Digital or Biofeedback-Assisted Posture Training Versus Conventional Exercise Therapy for Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Adolescent idiopathic scoliosis (AIS) is a structural spinal deformity that may compromise posture, physical function, and quality of life (QoL) during adolescence. Digital and biofeedback-assisted posture training systems have recently been incorporated into rehabilitation programs to provide real-time feedback and improve postural control. This review examined whether digital or biofeedback-assisted posture training provides additional benefits compared with conventional exercise therapy for adolescents with AIS. PubMed, Scopus, Web of Science, and the Cochrane Central Register of Randomized Controlled Trials (RCTs) were systematically searched from inception to 2026. RCTs comparing digital or biofeedback-assisted posture training with conventional exercise therapy in adolescents with AIS were eligible. Study selection, data extraction, and risk-of-bias evaluation were carried out independently by two reviewers; mean differences or risk ratios with 95% confidence intervals were used for meta-analyses; fixed-effects or random-effects models were used based on statistical heterogeneity. The certainty of evidence was evaluated using the GRADE approach. Five RCTs involving 328 participants were included. Overall, pooled results showed no significant differences between digital or biofeedback-assisted interventions and conventional therapy for Cobb angle, angle of trunk rotation, QoL, or patient engagement. One pooled analysis demonstrated a statistically significant higher risk of scoliosis progression in the digital or biofeedback-assisted intervention group than in the conventional exercise therapy group. However, this finding was based on low-certainty evidence and should therefore be interpreted with caution. Due to small sample sizes and intervention variability, the overall certainty of the evidence varied from low to moderate. Although it may complement traditional therapy, digital or biofeedback-assisted posture training does not yet show a definite advantage. It is necessary to conduct larger, better-designed RCTs with uniform procedures and extended follow-up.