Supervised physiotherapeutic scoliosis-specific exercises provide limited additional benefit at 24 months in braced adolescents with idiopathic scoliosis: a randomized trial

Aims: Physiotherapeutic scoliosis-specific exercises (PSSE) are used as an adjunct to bracing in adolescent idiopathic scoliosis (AIS), although evidence for their long-term benefit remains limited. This randomized trial assessed whether supervised PSSE provide clinically important radiological and patient-reported benefits compared with self-directed exercise in patients with AIS undergoing brace treatment. Methods: Patients with AIS (major Cobb angle 25° to 45°; Risser grade 0 to 2) were recruited from a tertiary scoliosis centre between December 2018 and December 2022. Patients were randomized to supervised Schroth-based PSSE, consisting of physiotherapist-led sessions plus daily home exercises, or to self-directed general exercise. The co-primary outcomes were change in major Cobb angle and change in health-related quality of life measured using the Chinese Brace Questionnaire-34. A 5° between-group difference in Cobb angle was prespecified as the minimal clinically important difference (MCID). To provide a clinically anchored interpretation, 24-month radiological outcomes were classified as improved (> 5° decrease), stable (-5° to +5°), or worsened (> 5° increase), and compared using adjusted ordinal logistic regression in intention-to-treat (ITT) and per-protocol (PP) analyses. Results: Supervised PSSE resulted in a greater reduction in major Cobb angle than self-directed exercise at 24 months (adjusted between-group difference -3.23° (95% CI -3.51 to -2.96); p < 0.001); however, this did not reach the prespecified MCID. There was no clinically meaningful difference in quality of life. Using the 5° threshold, radiological status was similar between groups. In the intention-to-treat analysis, the adjusted odds ratio (OR) for improved/stable/worsened status was 1.08 (95% CI 0.58 to 2.03; p = 0.805); per-protocol findings were similar (OR 1.48 (95% CI 0.75 to 2.92); p = 0.263). Conclusion: Supervised PSSE provided a statistically significant but clinically modest radiological benefit over self-directed exercise. This did not translate into a higher likelihood of clinically meaningful radiological improvement. No sustained clinically meaningful quality-of-life benefit was shown.