Comparative effects of non-specific exercise therapies on adolescent idiopathic scoliosis: a systematic review and network meta-analysis.

Abstract

Objective: Non-specific exercise therapies are widely used in the conservative management of adolescent idiopathic scoliosis (AIS) because of their accessibility and broad applicability. However, the comparative effectiveness of different non-specific exercise modalities remains unclear. This study aimed to systematically review the available evidence and compare the effects of different non-specific exercise therapies on AIS using network meta-analysis.

Methods: PubMed, Embase, Web of Science, the Cochrane Library, CNKI, Wanfang, and VIP databases were searched from inception to September 2025. Eligible studies included participants diagnosed with AIS aged 10-19 years. Non-specific exercise therapy was defined as an exercise-based intervention that was not individualized according to curve type or formal three-dimensional scoliosis classification and did not involve scoliosis-specific correction principles. The primary outcome was Cobb angle. Pairwise meta-analysis was conducted using RevMan 5.4, and network meta-analysis was conducted using Stata 18.0. Treatment rankings were estimated using SUCRA values.

Results: The overall pairwise random-effects meta-analysis suggested that non-specific exercise therapies were associated with a greater reduction in Cobb angle than control conditions (MD = -5.28, 95% CI -9.25 to -1.30). However, substantial heterogeneity was observed across studies (I² = 98%), and the 95% prediction interval was wide and crossed the null value (95% PI: -20.18 to 9.62). Therefore, this pooled estimate was interpreted as an exploratory summary of the overall direction of direct evidence rather than as a definitive treatment effect. In the primary network meta-analysis, spinal flexibility training and core muscle group training showed higher ranking probabilities according to SUCRA values. Nevertheless, these rankings should be interpreted cautiously because the evidence network was sparse, several comparisons were informed by a limited number of studies, and concerns remained regarding heterogeneity, risk of bias, transitivity, and confidence in network evidence.

Conclusion: Non-specific exercise therapies may be associated with reductions in Cobb angle in adolescents with idiopathic scoliosis. Spinal flexibility training and core muscle group training appeared to rank higher in the primary network analysis, but the certainty of these findings is limited by substantial heterogeneity, small sample sizes, sparse network structure, methodological limitations, concerns regarding transitivity, and the inclusion of non-randomized studies.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251242017, PROSPERO: CRD420251242017.