The superiority of Schroth exercise combined brace treatment for mild to moderate adolescent idiopathic scoliosis: A systematic review and network meta-analysis

The current study aimed to assess and rank the comparative efficacy of different non-operative treatments on Cobb angle, angle of trunk rotation (ATR), and quality of life (QoL) for mild to moderate adolescent idiopathic scoliosis (AIS). A comprehensive search of databases, including Medline, The Cochrane Library, PubMed, EMBASE, and Web of Science spanning all previous years up to January 1, 2024. The included studies were evaluated for literature quality according to Cochrane Handbook criteria, and a network meta-analysis was performed using STATA 14.0 statistical software. Twenty randomized controlled trials met all inclusion criteria and were analyzed. Schroth exercise and scoliosis-specific exercise combined with brace treatments had a significant positive effect on Cobb angle and QoL. For ATR, Schroth exercise and Schroth exercise combined with brace treatments prove more effective compared to the control group. On SUCRA (surface under the cumulative ranking curve) analysis, Schroth exercise combined with brace treatment had the highest likelihood for reducing Cobb angle (P-score=0.899), ATR (0.82), and improving QoL (0.828). Although most conservative treatments had benefits for mild to moderate AIS, the most optimal programs were those that included (1) at least 10 weeks of approximately 60-minute Schroth exercise sessions twice a week; (2) wearing the brace for 23 hours every day throughout the treatment period.