Schroth and Pilates for Adolescent Idiopathic Scoliosis

Condition(s) studied

Investigational drug(s) / intervention(s)

Schroth Group: Participants will be randomly allocated to either the intervention group or the control group.Participants in the control group will receive supervised Schroth exercise training twice weekly for 8 weeks in face-to-face sessions conducted by a physiotherapist. In addition, they will perform only the Schroth home exercise program.All participants will perform their home exercises twice daily, in the morning and evening. Before prescribing the home exercise program, the physiotherapist will provide detailed instructions and demonstrate each exercise during the clinical sessions. The home exercises will be performed twice daily, with each exercise consisting of 3 sets of 10 repetitions.

Schroth and Pilates Group: Participants will be randomly allocated to either the intervention group or the control group. Participants in the intervention group will receive supervised Schroth training combined with Pilates-based exercises twice weekly for 8 weeks in face-to-face sessions conducted by a physiotherapist. In addition, they will be prescribed a home exercise program consisting of Schroth home exercises and Pilates-based exercises.All participants will perform their home exercises twice daily, in the morning and evening. Before prescribing the home exercise program, the physiotherapist will provide detailed instructions and demonstrate each exercise during the clinical sessions. The home exercises will be performed twice daily, with each exercise consisting of 3 sets of 10 repetitions.

Study summary

The primary aim of this study is to investigate the effectiveness of Schroth training and the multidimensional effects of adding Pilates-based exercises to Schroth training in individuals with adolescent idiopathic scoliosis. Specifically, the study aims to evaluate the effects of Pilates-based exercises combined with Schroth training on lung capacity, trunk muscle strength, proprioception, trunk rotation, and posture. In addition, it seeks to examine the impact of the intervention on important functional and psychosocial outcomes, including quality of life, perceived cosmetic deformity, and pain threshold.

This study is expected to contribute to the existing evidence on the use of Pilates exercises in combination with Schroth exercises for individuals with adolescent idiopathic scoliosis by providing a comprehensive evaluation of the effects of this combined intervention. The findings are intended to provide guidance for clinicians and researchers regarding the combined use of different exercise approaches in the management of adolescent idiopathic scoliosis. Furthermore, the study aims to explore the potential benefits of integrating the Schroth method with Pilates as a holistic treatment approach for scoliosis management.

Eligibility

Primary outcome measure(s)

• Assessment of Lung Capacity — Baseline and 2 months
  Vital Capacity (VC) will be assessed using a COSMED microQuark PC spirometer (Rome, Italy). During the assessment, participants will be seated comfortably in an upright position. A nose clip will be applied to prevent airflow through the nose during the test. VC values will be interpreted by comparing the measured values with the predicted reference values obtained from healthy individuals.
• Assessment of Lung Capacity — Baseline and 2 months
  Forced Vital Capacity (FVC) will be assessed using a COSMED microQuark PC spirometer (Rome, Italy). During the assessment, participants will be seated comfortably in an upright position. A nose clip will be applied to prevent airflow through the nose during the test. FVC values will be interpreted by comparing the measured values with the predicted reference values obtained from healthy individuals.
• Assessment of Lung Capacity — Baseline and 2 months
  Total Lung Capacity (TLC) will be assessed using a COSMED microQuark PC spirometer (Rome, Italy). During the assessment, participants will be seated comfortably in an upright position. A nose clip will be applied to prevent airflow through the nose during the test. TLC values will be interpreted by comparing the measured values with the predicted reference values obtained from healthy individuals.
• Assessment of Lung Capacity — Baseline and 2 months
  Residual Volume (RV) will be assessed using a COSMED microQuark PC spirometer (Rome, Italy). During the assessment, participants will be seated comfortably in an upright position. A nose clip will be applied to prevent airflow through the nose during the test. RV values will be interpreted by comparing the measured values with the predicted reference values obtained from healthy individuals.
• Assessment of Lung Capacity — Baseline and 2 months
  Forced Expiratory Volume in One Second (FEV₁) will be assessed using a COSMED microQuark PC spirometer (Rome, Italy). During the assessment, participants will be seated comfortably in an upright position. A nose clip will be applied to prevent airflow through the nose during the test. FEV₁ values will be interpreted by comparing the measured values with the predicted reference values obtained from healthy individuals.
• Assessment of Core Muscle Strength — Baseline and 2 months
  Core muscle strength will be assessed using The Stabilizer Pressure Biofeedback Unit (Chattanooga Group Inc., USA) with the participant in the prone position. The pressure cuff of the Stabilizer unit will be placed horizontally beneath the abdominal region, with its lower edge aligned with the anterior superior iliac spines (ASIS). Participants will be instructed to take a deep breath, exhale, and gently draw the umbilicus toward the lumbar spine while maintaining normal breathing. After participants have been familiarized with the maneuver, the Stabilizer unit will be inflated to 70 mmHg. Participants will then be asked to repeat the maneuver and maintain the contraction for 10 seconds. The assessment will be performed three times, and the mean value will be recorded.
• Postural Assessment — Baseline and 2 months
  The device projects white light stripes (raster lines) onto the participant's back, and the three-dimensional shape of the back is reconstructed by analyzing the deformation of these projected lines. The resulting curved light patterns are captured by a camera, allowing a radiation-free and non-contact assessment of spinal alignment and posture. During the assessment, participants will be instructed to stand in a relaxed and stationary position facing forward, with their back toward the camera, arms hanging freely at their sides, and feet positioned on the designated markers on the platform. The following postural parameters will be assessed: pelvic symmetry, shoulder and scapular alignment, vertebral rotation, thoracic kyphosis angle, and lumbar lordosis angle.
• Assessment of Trunk Proprioception — Baseline and 2 months
  Trunk proprioception will be assessed using a dual digital inclinometer (ACUMAR™, Lafayette, IN, USA). Participants will stand barefoot on a firm surface with their feet shoulder-width apart. The inclinometer sensors will be placed over the T1 and S1 spinous processes, identified by palpation. Participants will perform 30° trunk flexion and 15° trunk extension with their eyes open, memorize each target position, return to the starting position, and then reproduce the target angle. Each measurement will be repeated three times. The difference between the target and reproduced angles will be recorded in degrees as the measure of trunk proprioception.
• Assessment of Trunk Rotation — Baseline and 2 months
  Trunk rotation will be assessed using a Baseline Scoliometer (Fabrication Enterprises, White Plains, NY, USA). Participants will stand upright with their feet together and parallel, facing forward. They will then be instructed to place their hands together and bend forward until the trunk is parallel to the floor while keeping the arms relaxed. Angle of trunk rotation (ATR) will be measured at the cervical, thoracic, and lumbar regions, and the values will be recorded
• Assessment of Pain Threshold — Baseline and 2 months
  Pressure pain threshold will be assessed using a Baseline algometer (White Plains, NY, USA). The device applies pressure through a 1 cm² rubber tip, and the pressure at which pain is first perceived will be recorded in kg/cm² . Measurements will be performed bilaterally at points 2-3 cm lateral to the paravertebral muscles at the level of the participant's primary spinal curve. Before testing, pressure will be applied to a non-test area to familiarize participants with the procedure. Pressure will then be gradually increased until the participant indicates that the sensation has become painful by raising a hand. Three consecutive measurements, separated by 5-second intervals, will be obtained, and the mean value will be recorded.

Trial sites (1)

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