Effect of Schroth therapy on adolescent idiopathic scoliosis: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

ZHANG Masen ^1,2 , HU Qiaoqiao ^1,3 , CUI Jing ⁴ ,  SUN Yuliang ⁵

1. Department of Physical Education, Northwestern Polytechnical University, Xi’an 710072, P. R. China;
2. School of Life Sciences, Northwestern Polytechnical University, Xi’an 710072, P. R. China;
3. School of Public Policy and Administration, Northwestern Polytechnical University, Xi’an 710072, P. R. China;
4. School of Nursing and Rehabilitation, Xi’an Fanyi University, Xi’an 710105, P. R. China;
5. School of Physical Education, Shaanxi Normal University, Xi’an 710119, P. R. China;

Corresponding author：

SUN Yuliang, Email: ysun@snnu.edu.cn

Keywords：

Adolescent idiopathic scoliosis; Physical therapy; Schroth; Meta-analysis; Systematic review

DOI：

10.7507/1672-2531.202502064

Video：

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Objective To systematically review the effect of Schroth therapy on adolescent idiopathic scoliosis. Methods The PubMed, Ebsco, Embase, Cochrane Library, Web of Science, CNKI and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) related to the objects from inception to November 2024. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.3 software. Results A total of 14 RCTs involving 589 patients were included. The results of meta-analysis showed that Schroth therapy significantly reduced patients' Cobb angle (MD=−3.21, 95%CI −3.87 to −2.55, P<0.01) and angle of trunk rotation (ATR) (MD=−2.39, 95%CI −3.07 to −1.71, P<0.01), and improved SRS-22 quality of life score (MD=0.16, 95%CI 0.01 to 0.30, P=0.04) compared with the control group. Subgroup analysis results showed that Schroth therapy had a better effect on improving the quality of life in moderate patients. Schroth therapy for 1.5-3 months, 5-7 times therapy a week, and a single 30 minute and 40-60 minutes therapy showed better improvement in patients' quality of life. Conclusion Current evidence shows that Schroth therapy can effectively improve Cobb angle, ATR, and quality of life in adolescents with idiopathic scoliosis. The improvement effect on quality of life is influenced by the intervention period, frequency, and duration of each intervention.

1.	封玉琨, 刘介生, 吕振, 等. 青少年特发性脊柱侧凸运动康复治疗的研究进展. 中国脊柱脊髓杂志, 2021, 31(11): 1039-1043.
2.	张威, 卜淑敏, 王涛, 等. 运动干预对青少年轻、中度特发性脊柱侧弯患者疗效的Meta分析. 中国循证医学杂志, 2022, 22(8): 896-900.
3.	王欢, 颉强, 陆清达, 等. 青少年特发性脊柱侧凸患者骨骼生长发育评价的研究进展. 中国脊柱脊髓杂志, 2023, 33(2): 174-178.
4.	柯竟悦, 马圣楠, 张晓慧, 等. 青少年特发性脊柱侧凸患者静态站立及步行时生物力学变化的Meta分析. 中国康复理论与实践, 2022, 28(10): 1178-1189.
5.	施冬冬, 陈前芬. 青少年特发性脊柱侧凸病因学的研究进展. 中国学校卫生, 2021, 42(2): 316-320.
6.	徐帅, 苏永佳, 王振波, 等. 中国大陆中小学生脊柱侧凸的患病特点: 关于72项研究的Meta分析. 中国脊柱脊髓杂志, 2021, 31(10): 901-910.
7.	张桂芳, 黄焕杰, 葛乐, 等. 青少年特发性脊柱侧凸患者的社会心理行为分析及应对措施探讨. 中国康复医学杂志, 2023, 38(12): 1656-1662.
8.	Negrini S, Donzelli S, Aulisa AG, et al. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis Spinal Disord, 2018, 13(3): 1-48.
9.	王阳阳, 李杨. 特定运动疗法在特发性脊柱侧凸患者中的应用及效果研究进展-以Schroth疗法为例. 中国康复医学杂志, 2019, 34(11): 1378-1382.
10.	Büyükturan Ö, Kaya MH, Alkan H, et al. Comparison of the efficacy of Schroth and Lyon exercise treatment techniques in adolescent idiopathic scoliosis: a randomized controlled, assessor and statistician blinded study. Musculoskelet Sci Pract, 2024, 72(1): 102952.
11.	Kocaman H, Bek N, Kaya MH, et al. The effectiveness of two different exercise approaches in adolescent idiopathic scoliosis: a single-blind, randomized-controlled trial. PLoS One, 2021, 16(4): e0249492.
12.	Hwangbo PN. Psychological and physical effects of Schroth and pilates exercise on female high school students with idiopathic scoliosis. J Korean Phys Ther, 2016, 28(6): 364-368.
13.	Kim G, HwangBo PN. Effects of Schroth and Pilates exercises on the Cobb angle and weight distribution of patients with scoliosis. J Phys Ther Sci, 2016, 28(3): 1012-1015.
14.	Ceballos-Laita L, Carrasco-Uribarren A, Cabanillas-Barea S, et al. The effectiveness of Schroth method in Cobb angle, quality of life and trunk rotation angle in adolescent idiopathic scoliosis: a systematic review and meta-analysis. Eur J Phys Rehabil Med, 2023, 59(2): 228-236.
15.	Dimitrijević V, Šćepanović T, Jevtić N, et al. Application of the Schroth method in the treatment of idiopathic scoliosis: a systematic review and meta-analysis. Int J Environ Res Public Health, 2022, 19(24): 16730.
16.	Chen C, Xu J, Li H. Effects of Schroth 3D exercise on adolescent idiopathic scoliosis: a systematic review and meta-analysis. Children (Basel), 2024, 11(7): 806.
17.	Park JH, Jeon HS, Park HW. Effects of the Schroth exercise on idiopathic scoliosis: a meta-analysis. Eur J Phys Rehabil Med, 2018, 54(3): 440-449.
18.	Czaprowski D, Kotwicki T, Biernat R, et al. Physical capacity of girls with mild and moderate idiopathic scoliosis: influence of the size, length and number of curvatures. Eur Spine J, 2012, 21(6): 1099-1105.
19.	曾宪涛, 刘同族, 田国祥. 应用STATA做meta分析. 北京: 军事医学科学出版社, 2014.
20.	Akyurek E, Zengin Alpozgen A, 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(5): 510-517.
21.	Kurak K, Altunhan A, Acak M, et al. The effect of electrical muscle stimulation (ems) enhanced Schroth method training on cobb angle and quality of life in patients with scoliosis. Pakistan J Med Health Sci, 2022, 16(1): 566-570.
22.	Kuru T, Yeldan İ, Dereli EE, et al. The efficacy of three-dimensional Schroth exercises in adolescent idiopathic scoliosis: a randomised controlled clinical trial. Clin Rehabil, 2016, 30(2): 181-190.
23.	Mohamed RA, Yousef AM. 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(24): 7717-7725.
24.	Schreiber S, Parent EC, Khodayari Moez E, et al. 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. PLoS One, 2016, 11(12): e0168746.
25.	Zapata KA, Dieckmann RJ, Hresko MT, et al. A United States multi-site randomized control trial of Schroth-based therapy in adolescents with mild idiopathic scoliosis. Spine Deform, 2023, 11(4): 861-869.
26.	许锐. “三步七法”推拿在青少年特发性脊柱侧弯中的应用效果. 中国当代医药, 2022, 29(10): 135-139.
27.	叶勇智. 轻度特发性脊柱侧凸患者应用: 柱侧凸特定运动疗法的可行性. 中外医学研究, 2018, 16(28): 19-21.
28.	Schreiber S, Parent EC, Moez EK, et al. The effect of Schroth exercises added to the standard of care on the quality of life and muscle endurance in adolescents with idiopathic scoliosis-an assessor and statistician blinded randomized controlled trial: "SOSORT 2015 Award Winner". Scoliosis, 2015, 10(1): 1-12.
29.	Tombak K, Yüksel İ, Ozsoy U, et al. A comparison of the effects of supervised versus home schroth exercise programs with adolescent idiopathic scoliosis. Children (Basel), 2024, 11(3): 354.
30.	Cheung JPY, Cheung PWH, Yeng WC, et al. Does curve regression occur during underarm bracing in patients with adolescent idiopathic scoliosis. Clin Orthop Relat Res, 2020, 478(2): 334-345.
31.	杨丽虹, 刘少南, 吴大嵘, 等. 最小临床意义差值的概念及其估算方法. 中国循证医学杂志, 2020, 20(11): 1345-1352.
32.	常赢, 扈盛, 赵祥虎, 等. 脊柱侧凸特定运动疗法治疗青少年特发性脊柱侧凸效果的Meta分析. 中国脊柱脊髓杂志, 2024, 34(6): 602-609.
33.	Berdishevsky H, Lebel VA, Bettany-Saltikov J, et al. Physiotherapy scoliosis-specific exercises - a comprehensive review of seven major schools. Scoliosis Spinal Disord, 2016, 11(20): 1-52.
34.	Sato K, Ito T, Endo T, et al. Novel assessment of physiotherapy outcomes in adults with structural spinal disorders. Eur Spine J, 2023, 32(6): 1887-1894.
35.	张娟娟, 蒋楠楠, 吴亚军, 等. Schroth疗法联合核心力量训练改善轻度青少年特发性脊柱侧凸患者的侧凸角度. 中国组织工程研究, 2025, 29(1): 1-7.
36.	李明, 王传锋, 贺石生, 等. 简体中文版脊柱侧凸研究学会22项问卷表(SRS-22)的信度和效度评价. 第二军医大学学报, 2008, 29(2): 203-205.
37.	陈绍丰, 李博, 周潇逸, 等. 青少年特发性脊柱侧凸相关生活质量评价量表现状. 第二军医大学学报, 2020, 41(11): 1188-1192.
38.	Crawford CH, Glassman SD, Bridwell KH, et al. The minimum clinically important difference in SRS-22R total score, appearance, activity and pain domains after surgical treatment of adult spinal deformity. Spine (Phila Pa 1976), 2015, 40(6): 377-381.
39.	肖斌, 张延斌, 阎凯, 等. 青少年特发性脊柱侧凸患者与家属对治疗前SRS-22量表评分认知的一致性及影响因素. 中国脊柱脊髓杂志, 2021, 31(8): 699-704.
40.	Park J, So WY. The effect of the schroth rehabilitation exercise program on spinal and feet alignment in adolescent patients with idiopathic scoliosis: a pilot study. Healthcare (Basel), 2022, 10(2): 398.

1. 封玉琨, 刘介生, 吕振, 等. 青少年特发性脊柱侧凸运动康复治疗的研究进展. 中国脊柱脊髓杂志, 2021, 31(11): 1039-1043.
2. 张威, 卜淑敏, 王涛, 等. 运动干预对青少年轻、中度特发性脊柱侧弯患者疗效的Meta分析. 中国循证医学杂志, 2022, 22(8): 896-900.
3. 王欢, 颉强, 陆清达, 等. 青少年特发性脊柱侧凸患者骨骼生长发育评价的研究进展. 中国脊柱脊髓杂志, 2023, 33(2): 174-178.
4. 柯竟悦, 马圣楠, 张晓慧, 等. 青少年特发性脊柱侧凸患者静态站立及步行时生物力学变化的Meta分析. 中国康复理论与实践, 2022, 28(10): 1178-1189.
5. 施冬冬, 陈前芬. 青少年特发性脊柱侧凸病因学的研究进展. 中国学校卫生, 2021, 42(2): 316-320.
6. 徐帅, 苏永佳, 王振波, 等. 中国大陆中小学生脊柱侧凸的患病特点: 关于72项研究的Meta分析. 中国脊柱脊髓杂志, 2021, 31(10): 901-910.
7. 张桂芳, 黄焕杰, 葛乐, 等. 青少年特发性脊柱侧凸患者的社会心理行为分析及应对措施探讨. 中国康复医学杂志, 2023, 38(12): 1656-1662.
8. Negrini S, Donzelli S, Aulisa AG, et al. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis Spinal Disord, 2018, 13(3): 1-48.
9. 王阳阳, 李杨. 特定运动疗法在特发性脊柱侧凸患者中的应用及效果研究进展-以Schroth疗法为例. 中国康复医学杂志, 2019, 34(11): 1378-1382.
10. Büyükturan Ö, Kaya MH, Alkan H, et al. Comparison of the efficacy of Schroth and Lyon exercise treatment techniques in adolescent idiopathic scoliosis: a randomized controlled, assessor and statistician blinded study. Musculoskelet Sci Pract, 2024, 72(1): 102952.
11. Kocaman H, Bek N, Kaya MH, et al. The effectiveness of two different exercise approaches in adolescent idiopathic scoliosis: a single-blind, randomized-controlled trial. PLoS One, 2021, 16(4): e0249492.
12. Hwangbo PN. Psychological and physical effects of Schroth and pilates exercise on female high school students with idiopathic scoliosis. J Korean Phys Ther, 2016, 28(6): 364-368.
13. Kim G, HwangBo PN. Effects of Schroth and Pilates exercises on the Cobb angle and weight distribution of patients with scoliosis. J Phys Ther Sci, 2016, 28(3): 1012-1015.
14. Ceballos-Laita L, Carrasco-Uribarren A, Cabanillas-Barea S, et al. The effectiveness of Schroth method in Cobb angle, quality of life and trunk rotation angle in adolescent idiopathic scoliosis: a systematic review and meta-analysis. Eur J Phys Rehabil Med, 2023, 59(2): 228-236.
15. Dimitrijević V, Šćepanović T, Jevtić N, et al. Application of the Schroth method in the treatment of idiopathic scoliosis: a systematic review and meta-analysis. Int J Environ Res Public Health, 2022, 19(24): 16730.
16. Chen C, Xu J, Li H. Effects of Schroth 3D exercise on adolescent idiopathic scoliosis: a systematic review and meta-analysis. Children (Basel), 2024, 11(7): 806.
17. Park JH, Jeon HS, Park HW. Effects of the Schroth exercise on idiopathic scoliosis: a meta-analysis. Eur J Phys Rehabil Med, 2018, 54(3): 440-449.
18. Czaprowski D, Kotwicki T, Biernat R, et al. Physical capacity of girls with mild and moderate idiopathic scoliosis: influence of the size, length and number of curvatures. Eur Spine J, 2012, 21(6): 1099-1105.
19. 曾宪涛, 刘同族, 田国祥. 应用STATA做meta分析. 北京: 军事医学科学出版社, 2014.
20. Akyurek E, Zengin Alpozgen A, 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(5): 510-517.
21. Kurak K, Altunhan A, Acak M, et al. The effect of electrical muscle stimulation (ems) enhanced Schroth method training on cobb angle and quality of life in patients with scoliosis. Pakistan J Med Health Sci, 2022, 16(1): 566-570.
22. Kuru T, Yeldan İ, Dereli EE, et al. The efficacy of three-dimensional Schroth exercises in adolescent idiopathic scoliosis: a randomised controlled clinical trial. Clin Rehabil, 2016, 30(2): 181-190.
23. Mohamed RA, Yousef AM. 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(24): 7717-7725.
24. Schreiber S, Parent EC, Khodayari Moez E, et al. 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. PLoS One, 2016, 11(12): e0168746.
25. Zapata KA, Dieckmann RJ, Hresko MT, et al. A United States multi-site randomized control trial of Schroth-based therapy in adolescents with mild idiopathic scoliosis. Spine Deform, 2023, 11(4): 861-869.
26. 许锐. “三步七法”推拿在青少年特发性脊柱侧弯中的应用效果. 中国当代医药, 2022, 29(10): 135-139.
27. 叶勇智. 轻度特发性脊柱侧凸患者应用: 柱侧凸特定运动疗法的可行性. 中外医学研究, 2018, 16(28): 19-21.
28. Schreiber S, Parent EC, Moez EK, et al. The effect of Schroth exercises added to the standard of care on the quality of life and muscle endurance in adolescents with idiopathic scoliosis-an assessor and statistician blinded randomized controlled trial: "SOSORT 2015 Award Winner". Scoliosis, 2015, 10(1): 1-12.
29. Tombak K, Yüksel İ, Ozsoy U, et al. A comparison of the effects of supervised versus home schroth exercise programs with adolescent idiopathic scoliosis. Children (Basel), 2024, 11(3): 354.
30. Cheung JPY, Cheung PWH, Yeng WC, et al. Does curve regression occur during underarm bracing in patients with adolescent idiopathic scoliosis. Clin Orthop Relat Res, 2020, 478(2): 334-345.
31. 杨丽虹, 刘少南, 吴大嵘, 等. 最小临床意义差值的概念及其估算方法. 中国循证医学杂志, 2020, 20(11): 1345-1352.
32. 常赢, 扈盛, 赵祥虎, 等. 脊柱侧凸特定运动疗法治疗青少年特发性脊柱侧凸效果的Meta分析. 中国脊柱脊髓杂志, 2024, 34(6): 602-609.
33. Berdishevsky H, Lebel VA, Bettany-Saltikov J, et al. Physiotherapy scoliosis-specific exercises - a comprehensive review of seven major schools. Scoliosis Spinal Disord, 2016, 11(20): 1-52.
34. Sato K, Ito T, Endo T, et al. Novel assessment of physiotherapy outcomes in adults with structural spinal disorders. Eur Spine J, 2023, 32(6): 1887-1894.
35. 张娟娟, 蒋楠楠, 吴亚军, 等. Schroth疗法联合核心力量训练改善轻度青少年特发性脊柱侧凸患者的侧凸角度. 中国组织工程研究, 2025, 29(1): 1-7.
36. 李明, 王传锋, 贺石生, 等. 简体中文版脊柱侧凸研究学会22项问卷表(SRS-22)的信度和效度评价. 第二军医大学学报, 2008, 29(2): 203-205.
37. 陈绍丰, 李博, 周潇逸, 等. 青少年特发性脊柱侧凸相关生活质量评价量表现状. 第二军医大学学报, 2020, 41(11): 1188-1192.
38. Crawford CH, Glassman SD, Bridwell KH, et al. The minimum clinically important difference in SRS-22R total score, appearance, activity and pain domains after surgical treatment of adult spinal deformity. Spine (Phila Pa 1976), 2015, 40(6): 377-381.
39. 肖斌, 张延斌, 阎凯, 等. 青少年特发性脊柱侧凸患者与家属对治疗前SRS-22量表评分认知的一致性及影响因素. 中国脊柱脊髓杂志, 2021, 31(8): 699-704.
40. Park J, So WY. The effect of the schroth rehabilitation exercise program on spinal and feet alignment in adolescent patients with idiopathic scoliosis: a pilot study. Healthcare (Basel), 2022, 10(2): 398.

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