Efficacy of a reduced brace wear regimen supported by Schroth exercise in adolescent idiopathic scoliosis: a randomized trial

Objectives This study aimed to determine whether reducing daily brace wear duration, when compensated by intensive Schroth exercise, yields non-inferior long-term curve correction and superior quality of life compared to standard full-time bracing in AIS. Methods A total of 52 AIS patients (Cobb angle 25°–40°) were randomly and equally assigned to a control group (full-time brace wear, 20–24 h/day) and an experimental group (part-time brace wear, 14–18 h/day combined with Schroth exercise). Specifically, the Schroth three-dimensional exercise including home-based and supervised outpatient sessions, were performed at least 5 times per week, with a minimum total duration of 4–5 h per week. Evaluations of Cobb angle, angle of trunk rotation (ATR), thoracic expansion, and the Scoliosis Research Society 22-item (SRS-22) questionnaire were conducted baseline and after 6 months of treatment. A subsequent follow-up assessment at 12-months was carried out, with the Cobb angle employed as the primary outcome to evaluate the long-term corrective efficacy between the two groups. Results The two-way repeated measures ANOVA revealed a significant Time × Group interaction for the primary outcome, the Cobb angle ( P < 0.001). At both the 6- and 12-month follow-ups, the Cobb angle was significantly reduced from baseline in both groups ( P < 0.01), with the experimental group demonstrating superior improvement compared to the control group ( P < 0.01). Regarding secondary outcomes at 6 months, the experimental group also showed significantly greater improvement than the control group in the ATR, thoracic expansion, and the pain and mental health domains of the SRS-22 ( P < 0.05). Furthermore, within the experimental group, ATR, thoracic expansion, and the pain and mental health domains of the SRS-22 improved significantly from baseline at 6 months ( P < 0.01), whereas in the control group, only the Cobb angle and ATR showed significant improvement ( P < 0.01). Conclusions This short-term study provides evidence that a protocol prioritizing intensive Schroth exercise combined with part-time bracing achieved superior corrective efficacy compared to full-time bracing alone for adolescent idiopathic scoliosis. These findings support integrating structured Schroth therapy as a core component within a part-time bracing regimen, suggesting a potential to reduce reliance on full-time wear while maintaining efficacy in the short term. Clinical Trial Registration https://www.chictr.org.cn/showproj.html?proj=201861 , identifier ChiCTR2300075910.