{"title":"Optimal exercise prescription parameters in Schroth training for adolescent idiopathic scoliosis: a systematic review and meta-analysis.","authors":"Daoquan Guan, Yahui Liu, Tongwu Yu, Wen Cheng","doi":"10.3389/fsurg.2026.1796813","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Adolescent idiopathic scoliosis (AIS) affects 0.5%-5% of the adolescent population, representing the most common spinal deformity in this age group. This systematic review and meta-analysis aimed to determine optimal exercise prescription parameters for Schroth training in AIS by examining dose-response relationships between exercise frequency, duration, and clinical outcomes.</p><p><strong>Methods: </strong>Systematic searches of PubMed, Scopus, Web of Science, and SPORTDiscus were conducted following PRISMA 2020 guidelines. Randomized controlled trials examining Schroth interventions in adolescents aged 10-18 years with idiopathic scoliosis were included. Network meta-analysis was performed using MetaInsight platform for Cobb angle outcomes, with traditional pairwise meta-analyses conducted for all outcomes using standardized mean differences with 95% confidence intervals.</p><p><strong>Results: </strong>15 randomized controlled trials encompassing 620 participants were included. The overall meta-analysis demonstrated Schroth exercises produced statistically significant Cobb angle improvements (SMD = -0.52, <i>p</i> < 0.0001; I<sup>2</sup> = 0%). Subgroup analysis revealed dose-response relationships favouring moderate exercise frequencies (3-4 sessions/week), which showed the largest pooled effect (SMD = -0.58, I<sup>2</sup> = 3%). Duration analysis demonstrated medium duration interventions (46-75 min) provided the most precise improvements (MD = -2.92°), while optimal frequency was the moderate (MD = -2.79°, 95% CI: -4.05, -1.48). Combined subgroup analysis identified moderate frequency plus medium duration as the most robust combination (SMD = -0.65, I<sup>2</sup> = 10%). Health-related quality of life outcomes showed non-significant improvements with substantial heterogeneity (SMD = 0.52, <i>p</i> = 0.43; I<sup>2</sup> = 93%). Secondary outcomes showed statistically significant improvements in trunk rotation (SMD = -0.86, <i>p</i> = 0.002; I<sup>2</sup> = 22%) and cosmetic appearance perception (SMD = -0.73, <i>p</i> = 0.01; I<sup>2</sup> = 0%), while postural stability measures showed non-significant effects (SMD = 0.08; <i>p</i> = 0.81; I<sup>2</sup> = 68%). Publication bias assessment using Egger's test shows no statistically significant funnel plot asymmetry (<i>p</i> = 0.745).</p><p><strong>Conclusions: </strong>Exploratory subgroup and network meta-analyses suggest that moderate frequency Schroth exercises (3-4 sessions/week) combined with medium duration sessions (46-75 min) may represent optimal parameters for Cobb angle improvement in AIS. Non-linear dose-response patterns show diminishing returns at higher frequencies, challenging conventional exercise prescription assumptions. These findings require validation through prospective studies with pre-specified dose-stratification examining long-term effectiveness, cost-effectiveness, and patient adherence across diverse healthcare contexts before broad clinical implementation.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1796813"},"PeriodicalIF":1.6000,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143934/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Frontiers in Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3389/fsurg.2026.1796813","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Adolescent idiopathic scoliosis (AIS) affects 0.5%-5% of the adolescent population, representing the most common spinal deformity in this age group. This systematic review and meta-analysis aimed to determine optimal exercise prescription parameters for Schroth training in AIS by examining dose-response relationships between exercise frequency, duration, and clinical outcomes.
Methods: Systematic searches of PubMed, Scopus, Web of Science, and SPORTDiscus were conducted following PRISMA 2020 guidelines. Randomized controlled trials examining Schroth interventions in adolescents aged 10-18 years with idiopathic scoliosis were included. Network meta-analysis was performed using MetaInsight platform for Cobb angle outcomes, with traditional pairwise meta-analyses conducted for all outcomes using standardized mean differences with 95% confidence intervals.
Results: 15 randomized controlled trials encompassing 620 participants were included. The overall meta-analysis demonstrated Schroth exercises produced statistically significant Cobb angle improvements (SMD = -0.52, p < 0.0001; I2 = 0%). Subgroup analysis revealed dose-response relationships favouring moderate exercise frequencies (3-4 sessions/week), which showed the largest pooled effect (SMD = -0.58, I2 = 3%). Duration analysis demonstrated medium duration interventions (46-75 min) provided the most precise improvements (MD = -2.92°), while optimal frequency was the moderate (MD = -2.79°, 95% CI: -4.05, -1.48). Combined subgroup analysis identified moderate frequency plus medium duration as the most robust combination (SMD = -0.65, I2 = 10%). Health-related quality of life outcomes showed non-significant improvements with substantial heterogeneity (SMD = 0.52, p = 0.43; I2 = 93%). Secondary outcomes showed statistically significant improvements in trunk rotation (SMD = -0.86, p = 0.002; I2 = 22%) and cosmetic appearance perception (SMD = -0.73, p = 0.01; I2 = 0%), while postural stability measures showed non-significant effects (SMD = 0.08; p = 0.81; I2 = 68%). Publication bias assessment using Egger's test shows no statistically significant funnel plot asymmetry (p = 0.745).
Conclusions: Exploratory subgroup and network meta-analyses suggest that moderate frequency Schroth exercises (3-4 sessions/week) combined with medium duration sessions (46-75 min) may represent optimal parameters for Cobb angle improvement in AIS. Non-linear dose-response patterns show diminishing returns at higher frequencies, challenging conventional exercise prescription assumptions. These findings require validation through prospective studies with pre-specified dose-stratification examining long-term effectiveness, cost-effectiveness, and patient adherence across diverse healthcare contexts before broad clinical implementation.
期刊介绍：
Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles.
Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery.
Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact.
The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
