Letter to “The Effect of Comprehensive Spinal Correction Rehabilitation in Children with Early-Onset Idiopathic Scoliosis: A Clinical Controlled Trial”

To the Editor:

We read with interest the article “The Effect of Comprehensive Spinal Correction Rehabilitation in Children With Early-Onset Idiopathic Scoliosis: A Clinical Controlled Trial.” ¹ The authors are to be commended for addressing an important area in pediatric spine deformity. However, several issues merit further discussion to contextualize these findings for clinical practice.

First, while the comprehensive spinal correction rehabilitation (CSCR) protocol aims to combine three-dimensional correction and functional training, the theoretical basis and reproducibility of the program remain unclear. The description of CSCR in the manuscript lacks detailed standardization-particularly regarding intensity, progression, and individual tailoring-which may introduce significant variability in implementation and limit generalizability to other centers or practitioners.

Second, the study reports significant improvements in pulmonary function following CSCR compared to controls, yet the extent and clinical relevance of these improvements warrant cautious interpretation. It is well-established that pulmonary impairment in early-onset idiopathic scoliosis (EOIS) is closely related to both the severity and structural rigidity of the spinal curve. ² Since the study population consists mostly of mild and moderate cases, it is uncertain whether similar improvements would be achievable in more advanced EOIS, which often pose greater respiratory challenges. Further, the respiratory measurements might be influenced by patients’ learning or motivational factors rather than true physiological gains.

Additionally, the control group received only “conventional observation and advice,” which may not represent an optimal standard of care for comparison. Recent guidelines suggest that scoliosis-specific exercises, such as the Schroth method, offer measurable benefits in mild idiopathic scoliosis. ³ The omission of an active exercise control arm may thus overestimate the relative efficacy of CSCR and does not clarify whether the multidimensionality of CSCR is necessary vs targeted physiotherapy alone.

In summary, this study adds to the limited body of literature on rehabilitation for EOIS, but future research should address protocol standardization, inclusion of comparative intervention arms, and expansion to diverse patient subgroups to better define the clinical utility of CSCR.