Rehabilitative game-based exercise integrated into conservative treatment for adolescent idiopathic scoliosis: a pilot randomized controlled trial

Abstract Background The incorporation of game-based exercise into conservative treatment for adolescent idiopathic scoliosis (AIS) has the potential to increase patient engagement, yet the evidence supporting its efficacy remains sparse. This study aimed to evaluate the effects and usability of game-based rehabilitative exercises in conservative treatment for AIS. Methods This assessor- and statistician-blinded pilot randomized controlled trial involved female participants aged 10–14 years with AIS, Cobb angles of 25°–40°, and full-time Chêneau-type brace use. Twenty-five participants were randomly assigned to the control or rehabilitative game-based exercise group. Both groups received scoliosis-specific physiotherapy exercises, core stabilization, balance training, and full time bracing for 24 weeks. Starting from week 5, the game-based group participated in game-based exercises targeting core stabilization and balance, conducted both in clinic and at home. The primary outcomes were Cobb angle, posterior trunk symmetry, and perceived trunk deformity. Secondary outcomes included trunk rotation, motivation to participate in physical activity, balance, and system usability. A per-protocol analysis was conducted on 20 participants. Results Both groups experienced a significant reduction in the thoracic Cobb angle, but a significant decrease in the lumbar Cobb angle was observed only in the game-based group. There were no significant differences between the groups in terms of changes in Cobb angle, trunk rotation, posterior trunk symmetry, perceived deformity, or balance. Motivation levels significantly declined in the control group but remained stable in the game-based group. After adjustment for baseline motivation, no significant between-group difference was observed at T1 ( p = 0.207), whereas a significant difference favoring the game-based group was observed at T2 ( p = 0.015, partial η 2 ₚ = 0.303). The median system usability score was 76.50, surpassing the threshold for acceptability, and no adverse events related to the intervention were reported. Conclusions In this pilot sample, no statistically significant between-group differences were detected in radiological, trunk symmetry, perceived deformity, or balance outcomes. Motivation declined in the control group but was maintained in the game-based group, and the system demonstrated satisfactory usability. Larger, adequately powered trials are required to confirm these preliminary findings. Trial registration ClinicalTrials.gov identifier NCT06469021 (Record date: 16/06/2024).