Superiority of combined physiotherapeutic scoliosis-specific exercises in spinal deformity and quality of life of adolescents with idiopathic scoliosis: A meta-analysis of randomized controlled trials

Abstract

Background

Adolescent idiopathic scoliosis (AIS) is a common spinal deformity during growth, and Physiotherapeutic Scoliosis-Specific Exercises (PSSE) are widely used interventions, while the effectiveness of PSSE-based combined interventions remains unclear.

Objective

To systematically evaluate the comparative effectiveness of PSSE-based combined interventions versus PSSE alone in adolescents with AIS.

Methods

Randomized controlled trials (RCTs) on PSSE-based combined interventions for AIS, published between June 30, 2015, and June 30, 2025, were searched in PubMed, the Cochrane Library, Web of Science, and Embase. Data on author, intervention, treatment duration, and outcomes (Cobb angle, ATR, SRS-22) were extracted. Analyses were conducted with CMA 3.0.

Results

Nine RCTs involving 348 participants were included. Both PSSE-based combined interventions and PSSE alone were associated with significant improvements in Cobb angle, ATR, and SRS-22 scores (all P < 0.001). Compared with PSSE alone, combined interventions demonstrated statistically significant additional improvements in Cobb angle (MD = −0.74, 95% CI: −1.46 to −0.02; I² = 0%), ATR (MD = −0.68, 95% CI: −1.20 to −0.15; I² = 0%), and SRS-22 scores (MD = 0.19, 95% CI: 0.11 to 0.28; I² = 0%). These between-group differences were modest in magnitude.

Conclusion

PSSE-based combined interventions were associated with greater, yet modest, additional improvements compared with PSSE alone in adolescents with AIS. These findings suggest incremental benefits beyond an already effective conservative strategy.