Supervised physiotherapeutic scoliosis-specific exercises provide limited additional benefit at 24 months in braced adolescents with idiopathic scoliosis: a randomized trial
In brief
Supervised scoliosis exercises reduced curve angle by 3.2 degrees, below the meaningful threshold
In braced adolescents with idiopathic scoliosis, supervised exercises reduced the spinal curve slightly more than self-directed exercise after 24 months, but the 3.2-degree difference fell short of the study's 5-degree threshold for clinical importance. The groups had similar rates of meaningful curve improvement and no meaningful quality-of-life difference, leaving the practical value of added supervision uncertain.
- Journal
- The bone & joint journal (Q1)
- Published
- 1 November 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Xiaohui Zhang, Meihua Liang, Yingzi Huang, Boyan Lin, Yan Lin, Yongrong Yang, et al.
- PMID
- 42966369
- DOI
- 10.1302/0301-620X.108B11.BJJ-2026-0416.R2
Why clinicians should know about it
- Picked for Spine Surgery (top studies of the week, 1 November 2026): Supervised PSSE vs self‑exercise in AIS
Abstract
AIMS: Physiotherapeutic scoliosis-specific exercises (PSSE) are used as an adjunct to bracing in adolescent idiopathic scoliosis (AIS), although evidence for their long-term benefit remains limited. This randomized trial assessed whether supervised PSSE provide clinically important radiological and patient-reported benefits compared with self-directed exercise in patients with AIS undergoing brace treatment. METHODS: Patients with AIS (major Cobb angle 25° to 45°; Risser grade 0 to 2) were recruited from a tertiary scoliosis centre between December 2018 and December 2022. Patients were randomized to supervised Schroth-based PSSE, consisting of physiotherapist-led sessions plus daily home exercises, or to self-directed general exercise. The co-primary outcomes were change in major Cobb angle and change in health-related quality of life measured using the Chinese Brace Questionnaire-34. A 5° between-group difference in Cobb angle was prespecified as the minimal clinically important difference (MCID). To provide a clinically anchored interpretation, 24-month radiological outcomes were classified as improved (> 5° decrease), stable (-5° to +5°), or worsened (> 5° increase), and compared using adjusted ordinal logistic regression in intention-to-treat (ITT) and per-protocol (PP) analyses. RESULTS: Supervised PSSE resulted in a greater reduction in major Cobb angle than self-directed exercise at 24 months (adjusted between-group difference -3.23° (95% CI -3.51 to -2.96); p < 0.001); however, this did not reach the prespecified MCID. There was no clinically meaningful difference in quality of life. Using the 5° threshold, radiological status was similar between groups. In the intention-to-treat analysis, the adjusted odds ratio (OR) for improved/stable/worsened status was 1.08 (95% CI 0.58 to 2.03; p = 0.805); per-protocol findings were similar (OR 1.48 (95% CI 0.75 to 2.92); p = 0.263). CONCLUSION: Supervised PSSE provided a statistically significant but clinically modest radiological benefit over self-directed exercise. This did not translate into a higher likelihood of clinically meaningful radiological improvement. No sustained clinically meaningful quality-of-life benefit was shown.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.