Effects of conservative exercise-based interventions on spinal curvature, respiratory function, and quality of life in patients with idiopathic scoliosis: a systematic review and meta-analysis

Study Design: Systematic review and meta-analysis. Purpose: This systematic review and meta-analysis aimed to evaluate the effectiveness of Schroth method (SM) on the spinal curvature, respiratory function, and quality of life (QoL) in patients with idiopathic scoliosis (IS). Overview of Literature: IS can cause substantial physical and psychological problems in both pediatric and juvenile populations, with significant repercussions in adulthood. The SM-based exercise intervention is a noninvasive therapeutic approach used for the conservative management of IS. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched databases for studies evaluating Cobb angle, respiratory outcomes, and QoL in IS treated with exercise-based interventions. Rigorous methods of data extraction and risk of bias assessment were employed to assess methodological quality, followed by statistical analyses using a random-effects model to assess heterogeneity and perform subgroup analyses. The inverse of the variance was used as the statistical method, and the mean difference was used as the measure of effect. The robustness of the findings was validated using sensitivity analysis. Results: Ten clinical trials were evaluated in this study. The meta-analysis revealed significant changes in the following outcomes using therapeutic exercise for IS: reduction in the Cobb angle, increases in the forced vital capacity (p =0.01), forced expiratory volume in one second (p =0.008), peak expiratory flow (p =0.000), and a decrease in pain intensity. Due to the limited number of bracing-related studies, no definitive conclusions regarding the effect of orthosis could be drawn. High heterogeneity was observed in the exercise subgroups, limiting the reliability and clinical interpretability of pooled estimates. Conclusions: Exercise-based interventions for IS, particularly the SM, are associated with small but statistically significant improvements in Cobb angle, respiratory function, pain, and functional capacity. However, the magnitude of change in spinal curvature reduction does not reach commonly accepted thresholds for clinical significance (PROSPERO registry number: CRD42024547664).