per 100,000 for men [14].
While the majority of scoliosis cases (e.g., adolescent idiopathic scoliosis, congenital scoliosis with single formation defects) may not result in significant health-related impairments in many individuals, even if untreated, the potential for psychosocial and functional consequences should not be overlooked. In this context, the trunk deformity caused by scoliosis often becomes a central concern for patients [15,16,17]. It is therefore advisable to focus more on the cosmetically significant changes in the shape of the trunk as an outcome parameter, as these can lead to impairments in quality of life under certain circumstances.
Considering all these factors, other outcome measurement methods to assess deformity, spine, and posture are gaining importance. The clinical evaluation of individuals with scoliosis involves a comprehensive assessment that includes anamnesis, physical examination, inspection, the forward bending test, general anthropometric measurements, maturation assessment, the evaluation of leg length discrepancy, the assessment of the plumb line (midline alignment), trunk rotation angle measurement, gibbosity evaluation, lumbar asymmetry assessment, the assessment of spinal rigidity and flexibility, as well as endurance and muscle strength testing. Furthermore, it incorporates subjective assessment methods such as aesthetic evaluation, posture analysis, stress scales, and quality of life questionnaires [18].
The forward bending test has been reported to have a sensitivity of 92% to 100% for detecting curvatures exceeding 20 degrees and a specificity of 60% to 91% [18]. Among these evaluation methods, height measurement, as part of general anthropometric assessments, is recommended with 95.6% agreement by SOSORT professionals [19]. As part of the maturation assessment, the evaluation of menarche status is suggested by members of SOSORT and the Schroth Best Practice Academy [18,19,20]. The SOSORT consensus report recommends assessing the C7 plumb line with 73.9% agreement [19]. The evaluation of the angle of trunk rotation (ATR) using a scoliometer has been reported to have excellent intra-rater reliability and very good inter-rater reliability. A minimum of a 5 degree ATR detected by the scoliometer is considered a good criterion for identifying a Cobb angle of 20 degrees or more [21]. While studies on surface topography systems have reported positive results related to the Cobb angle, some publications have highlighted issues such as false positive results, poor sensitivity, and reliability. Aesthetic appearance and the perception of postural appearance are among the most critical parameters to be addressed in the treatment of adolescent idiopathic scoliosis. Various tools have been developed to assess aesthetic and deformity perception, including the Walter Reed Visual Assessment Scale (WRVAS), the Spinal Appearance Questionnaire (SAQ), and indices such as the Anterior Trunk Symmetry Index (ATSI) and the Posterior Trunk Symmetry Index (POTSI) [18].
The aim of this systematic review was to identify and highlight the most commonly used and preferred clinical outcome measures used in randomized controlled studies to assess spinal deformity and posture, either alone or in combination with the Cobb angle.
2. Materials and Methods
2.1. Search Strategy
A search was carried out in the databases PubMed, PEDro, OVID, and Scopus provided by the remote access system of the Marmara University Library and Documentation Department. The search strategy was constrained to the period of January 2004 to May 2024. Only articles written in English were included. The search strategy used was as follows: (scoliosis [MeSH Terms] OR scoliosis [Title/Abstract]) AND (exercise [MeSH Terms] OR exercise [Title/Abstract] OR “physical activity” [Title/Abstract] OR brace [Title/Abstract] OR bracing [Title/Abstract] OR “conservative treatment” [Title/Abstract] OR rehabilitation [Title/Abstract] OR physiotherapy [Title/Abstract] OR “physical therapy” [Title/Abstract] OR treatment [Title/Abstract]) AND Randomized Controlled Trial [pt]. We employed comparable search terms or synonymous terms in alternative databases.
This systematic review was conducted in accordance with the Preferred Reporting Items in Systematic Reviews and Meta-Analyses (PRISMA) Statement.
2.2. Study Selection and Criteria
The studies were chosen according to predetermined criteria for inclusion and exclusion after searching through the databases. Initially, the identification of studies relied on screening titles and abstracts, which was followed by full-text evaluation and the eventual inclusion of studies. Three reviewers conducted the screening process for the articles. Criteria for inclusion and exclusion were based on the PICOS format (Table 1) [22]. For the population criterion, individuals who were diagnosed with adolescent idiopathic scoliosis between the ages of 9 and 19 and did not have any other concomitant disease were included, regardless of gender. Studies including radiologically diagnosed cases were enrolled in this systematic review. The interventions included were determined as deformity corrective interventions for the spine (exercise, brace, physiotherapy, and other interventions). Studies performed before or after surgical intervention were excluded. Studies including surgical and post-surgical interventions were excluded. The outcome of our interest included any measurement method that evaluates scoliosis, spine, deformity, or posture other than the Cobb angle. Only randomized controlled trials (RCTs) were examined for this study. A limitation was placed by including only English language studies published from January 2004 to May 2024.
2.3. Data Extraction and Data Synthesis
After reviewing all of the final included studies, data extraction was performed in Microsoft Excel independently by three authors. A reliability assessment of the studies was made using the PEDro scale [23]. After data extraction, narrative synthesis was conducted. Heterogeneity tests and meta-analysis of the studies were not performed.
3. Result
3.1. Study Selection
A total of 1083 articles were retrieved from the four databases. A total of 81 articles were excluded due to duplication. A total of 909 articles were excluded after reading the title and abstract. Finally, 23 articles were included in the study after reviewing the remaining 93 articles (Figure 1) (Table 2).
3.2. Study Characteristics
In all included studies, it was ensured that the diagnosis of scoliosis was made by radiographic evaluation. All articles were in English. The oldest study included in the study was from 2005 [24], and the most recent study was from 2024 [45]. Seven of the included studies were conducted in Turkey, four in China, and three in the USA.
A total of 1252 participants were assessed in the studies. Of the participants, 1086 (86.74%) were female. Seven of the studies [24,26,31,35,38,40,41] included only females. In one of the studies that included [34], the participants’ gender was not clearly defined.
The most commonly evaluated outcome, other than the Cobb angle, was the trunk rotation angle (ATR). In 15 studies [26,27,29,30,32,33,36,37,38,40,42,43,44,45], the ATR was evaluated as the primary or secondary outcome measurement. The apical vertebral rotation (AVR) was evaluated on X-ray in one study [24]. Sagittal balance was evaluated in three studies [6,26,42], and coronal balance in two studies [6,42].
Surface topography was used as a non-invasive imaging technique to evaluate deformity in four studies [25,26,27,28]. In one study, a computer system was used to assess posture [35], and in another study, a posture assessment application [40] was used.
The Posterior Trunk Asymmetry Index (POTSI) was used to evaluate trunk asymmetry in four studies [30,31,33,40]. The Anterior Trunk Asymmetry Index (ATSI) was used in one study [40].
In addition to objective measurements, the studies also used some scale assessments as outcome measures. The Walter Reed Visual Assessment Scale (WRVAS) was the most commonly used visual assessment scale and was used in four articles [31,33,37,40]. Two studies used the Scoliosis Appearance Questionnaire (SAQ) [34,36] and the other two used the Trunk Appearance Perception Scale (TAPS) [30,41].
Improved quality of life was evaluated as an outcome in 11 studies. The most used scale to assess quality of life was The Scoliosis Research Society-22r (SRS-22r). In 10 studies [27,30,31,33,34,36,37,41,42,43], SRS-22r was used, and in one study, SRS-23 [29] was used to assess quality of life.
Quality of life was assessed in one study [6] by using the Pediatric Quality of Life Inventory (PedsQL), and in one study using the EuroQol 5-Dimensions Youth (EQ-5D-Y) [33].
3.3. Methodological Quality of Included Studies
The PEDro scale was ranked from 3 to 8, with an average score of 6.21/10 for overall articles. Five of the studies [6,24,25,32,34] scored four or less on the PEDro scale (Table 3). These scores indicate low methodological quality. Seventeen studies scored between 5 and 7, indicating moderate methodological quality. Only three studies had high methodological quality. These three studies [37,38,42] scored eight and above (Table 4). The most important reason for the low scores of the studies was the lack of blinding of the physiotherapists, patients, and evaluators included in the study.
3.4. Interventions Used in the Studies
In the reviewed articles, various interventions were employed to manage AIS. The most commonly used intervention across the studies was Schroth exercises, which demonstrated significant positive outcomes in improving both the ATR and quality of life [27,43,44]. Schroth exercises were particularly effective, with multiple studies [27,29] highlighting improvements in spinal deformities and patient functionality. Additionally, bracing was another widely used intervention, with various forms such as the Boston brace, the TLSO brace, and innovative braces designed using CAD/CAM technology [24,28]. For instance, Wong et al. found that CAD/CAM braces were more effective than manually produced braces [24].
Several studies also combined Schroth exercises with other interventions such as balance training and hippotherapy. Abdel-Aziem et al. showed that combining hippotherapy with Schroth exercises improved balance and postural asymmetries [39]. Furthermore, recent technological advancements have introduced the use of 3D-printed orthoses. Lin et al. reported significant improvements in initial flexibility and quality of life with these orthoses [41].
Control groups in the studies varied but commonly included standard treatments or observational groups to measure the effectiveness of the interventions. Many control groups were provided with standard braces, such as the traditional Boston brace, against which newer or more specialized interventions were compared [28]. In some studies, the control groups engaged in conventional exercise programs in contrast with more specialized therapeutic exercises [31]. Several studies also included control groups that received no active treatment to measure the natural progression of scoliosis without intervention [6].
Overall, the Schroth exercise program was the most frequently used intervention due to its proven efficacy in improving both physical deformity and quality of life in AIS patients. For the control groups, standard bracing and conventional exercise programs were most commonly preferred to provide a baseline for comparing the effectiveness of newer or more intensive treatment methods.
4. Discussion
This systematic review aimed to identify and present the most commonly used clinical assessment methods, apart from Cobb angle measurements, in randomized controlled trials (RCTs) evaluating the results of conservative treatments in patients with adolescent idiopathic scoliosis. According to the results of our study, ATR assessment was the most used non-invasive and objective deformity assessment method. Surface topography was the most widely used technological system to assess posture and deformity. The POTSI, in which asymmetry is evaluated with certain calculations on the photograph, was the other most commonly used asymmetry assessment. The WRVAS was the most preferred visual asymmetry assessment scale. The SRS-22 instrument was the most commonly used quality-of-life assessment questionnaire.
4.1. Cobb Angle and Clinical Significance
The Cobb angle remains the gold standard for assessing the severity of scoliosis. However, its clinical significance extends beyond simply quantifying spinal curvature. While the Cobb angle is crucial for diagnosing scoliosis and determining treatment strategies, its impact on long-term functional outcomes, quality of life, and self-image is less clear. Several studies indicate that untreated AIS patients with significant spinal deformities can maintain high levels of functionality and productivity [6]. This finding suggests that improvements in the Cobb angle do not necessarily correlate with better patient-centered outcomes, such as quality of life and physical functioning [8].
The frequent use of X-rays for Cobb angle assessment raises concerns about radiation exposure, particularly in young patients. Studies have shown that repeated radiographic examinations can increase the risk of radiation-induced conditions, including cancer [12]. Non-invasive assessment methods and computer-assisted measurement tools are being created and should be used more frequently to reduce these risks.
As the authors of the study, we would like to emphasize the importance of the Cobb angle and radiological evaluation in the differential diagnosis of idiopathic scoliosis. A postural asymmetry or an ATR value above the cut-point in an evaluation with a scoliometer cannot confirm the diagnosis of scoliosis. The patient may have a congenital deformity or a hemidystrophic thorax [1,46]. However, it is clear that alternative methods are needed for follow-up and evaluation after diagnosis.
4.2. Outcome Measurement Methods
Nowadays, measurement methods that provide a more holistic view of patient outcomes are preferred in scoliosis management. Many patients and their families care more about the cosmetic appearance than the angle measured on the X-ray. One of the main objectives of scoliosis treatment has been identified as improving one’s aesthetic appearance, and quality of life is also significantly impacted by one’s perception of one’s body [47,48].
ATR measurement has been shown to be highly correlated with the Cobb angle. It is a simple, cost-effective, safe, valid, and reliable method for clinical use. A change in the ATR is associated with a change in the Cobb angle and the asymmetries that the patient recognizes in the body [49,50,51,52]. Therefore, it can be suggested that ATR measurements made with a scoliometer can be used in patient evaluation and follow-up.
When the randomized controlled studies were examined, it was determined that parameters such as the trunk rotation angle (ATR), the posterior trunk asymmetry index (POTSI), and surface topography assessment gained importance. For example, the ATR, in addition to the two-dimensional Cobb angle measurement, provides an assessment of the change of spinal deformity in the horizontal plane.
Surface topography techniques were identified as a preferred assessment method in the studies. This method has been reported to be valid and reliable, especially in evaluating sagittal and frontal plane asymmetries [53]. Surface tomography and ATR measurements may have great potential in the evaluation of scoliosis, especially in reducing radiation exposure and in cosmetic evaluations. Research indicates that integrating these measures could yield a more precise and all-encompassing evaluation of scoliosis for patient assessment and treatment effectiveness.
4.3. Cosmetic Appearance and Quality of Life
The psychosocial impact of scoliosis, particularly concerning cosmetic appearance and quality of life, is significant. The evaluation of cosmetic appearance and quality of life is suggested as a parameter that should be included in the management of scoliosis [10]. Trunk deformity is an important symptom of idiopathic scoliosis and has also been reported to present a major problem for patients [10]. In the literature, various scales have been developed to evaluate patients’ and families’ perceptions of deformity and physical appearance. In the studies included in this systematic review, it was determined that the Walter Reed Visual Assessment Scale (WRVAS) scale, which evaluates deformity with seven different photographs, was used the most. In addition, it was determined that the TAPS, which includes deformity assessment with photographs, and SAQ scales, which include both photographs and questions, were also preferred in the studies. These tools are crucial as they address the subjective aspects of scoliosis, often overlooked in clinical practice.
Quality of life assessment is also an important parameter in the treatment and follow-up of scoliosis because the treatment of scoliosis can be quite long-term, especially in individuals diagnosed at a young age [10]. The most preferred quality of life assessment in the studies was the SRS-22 questionnaire, which includes 22 questions and five subgroup assessments.
4.4. Treatment Interventions and Outcomes
Nearly all studies included in this review focused on conservative treatment methods, excluding surgical interventions. The interventions evaluated include Schroth exercises, 3D-printed orthoses, balance training, and hippotherapy. Schroth exercises demonstrated significant positive outcomes across multiple studies. These exercises have been shown to significantly improve the Cobb angle, the ATR, and quality of life [27,29,44]. Other interventions, such as balance training combined with Schroth therapy, also showed promising results in improving spinal deformities and patient functionality [43].
Specifically, Abdel-Aziem et al. [39] found that a combination of hippotherapy and Schroth exercises improved balance and postural asymmetries. Wong et al. [24] demonstrated that the CAD/CAM method for spinal orthosis was more effective than the manual method in managing AIS. Lin et al. [41] reported significant improvements in initial flexibility and quality of life with the use of 3D-printed orthoses, as measured by SRS-22r and TAPS.
4.5. Methodological Quality and Future Research Directions
The methodological quality of the studies included in this review, as assessed by the PEDro scale, ranged from low to moderate. Common methodological weaknesses included a lack of blinding and allocation concealment. However, it is important to note that all the studies included in this systematic review were randomized controlled trials, which are positioned at the top of the evidence hierarchy. Since our focus was not on treatment effectiveness but rather on analyzing the assessment measures used, the low-quality scores of some articles were considered less critical for the purposes of this review. Future research should focus on high-quality RCTs that incorporate both objective and subjective outcome measures, providing a more comprehensive understanding of the impacts of scoliosis treatment [23].
4.6. Limitations
This systematic review has several limitations. The heterogeneity in the measurement methods and outcome assessment criteria used in the studies may reduce data homogeneity. Additionally, the focus on English-language publications may introduce language bias and result in the omission of relevant studies published in other languages.
5. Conclusions
Our findings underscore the diversity and effectiveness of various measurement methods and interventions employed in scoliosis management, highlighting the need for a multifaceted approach to patient assessment and treatment. The most widely used non-invasive objective deformity assessment technique, according to the findings of our study, was ATR evaluation. In order to evaluate posture and deformity, surface topography was the most commonly utilized technical system. The POTSI was the other most widely used asymmetry assessment method. In this method, asymmetry is assessed using specific calculations on a picture. The visual asymmetry assessment scale that was most favored was the WRVAS. Questionnaires for quality-of-life assessments were most frequently administered using the SRS-22 scale.
Conceptualization, T.K.Ç. and B.A.; methodology, T.K.Ç., B.A., B.B.D., E.Z.S., E.Ç. and S.L.M., formal analysis, B.B.D., E.Z.S. and E.Ç., investigation, T.K.Ç., B.A., B.B.D., E.Z.S., E.Ç. and S.L.M.; data curation, B.B.D., E.Z.S. and E.Ç.; writing—original draft preparation, T.K.Ç., B.A., B.B.D., E.Z.S., E.Ç. and S.L.M.; writing—review and editing, T.K.Ç., B.A., B.B.D., E.Z.S., E.Ç. and S.L.M.; supervision, T.K.Ç. All authors have read and agreed to the published version of the manuscript.
Not applicable.
Not applicable.
The data presented in this study are available on request from the corresponding author.
The authors declare no conflicts of interest.
Footnotes
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.
The inclusion and exclusion criteria of the study.
| Inclusion | Exclusion | |
|---|---|---|
| Population | Female/Male | Having any other concomitant disease |
| Intervention | Physiotherapy | Surgical operation |
| Comparator | Any comparator | Surgery |
| Outcome | Any measurement method that | Not include a spine-related measurement |
| Study | RCT | Non-randomized study |
| Language | English | Non-English |
| Year | 2004–Present | Before 2004 |
Study characteristics (studies are listed by year).
| Study | Country | Gender | Age | Risser Sign | Cobb Angle Assessment | Outcome Measurements | Control Group | Intervention Group |
|---|---|---|---|---|---|---|---|---|
| Wong et al., 2005 [ | China | 40 (0/40) | 10–14 | Risser Sign < 2 | Yes | AVR | Brace produced by manual method | Brace produced by the CAD/CAM method |
| Labelle et al., 2007 [ | Canada | 48 (2/46) | 10–16 | Risser Sign ≤ 3 | Yes | Thoracic kyphosis Lumbar lordosis | Boston brace | Boston brace designed and adjusted using a computer-aided 3-dimensional tool |
| Hasler et al., 2010 [ | Switzerland | 20 (0/20) | 15.2–18.5 | - | Yes | ATR | Observation | Osteopathy |
| Weinstein et al., 2013 [ | USA | 242 (21/221) | 10–15 | Risser Sign 0–2 | Yes | Coronal balance | Observation | TLSO Brace |
| Monticone et al., 2014 [ | Italy | 110 (30/80) | >10 | Risser Sign < 2 | Yes | ATR | General exercises aimed at spinal mobilization | Active self-correction, task-oriented exercises |
| Cobetto et al., 2016 [ | Canada | 40 (5/35) | 10–16 | Risser Sign 0–2 | Yes | Thoracic kyphosis Lumbar lordosis | Conventional TLSO Brace | New TLSO brace (NewBrace) |
| Kuru et al., 2016 [ | Turkey | 45 (6/39) | 10–18 | Risser Sign 0–3 | Yes | ATR | No treatment | I1: Schroth exercises under |
| Gur et al., 2017 [ | Turkey | 25 (1/24) | 10–16 | Risser Sign 0–5 | Yes | ATR | Traditional rehabilitation | Core stabilization in addition to traditional rehabilitation |
| Yagci et al., 2018 [ | Turkey | 20 (0/20) | 10–16 | Risser Sign 1–3 | Yes | ATR | Conventional exercise | Basic body awareness therapy |
| Sarkisova et al., 2019 [ | USA | 64 (11/53) | 10–17 | - | Yes | ATR | Front plank | Side plank |
| Yagci et al., 2019 [ | Turkey | 30 (0/30) | >12 | Risser Sign 2–3 | Yes | ATR | Core stabilization exercises and brace | Scientific exercises approach to scoliosis and brace |
| Lin et al., 2020 [ | Hong-Kong | 23 (0/23) | 10–14 | Risser Sign 0 to 2 | Yes | SRS-22r | Conventional orthosis | Automated pressure-adjustable orthosis |
| Trzcińska et al., 2020 [ | Poland | 60 (0/60) | 11–15 | Risser Sign < 5 | Yes | Posture analysis using Zebris CMS10 system | FITS method according to Białek and M’hango. | FED method |
| Dufvenberg et al., 2021 [ | Sweden | 135 (24 /111) | 9–17 | NA | Yes | ATR | Physical activity | I1: Boston night brace |
| Kocaman et al., 2021 [ | Turkey | 28 (7/21) | 10–18 | Risser Sign ≤ 3 | Yes | ATR | Core stabilization exercises | Schroth exercises |
| Mohamed et al., 2021 [ | Egypt | 32 (0/32) | 14–16 | Risser Sign 2–5 | Yes | ATR | PNF exercises | Schroth exercises |
| Abdel-Aziem et al., 2022 [ | Saudi Arabia | 52 (15/37) | 10–18 | NA | Yes | Surface topographyDynamic postural stability | Schroth exercises | Hippotherapy in combination with Schroth exercises |
| Akyurek et al., 2022 [ | Turkey | 29 (0/29) | 10–17 | Risser Sign ≤ 3 | Yes | ATR | Waiting list | Schroth exercises |
| Lin et al., 2022 [ | China | 30 (0/30) | 10–14 | Risser Sign 0–2 | Yes | SRS-22r | Conventional orthosis | 3D-printed orthosis |
| Wang et al., 2022 [ | China | 31 (6/25) | 10–18 | Risser Sign ≤ 3 | Yes | ATR | Exercise and brace | Insoles in addition to exercise and brace |
| Shen et al., 2023 [ | China | 59 (21/38) | 10–18 | Risser Sign < 5 | Yes | ATR | Schroth exercises | Schroth and balance exercises |
| Zapata et al., 2023 [ | USA | 57 (16/41) | 10–16 | Risser Sign 0 | Yes | Adherence to treatment | Observation | Schroth-based Barcelona Scoliosis Physical Therapy School exercises |
| Manzak Dursun et al., 2024 [ | Turkey | 32 (1/31) | 10–18 | Risser Sign 0–5 | Yes | ATR | Pilates-based home exercises | Supervised pilates-based exercises with hybrid telerehabilitation |
AVR: apical vertebral rotation, ATR: angle of trunk rotation, Posterior Trunk Symmetry Index (POTSI), cosmetic trunk deformity with the Trunk Appearance Perception Scale (TAPS), and quality of life with the Scoliosis Research Society-22 questionnaire (SRS-22), SAQ: Scoliosis Appearance Questionnaire, IPAQ-SF: International Physical Activity Questionnaire short form, 6 MWT: 6 Minutes Walking Test, WRVAS: The Walter Reed Visual Assessment Scale, PedsQL: Pediatric Quality of Life Inventory, BrQ: The Brace Questionnaire, SRS-23: Scoliosis Research Society-23, EQ-5D-Y: EuroQol 5-Dimensions Youth, CAD/CAM: Computer-Aided Design/ Computer-Aided Manufacturing, TLSO: Thoracolumbosacral Orthosis, PNF: Proprioceptive Neuromuscular Facilitation, I1: Intervention Group 1, I2: Intervention Group 2.
Methodological quality (PEDro scale score).
| 1 * | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | Total | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Wong et al., 2005 [ | Yes | No | No | No | No | No | No | No | Yes | Yes | Yes | 3/10 |
| Labelle et al., 2007 [ | Yes | Yes | Yes | Yes | No | No | No | No | No | Yes | No | 4/10 |
| Hasler et al., 2010 [ | Yes | Yes | Yes | Yes | No | No | Yes | No | No | Yes | Yes | 6/10 |
| Weinstein et al., 2013 [ | No | Yes | No | Yes | No | No | No | No | Yes | Yes | No | 4/10 |
| Monticone et al., 2014 [ | Yes | Yes | Yes | Yes | No | No | Yes | Yes | No | Yes | Yes | 7/10 |
| Cobetto et al., 2016 [ | Yes | Yes | Yes | No | No | Yes | Yes | Yes | No | Yes | Yes | 7/10 |
| Kuru et al., 2016 [ | Yes | Yes | Yes | Yes | No | No | No | Yes | No | Yes | Yes | 6/10 |
| Gur et al., 2017 [ | Yes | Yes | No | Yes | Yes | No | No | Yes | Yes | Yes | Yes | 7/10 |
| Yagci et al., 2018 [ | No | Yes | No | Yes | No | No | Yes | Yes | Yes | Yes | Yes | 7/10 |
| Sarkisova et al., 2019 [ | Yes | Yes | No | Yes | No | No | No | No | No | Yes | No | 3/10 |
| Yagci et al., 2019 [ | Yes | Yes | No | Yes | No | No | Yes | Yes | Yes | Yes | Yes | 7/10 |
| Lin et al., 2020 [ | Yes | No | Yes | No | No | No | No | Yes | No | Yes | Yes | 4/10 |
| Trzcińska et al., 2020 [ | No | Yes | No | Yes | No | No | No | Yes | No | Yes | Yes | 5/10 |
| Dufvenberg et al., 2021 [ | No | Yes | No | Yes | No | No | Yes | Yes | Yes | Yes | Yes | 7/10 |
| Kocaman et al., 2021 [ | Yes | Yes | Yes | Yes | No | No | Yes | Yes | Yes | Yes | Yes | 8/10 |
| Mohamed et al., 2021 [ | No | Yes | Yes | Yes | No | No | Yes | Yes | Yes | Yes | Yes | 8/10 |
| Abdel-Aziem et al., 2022 [ | No | Yes | Yes | Yes | No | No | Yes | Yes | No | Yes | Yes | 7/10 |
| Akyurek et al., 2022 [ | Yes | Yes | No | Yes | No | No | No | Yes | No | Yes | Yes | 5/10 |
| Lin et al., 2022 [ | Yes | Yes | No | Yes | No | No | No | Yes | No | Yes | Yes | 5/10 |
| Wang et al., 2022 [ | Yes | Yes | Yes | Yes | No | No | Yes | Yes | Yes | Yes | Yes | 8/10 |
| Shen et al., 2023 [ | Yes | Yes | No | Yes | No | No | No | Yes | Yes | Yes | Yes | 6/10 |
| Zapata et al., 2023 [ | No | Yes | No | Yes | No | No | Yes | No | No | Yes | Yes | 5/10 |
| Manzak Dursun et al., 2024 [ | Yes | Yes | No | Yes | No | No | Yes | Yes | No | Yes | Yes | 6/10 |
* Note: the ligibility criteria item does not contribute to the total score.
Physiotherapy Evidence Database (PEDro) scale.
| 1 * | Eligibility criteria were specified. |
| 2 | Subjects were randomly allocated to groups. |
| 3 | Allocation was concealed. |
| 4 | The groups were similar at baseline regarding the most important prognostic indicators. |
| 5 | There was blinding of all subjects. |
| 6 | There was blinding of all therapists who administered the therapy. |
| 7 | There was blinding of all assessors who measured at least one key outcome. |
| 8 | Measures of at least one key outcome were obtained from more than 85% of the subjects initially allocated to groups. |
| 9 | All subjects for whom outcome measures were available received the treatment or control condition as allocated, or where |
| 10 | The results of between-group statistical comparisons are reported for at least one key outcome. |
| 11 | The study provides both point measures and measures of variability for at least one key outcome. |
* Note: the ligibility criteria item does not contribute to the total score.
References
1. Chik, S.K.T. Classification and terminology. Schroth’s Textbook of Scoliosis and Other Spinal Deformities; Cambridge Scholars Publishing: Newcastle upon Tyne, UK, 2020; pp. 150-158.
2. Sarwark, J.F.; Castelein, R.M.; Maqsood, A.; Aubin, C.E. The biomechanics of induction in adolescent idiopathic scoliosis: Theoretical factors. J. Bone Jt. Surg. Am.; 2019; 101, e22. [DOI: https://dx.doi.org/10.2106/JBJS.18.00846]
3. Cobb, J.R. Outline for the study of scoliosis. Instr. Course Lect.; 1948; pp. 261-275.
4. Langensiepen, S.; Semler, O.; Sobottke, R.; Fricke, O.; Franklin, J.; Schönau, E.; Eysel, P. Measuring procedures to determine the Cobb angle in idiopathic scoliosis: A systematic review. Eur. Spine J.; 2013; 22, pp. 2360-2371. [DOI: https://dx.doi.org/10.1007/s00586-013-2693-9] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/23443679]
5. Bridwell, K.H.; Anderson, P.A.; Boden, S.D.; Vaccaro, A.R.; Wang, J.C. What’s new in spine surgery. J. Bone Jt. Surg. Am.; 2008; 90, pp. 1609-1619. [DOI: https://dx.doi.org/10.2106/JBJS.H.00418]
6. Weinstein, S.L.; Dolan, L.A.; Wright, J.G.; Dobbs, M.B. Effects of bracing in adolescents with idiopathic scoliosis. N. Eng. J. Med.; 2013; 369, pp. 1512-1521. [DOI: https://dx.doi.org/10.1056/NEJMoa1307337] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24047455]
7. Asher, M.A.; Burton, D.C. Adolescent idiopathic scoliosis: Natural history and long term treatment effects. Scoliosis; 2006; 1, 2. [DOI: https://dx.doi.org/10.1186/1748-7161-1-2] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/16759428]
8. Parent, E.C.; Wong, D.; Hill, D.; Mahood, J.; Moreau, M.; Raso, V.J.; Lou, E. The association between Scoliosis Research Society-22 scores and scoliosis severity changes at a clinically relevant threshold. Spine; 2010; 35, pp. 315-322. [DOI: https://dx.doi.org/10.1097/BRS.0b013e3181cabe75]
9. Richards, B.S.; Bernstein, R.M.; D’Amato, C.R.; Thompson, G.H. Standardization of criteria for adolescent idiopathic scoliosis brace studies: SRS Committee on Bracing and Nonoperative Management. Spine; 2005; 30, pp. 2068-2075. [DOI: https://dx.doi.org/10.1097/01.brs.0000178819.90239.d0]
10. Negrini, S.; Donzelli, S.; Aulisa, A.G.; Czaprowski, D.; Schreiber, S.; De Mauroy, J.C.; Diers, H.; Grivas, T.B.; Knott, P.; Kotwicki, T. et al. 2016 SOSORT guidelines: Orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis Spinal Disord.; 2018; 13, pp. 1-48. [DOI: https://dx.doi.org/10.1186/s13013-017-0145-8]
11. Wu, W.; Liang, J.; Du, Y.; Tan, X.; Xiang, X.; Wang, W.; Ru, N.; Le, J. Reliability and reproducibility analysis of the Cobb angle and assessing sagittal plane by computer-assisted and manual measurement tools. BMC Musculoskelet. Disord.; 2014; 15, pp. 1-8. [DOI: https://dx.doi.org/10.1186/1471-2474-15-33] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24502397]
12. Oakley, P.A.; Ehsani, N.N.; Harrison, D.E. The scoliosis quandary: Are radiation exposures from repeated X-rays harmful?. Dose-Response; 2019; 17, 1559325819852810. [DOI: https://dx.doi.org/10.1177/1559325819852810] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/31217755]
13. Nash, C.L., Jr.; Gregg, E.C.; Brown, R.H.; Pillai, K. Risks of exposure to X-rays in patients undergoing long-term treatment for scoliosis. J. Bone Jt. Surg. Am.; 1979; 61, pp. 371-374. [DOI: https://dx.doi.org/10.2106/00004623-197961030-00009] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/429405]
14. Levy, A.R.; Goldberg, M.S.; Mayo, N.E.; Hanley, J.A.; Poitras, B. Reducing the lifetime risk of cancer from spinal radiographs among people with adolescent idiopathic scoliosis. Spine; 1996; 21, pp. 1540-1547. [DOI: https://dx.doi.org/10.1097/00007632-199607010-00011] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/8817782]
15. Weinstein, S.L.; Dolan, L.A.; Spratt, K.F.; Peterson, K.K.; Spoonamore, M.J.; Ponseti, I.V. Health and function of patients with untreated idiopathic scoliosis: A 50-year natural history study. JAMA; 2003; 289, pp. 559-567. [DOI: https://dx.doi.org/10.1001/jama.289.5.559] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/12578488]
16. Weiss, H.R.; Karavidas, N.; Moramarco, M.; Moramarco, K. Long-Term Effects of Untreated Adolescent Idiopathic Scoliosis: A Review of the Literature. Asian Spine J.; 2016; 10, pp. 1163-1169. [DOI: https://dx.doi.org/10.4184/asj.2016.10.6.1163] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/27994795]
17. Kaspiris, A.; Grivas, T.B.; Weiss, H.R.; Turnbull, D. Surgical and conservative treatment of patients with congenital scoliosis: α search for long-term results. Scoliosis; 2011; 6, 12. [DOI: https://dx.doi.org/10.1186/1748-7161-6-12] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21639924]
18. Moramarco, M.; Borysov, M.; Ng, S.Y.; Weiss, H.R. Schroth’s Textbook of Scoliosis and Other Spinal Deformities; Cambridge School Publishing: Newcastle upon Tyne, UK, 2020.
19. Kotwicki, T.; Negrini, S.; Grivas, T.B.; Rigo, M.; Maruyama, T.; Durmala, J.; Zaina, F. Members of the international Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT). Methodology of evaluation of morphology of the spine and the trunk in idiopathic scoliosis and other spinal deformities—6th SOSORT consensus paper. Scoliosis; 2009; 4, 2. [DOI: https://dx.doi.org/10.1186/1748-7161-4-S2-O2]
20. Dereli, E.E.; Gong, S.; Çolak, T.K.; Turnbull, D. Guidelines for the conservative treatment of spinal deformities—Questionnaire for a Delphi consensus. S. Afr. J. Physiother.; 2021; 77, 1587. [DOI: https://dx.doi.org/10.4102/sajp.v77i2.1587]
21. Bunnell, W.P. An objective criterion for scoliosis screening. J. Bone Jt. Surg.; 1984; 66, pp. 1381-1387. [DOI: https://dx.doi.org/10.2106/00004623-198466090-00010] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/6501335]
22. Amir-Behghadami, M.; Janati, A. Population, Intervention, Comparison, Outcomes and Study (PICOS) design as a framework to formulate eligibility criteria in systematic reviews. Emerg. Med. J.; 2020; 37, 387. [DOI: https://dx.doi.org/10.1136/emermed-2020-209567]
23. Maher, C.G.; Sherrington, C.; Herbert, R.D.; Moseley, A.M.; Elkins, M. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys. Ther.; 2003; 83, pp. 713-721. [DOI: https://dx.doi.org/10.1093/ptj/83.8.713]
24. Wong, M.S.; Cheng, J.C.Y.; Lo, K.H. A comparison of treatment effectiveness between the CAD/CAM method and the manual method for managing adolescent idiopathic scoliosis. Prosthet. Orthot. Int.; 2005; 29, pp. 105-111. [DOI: https://dx.doi.org/10.1080/17461550500069547]
25. Labelle, H.; Bellefleur, C.; Joncas, J.; Aubin, C.É.; Cheriet, F. Preliminary evaluation of a computer-assisted tool for the design and adjustment of braces in idiopathic scoliosis: A prospective and randomized study. Spine; 2007; 32, pp. 835-843. [DOI: https://dx.doi.org/10.1097/01.brs.0000259811.58372.87] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/17426626]
26. Hasler, C.; Schmid, C.; Enggist, A.; Neuhaus, C.; Erb, T. No effect of osteopathic treatment on trunk morphology and spine flexibility in young women with adolescent idiopathic scoliosis. J. Child. Orthop.; 2010; 4, pp. 219-226. [DOI: https://dx.doi.org/10.1007/s11832-010-0258-6]
27. Monticone, M.; Ambrosini, E.; Cazzaniga, D.; Rocca, B.; Ferrante, S. Active self-correction and task-oriented exercises reduce spinal deformity and improve quality of life in subjects with mild adolescent idiopathic scoliosis. Results of a randomised controlled trial. Eur. Spine J.; 2014; 23, pp. 1204-1214. [DOI: https://dx.doi.org/10.1007/s00586-014-3241-y] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24682356]
28. Cobetto, N.; Aubin, C.E.; Parent, S.; Barchi, S.; Turgeon, I.; Labelle, H. Effectiveness of braces designed using computer-aided design and manufacturing (CAD/CAM) and finite element simulation compared to CAD/CAM only for the conservative treatment of adolescent idiopathic scoliosis: A prospective randomized controlled trial. Eur. Spine J.; 2016; 25, pp. 3056-3064. [DOI: https://dx.doi.org/10.1007/s00586-016-4434-3]
29. Kuru, T.; Yeldan, İ.; Dereli, E.E.; Özdinçler, A.R.; Dikici, F.; Çolak, İ. The efficacy of three-dimensional Schroth exercises in adolescent idiopathic scoliosis: A randomised controlled clinical trial. Clin. Rehabil.; 2016; 30, pp. 181-190. [DOI: https://dx.doi.org/10.1177/0269215515575745]
30. Gür, G.; Ayhan, C.; Yakut, Y. The effectiveness of core stabilization exercise in adolescent idiopathic scoliosis: A randomized controlled trial. Prosthet. Orthot. Int.; 2017; 41, pp. 303-310. [DOI: https://dx.doi.org/10.1177/0309364616664151]
31. Yagci, G.; Ayhan, C.; Yakut, Y. Effectiveness of basic body awareness therapy in adolescents with idiopathic scoliosis: A randomized controlled study. J. Back Musculoskelet. Rehabil.; 2018; 31, pp. 693-701. [DOI: https://dx.doi.org/10.3233/BMR-170868]
32. Sarkisova, N.; Andras, L.M.; Yang, J.; Zaslow, T.L.; Edison, B.R.; Tolo, V.T.; Skaggs, D.L. Side plank pose exercises for adolescent idiopathic scoliosis patients. Glob. Adv. Health Med.; 2019; 8, 2164956119887720. [DOI: https://dx.doi.org/10.1177/2164956119887720] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/31723480]
33. Yagci, G.; Yakut, Y. Core stabilization exercises versus scoliosis-specific exercises in moderate idiopathic scoliosis treatment. Prosthet. Orthot. Int.; 2019; 43, pp. 301-308. [DOI: https://dx.doi.org/10.1177/0309364618820144]
34. Lin, Y.; Lou, E.; Lam, T.P.; Cheng, J.C.-Y.; Sin, S.W.; Kwok, W.K.; Wong, M.S. The intelligent automated pressure-adjustable orthosis for patients with adolescent idiopathic scoliosis: A bi-center randomized controlled trial. Spine; 2020; 45, pp. 1395-1402. [DOI: https://dx.doi.org/10.1097/BRS.0000000000003559]
35. Trzcińska, S.; Nowak, Z. Analysis of scoliosis deformation in the Zebris computer study as an assessment of the effectiveness of the FED method in the treatment of idiopathic scolioses. Pol. Merkur Lekarski; 2020; 48, pp. 87-92.
36. Dufvenberg, M.; Diarbakerli, E.; Charalampidis, A.; Öberg, B.; Tropp, H.; Ahl, A.A.; Möller, H.; Gerdhem, P.; Abbott, A. Six-month results on treatment adherence, physical activity, spinal appearance, spinal deformity, and quality of life in an ongoing randomised trial on Conservative Treatment for Adolescent Idiopathic Scoliosis (CONTRAIS). J. Clin. Med.; 2021; 10, 4967. [DOI: https://dx.doi.org/10.3390/jcm10214967] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/34768487]
37. Kocaman, H.; Bek, N.; Kaya, M.H.; Büyükturan, B.; Yetiş, M.; Büyükturan, Ö. The effectiveness of two different exercise approaches in adolescent idiopathic scoliosis: A single-blind, randomized-controlled trial. PLoS ONE; 2021; 16, e0249492. [DOI: https://dx.doi.org/10.1371/journal.pone.0249492]
38. Mohamed, R.A.; Yousef, A.M. Impact of Schroth three-dimensional vs. proprioceptive neuromuscular facilitation techniques in adolescent idiopathic scoliosis: A randomized controlled study. Eur. Rev. Med. Pharmacol. Sci.; 2021; 25, pp. 7717-7725. [DOI: https://dx.doi.org/10.26355/eurrev_202112_27618]
39. Abdel-Aziem, A.A.; Abdelraouf, O.R.; Ghally, S.A.; Dahlawi, H.A.; Radwan, R.E. A 10-week program of combined Hippotherapy and Scroth’s exercises improves balance and postural asymmetries in adolescence idiopathic scoliosis: A randomized controlled study. Children; 2021; 9, 23. [DOI: https://dx.doi.org/10.3390/children9010023] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/35053648]
40. Akyurek, E.; Alpozgen, A.Z.; Akgul, T. The preliminary results of physiotherapy scoliosis-specific exercises on spine joint position sense in adolescent idiopathic scoliosis: A randomized controlled trial. Prosthet. Orthot. Int.; 2022; 46, pp. 510-517. [DOI: https://dx.doi.org/10.1097/PXR.0000000000000136] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/36215059]
41. Lin, Y.; Cheung, J.P.Y.; Chan, C.K.; Wong, S.W.F.; Cheung, K.M.C.; Wong, M.; Wong, W.C.B.; Cheung, P.W.H.; Wong, M.S. A randomized controlled trial to evaluate the clinical effectiveness of 3D-printed orthosis in the management of adolescent idiopathic scoliosis. Spine; 2022; 47, pp. 13-20. [DOI: https://dx.doi.org/10.1097/BRS.0000000000004202] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/34392277]
42. Wang, B.; Sun, Y.; Guo, X.; Cao, J.; Lu, H.; Chen, W.; Chen, J.; Zhu, Q.; Zhang, C.; Zhang, M. et al. The efficacy of 3D personalized insoles in moderate adolescent idiopathic scoliosis: A randomized controlled trial. BMC Musculoskelet. Disord.; 2022; 23, 983. [DOI: https://dx.doi.org/10.1186/s12891-022-05952-z] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/36376952]
43. Shen, X.; Yang, Z.; Zhang, P.; Xu, Y.; Wang, J. Effects of balance training combined with Schroth therapy on adolescents with mild idiopathic scoliosis: A six-week randomized controlled trial. J. Back. Musculoskelet. Rehabil.; 2023; 36, pp. 1365-1373. [DOI: https://dx.doi.org/10.3233/BMR-220383]
44. Zapata, K.A.; Dieckmann, R.J.; Hresko, M.T.; Sponseller, P.D.; Vitale, M.G.; Glassman, S.D.; Smith, B.G.; Jo, C.-H.; Sucato, D.J. A United States multi-site randomized control trial of Schroth-based therapy in adolescents with mild idiopathic scoliosis. Spine Deform.; 2023; 11, pp. 861-869. [DOI: https://dx.doi.org/10.1007/s43390-023-00665-2] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/36807105]
45. Dursun, A.S.M.; Ozyilmaz, S.; Ucgun, H.; Elmadag, N.M. The effect of Pilates-based exercise applied with hybrid telerehabilitation method in children with adolescent idiopathic scoliosis: A randomized clinical trial. Eur. J. Pediatr.; 2024; 183, pp. 759-767. [DOI: https://dx.doi.org/10.1007/s00431-023-05340-2] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/37993666]
46. Weiss, H.R.; Seibel, S. Hemidystrophic thorax mimicking scoliosis. Open. Orthop. J.; 2018; 12, pp. 252-260. [DOI: https://dx.doi.org/10.2174/1874325001812010252] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/30123374]
47. Sanders, J.O.; Polly, D.W., Jr.; Cats-Baril, W.; Jones, J.; Lenke, L.G.; O’Brien, M.F.; Richards, B.S.; Sucato, D.J. Analysis of patient and parent assessment of deformity in idiopathic scoliosis using the Walter Reed Visual Assessment Scale. Spine; 2003; 28, pp. 2158-2163. [DOI: https://dx.doi.org/10.1097/01.BRS.0000084629.97042.0B] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/14501929]
48. Negrini, S.; Grivas, T.B.; Kotwicki, T.; Maruyama, T.; Rigo, M.; Weiss, H.R. the members of the Scientific society On Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT). Why do we treat adolescent idiopathic scoliosis? What we want to obtain and to avoid for our patients. SOSORT 2005 Consensus paper. Scoliosis; 2006; 1, 4. [DOI: https://dx.doi.org/10.1186/1748-7161-1-4]
49. Coelho, D.M.; Bonagamba, G.H.; Oliveira, A.S. Scoliometer measurements of patients with idiopathic scoliosis. Braz. J. Phys. Ther.; 2013; 17, pp. 179-184. [DOI: https://dx.doi.org/10.1590/S1413-35552012005000081]
50. Jankowski, P.P.; Yaszay, B.; Cidambi, K.R.; Bartley, C.E.; Bastrom, T.P.; Newton, P.O. The relationship between apical vertebral rotation and truncal rotation in adolescent idiopathic scoliosis using 3D reconstructions. Spine Deform.; 2018; 6, pp. 213-219. [DOI: https://dx.doi.org/10.1016/j.jspd.2017.10.003] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/29735128]
51. Larson, J.E.; Meyer, M.A.; Boody, B.; Sarwark, J.F. Evaluation of angle trunk rotation measurements to improve quality and safety in the management of adolescent idiopathic scoliosis. J. Orthop.; 2018; 15, pp. 563-565. [DOI: https://dx.doi.org/10.1016/j.jor.2018.05.032]
52. Lendzion, M.; Łukaszewicz, E.; Waś, J.; Czaprowski, D. Self-evaluation of trunk aesthetics in conservatively treated children and adolescents with idiopathic scoliosis. Ortop. Traumatol. Rehabil.; 2018; 20, pp. 371-382. [DOI: https://dx.doi.org/10.5604/01.3001.0012.8273]
53. Su, X.; Dong, R.; Wen, Z.; Liu, Y. Reliability and validity of scoliosis measurements obtained with surface topography techniques: A systematic review. J. Clin. Med.; 2022; 11, 6998. [DOI: https://dx.doi.org/10.3390/jcm11236998] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/36498575]
© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.
Details
; Durmuş, Betül Beyza 1 ; Ece, Zeynep Saatçı 1 ; Çağlar, Engin 2 ; Akçay, Burçin 3
; Santiago Lasa Maeso 4 1 Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Marmara University, 34854 Istanbul, Turkey;
2 Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Fenerbahce University, 34854 Istanbul, Turkey;
3 Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bandırma Onyedi Eylül University, 10200 Balıkesir, Turkey;
4 Clinica De La Escoliosis, Montevideo 11600, Uruguay;