Comparative efficacy of conservative interventions for adolescent idiopathic scoliosis: a systematic review and network meta-analysis of randomized controlled trials.

Abstract

Background: Adolescent idiopathic scoliosis (AIS) is a prevalent spinal disorder, and the efficacy of conservative interventions for AIS remains unclear. This study aimed to identify the comparative efficacy of all available conservative interventions for AIS.

Methods: Nine databases were searched from their inception to February 2024 for randomized controlled trials comparing conservative interventions for AIS. Paired reviewers independently selected studies, assessed risk of bias, and assessed certainty of the evidence. Pairwise meta-analyses were performed by DerSimonian-Laird random-effects model. Network meta-analysis within the frequentist framework was conducted by R package netmeta, and network plots were generated by the network plot command in Stata.

Results: We identified 3903 citations, of which 54 trials including 3984 participants were included in our review. All subsequent estimates refer to the comparison with minimal interventions. Brace plus physiotherapeutic scoliosis-specific exercises (PSSE, mean difference (MD): 4.80, 95% confidence interval (CI): 0.56 to 9.04, moderate certainty), manual therapy plus PSSE (MD: 5.26, 95% CI: 1.09 to 9.43, moderate certainty), and manual therapy plus mind-body exercise (MD: 5.14, 95% CI: 1.25 to 9.04, moderate certainty) could be intermediately effective in improving Cobb angle of patients with AIS at post-interventions. Although brace alone (MD: 1.53, 95% CI: 1.09 to 2.14, high certainty) could be the intermediate effective intervention in preventing scoliosis progression, moderate to high certainty evidence showed that brace alone and PSSE alone probably have little or no difference in improving Cobb angle, function, mental health, self-image, angle of trunk rotation (ATR), or satisfaction of patients with AIS compared to minimal interventions. There was no evidence on the follow-up effects of conservative interventions for AIS. We did not identify serious adverse events for any included conservative interventions.

Conclusions: Brace plus PSSE, manual therapy plus PSSE, and manual therapy plus mind-body exercise could provide short-term effects in improving Cobb angle of patients with AIS. The evidence of brace alone and PSSE alone for managing AIS is still not robust. Our findings are useful for decision-making in clinical practice, as we presented the most comprehensive evidence regarding all available conservative interventions for AIS.

Systematic review registration: PROSPERO CRD42024521298.