Effectiveness of physical therapeutic scoliosis exercise (PSSE) intervention for adolescent idiopathic scoliosis: a systematic review and meta-analysis.

Objective: To systematically evaluate the effects of physiotherapeutic scoliosis-specific exercise (PSSE) on Cobb angle, angle of trunk rotation (ATR) and quality of life (QoL) in patients with adolescent idiopathic scoliosis (AIS), and to explore the modifying role of exercise period, thereby providing an evidence-based foundation for the clinical optimisation of exercise prescriptions.

Methods: Following PRISMA guidelines, the EMBASE, PubMed, Cochrane Library, and SinoMed databases were searched (up to 15 June 2025) without language restriction; a total of 18 RCTs (involving 1,014 patients with AIS, mean age 13.98 ± 1.81 years) were included. Risk of bias was assessed using the Cochrane RoB 2 (11 low-risk, 7 medium-risk). Standardised mean differences (SMDs) and 95% confidence intervals (CIs) were calculated using a random-effects model, and the frequency of exercise was quantified by subgroup analyses (low: ≤2 times/week; high: ≥3 times/week).

Results: The combined effect of PSSE on Cobb angle in patients with AIS had an SMD of - 1.00, 95% confidence area [- 1.47, - 0.53], P < 0.001; the combined SMD of ATR was - 1.15, 95% CI [- 1.94, - 0.36], P < 0.001; the combined SMD of QoL was 0.63, 95% CI [0.15, 1.11], P < 0.01. Subgroup analyses showed that high-frequency exercise practice (≥ 3 times/week) was more effective.

Conclusion: PSSE effectively improves Cobb angle, ATR, and QoL in patients with AIS. High-frequency exercise forms are recommended; however, the actual application needs to be individualised based on patient characteristics. Spreading RCTs are recommended to further define the optimal exercise dose and identify key influencing factors.