H R Weiss1. 1. Orthopedic Rehabilitation Services, Alzeryerstr, Germany.
Abstract
UNLABELLED: There is a wide variation of the inclusion criteria found in studies investigating the outcome of conservative scoliosis treatment. While the application of the SRS criteria for studies on bracing seem useful, there are no inclusion criteria for the investigation of physiotherapy alone. This study has been performed to investigate the possibility to find useful inclusion criteria for future prospective studies on physiotherapy (PT). MATERIALS AND METHODS: A PubMed and (incomplete) hand search for outcome papers on PT has been performed in order to detect study designs and inclusion criteria used. RESULTS: Real outcome papers (start of treatment in immature samples / end results after the end of growth) have not been found. Some papers investigated mid-term effects of exercises, most were retrospective, few prospective and many included patient samples with questionable treatment indications. DISCUSSION: No paper has been found with patients of risk for being progressive followed from premenarchial status until skeletal maturity under physiotherapy treatment alone. Claims made to regard physiotherapy as an evidence based method of treatment are not justified scientifically. An agreement of the scientific community on common inclusion criteria for future studies on PT is necessary. We would suggest the following: (1) girls only, (2) age 10 to 13 with the first signs of maturation (Tanner II), (3) Risser 0-2, (4) risk for progression 40 - 60% according to Lonstein and Carlson. CONCLUSION: There is no outcome paper on PT in scoliosis with a patient sample at risk for being progressive followed from premenarchial status until skeletal maturity. Therefore, only bracing can be regarded as being evidence based in the management of scoliosis patients during growth.
UNLABELLED: There is a wide variation of the inclusion criteria found in studies investigating the outcome of conservative scoliosis treatment. While the application of the SRS criteria for studies on bracing seem useful, there are no inclusion criteria for the investigation of physiotherapy alone. This study has been performed to investigate the possibility to find useful inclusion criteria for future prospective studies on physiotherapy (PT). MATERIALS AND METHODS: A PubMed and (incomplete) hand search for outcome papers on PT has been performed in order to detect study designs and inclusion criteria used. RESULTS: Real outcome papers (start of treatment in immature samples / end results after the end of growth) have not been found. Some papers investigated mid-term effects of exercises, most were retrospective, few prospective and many included patient samples with questionable treatment indications. DISCUSSION: No paper has been found with patients of risk for being progressive followed from premenarchial status until skeletal maturity under physiotherapy treatment alone. Claims made to regard physiotherapy as an evidence based method of treatment are not justified scientifically. An agreement of the scientific community on common inclusion criteria for future studies on PT is necessary. We would suggest the following: (1) girls only, (2) age 10 to 13 with the first signs of maturation (Tanner II), (3) Risser 0-2, (4) risk for progression 40 - 60% according to Lonstein and Carlson. CONCLUSION: There is no outcome paper on PT in scoliosis with a patient sample at risk for being progressive followed from premenarchial status until skeletal maturity. Therefore, only bracing can be regarded as being evidence based in the management of scoliosispatients during growth.