Optimal exercise prescription parameters in Schroth training for adolescent idiopathic scoliosis: a systematic review and meta-analysis

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: = 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.