Effects of Pilates-Based Exercises Added to Schroth Training on Physical and Clinical Outcomes in Adolescents With Idiopathic Scoliosis
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 发起方
- 入组人数
- 34
- 试验地点
- 1
- 主要终点
- Assessment of Lung Capacity
研究概览
简要总结
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.
详细描述
Scoliosis is a three-dimensional spinal deformity characterized by a lateral curvature greater than 10° measured using the Cobb angle, accompanied by vertebral rotation . Approximately 80% of idiopathic scoliosis cases occur during adolescence . Adolescent idiopathic scoliosis (AIS) typically develops between the ages of 10 and 18 years. Several factors, including the initial curve magnitude, curve location, apical vertebral rotation, and age, have been identified as risk factors for curve progression .
Treatment of AIS depends on the severity of the spinal curvature and may include bracing, exercise-based interventions, or surgical treatment. The International Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) classifies scoliosis exercise approaches under the category of Physiotherapeutic Scoliosis-Specific Exercises (PSSE). Among these approaches, the Schroth method, which is based on rotational angular breathing, is one of the most widely used and extensively studied treatment methods in the literature . revious research has demonstrated that Schroth therapy may contribute to reductions in Cobb angle and improvements in quality of life in adolescents with idiopathic scoliosis. In addition, Schroth-based exercises have been associated with enhanced thoracic and lumbar proprioception.
The literature has associated increases in thoracic curvature, measured by the Cobb angle, with reductions in pulmonary function. Although these reductions have not yet been classified as abnormal by the American Thoracic Society, decreased pulmonary function has been observed even in individuals with mild spinal curvatures. It has been estimated that every 4-5° increase in Cobb angle is associated with approximately a 1% reduction in total lung capacity .
Pilates, originally referred to as "Contrology", was developed by Joseph Pilates and has become widely practiced in both fitness and rehabilitation settings . Although relatively few studies have investigated the effects of Pilates on scoliosis, existing evidence suggests that it may have beneficial effects in this population . Gou et al. reported that Pilates exercises reduced the Cobb angle while improving quality of life and trunk range of motion.
In a 12-week intervention study, Khaledi et al. compared Schroth exercises combined with asymmetric spinal stabilization exercises and found no significant between-group differences in back muscle endurance. Nevertheless, numerical improvements favored the combined exercise group compared with the control group. Similarly, previous studies were compared Schroth exercises with core stabilization exercises in adolescents with idiopathic scoliosis and found that participants receiving Schroth training demonstrated significantly greater improvements in perceived cosmetic appearance than those performing core stabilization exercises. Despite these promising findings, the level of evidence supporting the effectiveness of Pilates exercises in the management of scoliosis-related deformities remains limited. Pilates exercises have been reported to reduce asymmetrical posture in individuals with mild scoliosis and a low risk of progression. Both Schroth and Pilates exercises are considered to have positive effects on lung capacity, trunk proprioception, trunk muscle strength, and quality of life in individuals with AIS. However, previous studies have primarily investigated the effects of these exercise approaches separately. Based on the current literature, no study has evaluated the effects of Pilates-based core stabilization exercises added to Schroth training in individuals with adolescent idiopathic scoliosis. Therefore, further research is needed to investigate the potential benefits of this combined intervention.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 10 Years 至 18 Years（Child, Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Aged 10-18 years.
- •Diagnosed with adolescent idiopathic scoliosis by a physician.
- •Cobb angle between 10° and 45°.
- •Willingness of both the participant and their parent/legal guardian to participate in the study.
- •No additional rheumatologic, neurological, or orthopedic disorders.
- •No scoliosis-specific treatment received within the previous 6 months.
排除标准
- •History of scoliosis or spinal surgery.
- •Scoliosis secondary to neurological, congenital, or other non-idiopathic causes.
- •Any contraindication to exercise.
- •A spinal curve with an apex at T12-L
- •Presence of cognitive impairment that would interfere with study participation or assessments.
- •Current brace treatment. Participants who are eligible for bracing but have not been prescribed a brace by their physician or who decline brace treatment despite being eligible will remain eligible for inclusion.
研究组 & 干预措施
Schroth Group
Participants will receive supervised Schroth exercises based on the standardized Schroth method throughout the intervention period.
干预措施: Schroth Group (Behavioral)
Schroth Combined with Pilates Group
Participants in this group will receive Schroth exercises combined with Pilates-based exercises under the supervision of a physiotherapist throughout the intervention period.
干预措施: Schroth and Pilates Group (Other)
结局指标
主要结局
Assessment of Lung Capacity
时间窗: 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 Core Muscle Strength
时间窗: 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
时间窗: 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
时间窗: 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
时间窗: 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
时间窗: 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.
次要结局
- Assessment of Quality of Life(Baseline and 2 months)
- Assessment of Perceived Cosmetic Deformity(Baseline and 2 months)