Efficacy Of Postural Management-Based Comprehensive Exercise Therapy On Mild Adolescent Idiopathic Scoliosis

Purpose:Adolescent idiopathic scoliosis（AIS）is a complex three-dimensional spinal deformity of unknown etiology,with a prevalence of 2%～5%in children aged 10 to16 years.Without timely intervention,scoliosis continues to progress and thus endangers the healthy development of adolescents.The purpose of this study was to investigate the efficacy analysis of postural management-based comprehensive exercise therapy in patients with mild AIS and to perform a multidimensional assessment by imaging,physical appearance,bone strength,pulmonary function,and quality of life.Methods:A prospective clinical controlled study was used.52 patients with mild adolescent idiopathic scoliosis were recruited according to the inclusion and exclusion criteria,and then divided into experimental or control groups in a 1:1 matching format.The experimental group underwent postural management-based comprehensive exercise therapy（home rehabilitation:1 time/day,45 min/time;hospital rehabilitation:1 time/week,60 min/time）,and the control group was followed up with observation according to the recommendations of the Scoliosis Research Society for a total of 6months of intervention.Before and after the intervention,patients in both groups were assessed for main bend Cobb angle,angle of vertebral rotation,angle of trunk rotation（ATR）,sagittal plane distance,speed of sound（SOS）and percentile value of bone strength,and fall index（FI）,forced vital capacity（FVC）,percentage of forced vital capacity predicted（FVC pred%）,first second force expiratory volume（FEV₁）,percentage of forced expiratory volume in the first second predicted（FEV₁pred%）,percentage of forced expiratory volume in the first second to forced vital capacity（FEV₁/FVC%）and the scores of each dimension of SRS-22 questionnaire of the two groups of patients.Improvement（≥5°reduction in Cobb angle post-treatment compared with pre-treatment）and stability（<5°change in Cobb angle compared with pre-treatment）were defined as effective for treatment.Paired-samples t test or Wilcoxon signed rank sum test was used for within-group comparisons,independent-samples t test or Mann-Whitney rank sum test was used to compare groups before and after intervention and the difference between before and after intervention,and chi-square test was used to compare the difference in treatment efficiency between groups.The relationship between changes in physical appearance,bone strength,pulmonary function,balance function and quality of life and the degree of improvement in scoliosis in both groups before and after the intervention was examined using Spearman’s correlation analysis.Statistical difference level P<0.05.Results:The differences in basic information such as gender,age,height,weight,BMI,and Risser’s sign between the two groups were not statistically significant（P>0.05）.After 6 months of intervention,the patients with AIS in the experimental group had significantly lower Cobb angle（P=0.000）,significantly reduced angle of trunk rotation（P=0.026）,significantly improved pulmonary function index FVC（P=0.037）,and significantly increased SRS-22 self-image score（P=0.017）,and no other indexes before and after the intervention significantly changed（P>0.05）.All indicators did not change significantly in the control group of AIS patients（P>0.05）.The treatment effective rate was 96.2%in the experimental group and 73.1%in the control group,and the difference was statistically significant（P=0.001）.In the intergroup analysis of the difference between the before and after intervention values of all observed indexes,the difference between the before and after intervention values of the main bend Cobb angle in the experimental group was significantly lower than that in the control group（P=0.000）,the difference between the before and after intervention values of the ATR in the experimental group was significantly lower than that in the control group（P=0.045）,the difference between the before and after intervention values of FVC in the experimental group was significantly higher than that in the control group（P=0.031）,and the other indexes was no significant change before and after the intervention（P>0.05）.The amount of change in ATR（r=0.268,P=0.040）was significantly and positively correlated with the degree of improvement in scoliosis,and the amount of change in the pulmonary function index FEV₁（r=-0.304,P=0.028）was significantly and negatively correlated with the degree of improvement in scoliosis.Conclusion:Postural management-based comprehensive exercise therapy highly effective in reducing Cobb angle,improving trunk appearance deformity,improving pulmonary function and quality of life in patients with mild AIS.Postural management-based comprehensive exercise therapy is worthy of application and promotion in patients with mild AIS.