Adolescent idiopathic scoliosis, considered as the most predominant orthopedic condition affecting children [
The concept of HRQoL “refers to the subjective evaluation of one’s ability to perform usual tasks and their impact on one’s everyday physical, emotional and social well-being” [
Surprisingly, no studies regarding this subject matter in persons treated with scoliosis-specific exercises (SSEs) have been reported. Systematic reviews addressing this issue have concentrated on technical or surrogate outcomes, typically curve angle and its progression [
Different SSE treatments, methods, or “schools” have been developed and widely used, especially in Europe [
We conducted a study among young adult men and women, who in adolescence participated in a specific therapeutic exercise regime.
Spine deformity, especially in adult patients, may be associated with back pain and may potentially, depending on the severity of the deformity, lead to respiratory complications [
We followed the recommendations of Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement [
We analyzed the medical records of 5017 children enrolled for conservative treatment or observation through a screening program for idiopathic scoliosis, conducted between 1984 and 1995 in the Centre of Corrective and Compensatory Gymnastics, Bielsko-Biala, Poland. The centre provided scoliosis screening for schoolchildren from the urban and suburban population of about 300 000 inhabitants. We excluded registries of those children in whom bracing and/or surgical treatment were recommended, and, with the use of a random numbers table, randomly selected 250 registries of the children who were enrolled for SSE treatment or observation.
The regime involved scoliosis-specific, symmetrical, strengthening, antigravity, and elongating exercises of the postural muscles. Exercises were performed in group during 45-minute gym sessions twice a week and individually at home (sets of 12–15 exercises, 30–45 minutes a day). The remaining children were under observation for three to five years on the basis of scheduled follow-up orthopedic examinations. The diagnosing orthopedic surgeon, based on physical examination and radiograph, made a decision regarding the introduction of the SSE treatment. At that time, they did not, however, follow the Scoliosis Research Society criteria for the minimal Cobb angle of 11° for scoliosis, and the so-called “scoliotic posture” was also regarded as spinal deformity.
Subsequently, we attempted to locate the subjects. As, after 14–25 years, many of the potential participants changed addresses and telephone numbers; unless locating the subjects from their original addresses, we tried to retrieve the current contact data from their parents or other residents. We also applied other procedures suggested to increase participation [
We managed to locate 189 (75.6% of the selected registries) potential participants. Seven addresses were not found, 49 people had emigrated, and four potential participants had died. Twenty-six people (10.4% of the initial cohort and 13.8% of the located persons) refused to participate. Fifteen people were subsequently excluded due to severe scoliosis (
Characteristics of the participants and intergroup comparisons.
Factor or domain | Total group |
Able-bodied |
Scoliotics |
|
---|---|---|---|---|
Age |
|
|
|
.98 |
(24–39), 30 | (24–38), 30 | (25–39), 30 | ||
Women ( |
81 | 38 | 43 | .10 |
Place of residence ( |
||||
Rural | 8 | 5 | 3 | .18 |
Urban ≤ 20 000 | 1 | 0 | 1 | |
Urban 20 000–50 000 | 2 | 0 | 2 | |
Urban > 50 000 | 133 | 71 | 62 | |
Marital status ( |
||||
Single | 75 | 35 | 40 | .17 |
Married/living together | 69 | 41 | 28 | |
Education ( |
||||
Vocational | 11 | 5 | 6 | .88 |
Preuniversity/college | 34 | 18 | 16 | |
University | 99 | 53 | 46 | |
Intervention ( |
||||
Observation | 73 | 41 | 32 | .37 |
Exercises | 71 | 35 | 36 |
Data for age are presented as mean ± SD (range), median.
To obtain current spine deformity characteristics, two blinded specialists independently measured the magnitude of the curvature, using the Cobb method [
Clinical characteristics of the participants with scoliosis.
Curve size |
Curve severity ( |
Curve location |
Scoliosis type ( |
||||
---|---|---|---|---|---|---|---|
11–24°Cobb (mild) |
25–40°Cobb (moderate) |
Single primary Th | Single primary Th-L or L | Double major | Early-onset idiopathic |
Adolescent idiopathic |
|
|
62 (92) | 6 (8) | 9 (13) | 45 (66) | 14 (25) | 11 (16) | 57 (74) |
Curve size expressed as mean ± SD (range);
We enrolled subjects with mild and moderate scoliosis (
Spirometry and body plethysmography (total lung capacity, TLC) measurements were conducted by highly trained technicians in the Laboratory of the Centre of Pulmonology and Thoracic Surgery, Bystra, Poland, in accordance with the standard European Respiratory Society’s (ERS) formula, using Lungtest 1000 spirometer, MES, Poland, and Bodyscreen system body plethysmograph, Jaeger, Germany. Body plethysmography and spirometric measurements were taken in subjects in a sitting and in a standing position, respectively. Table
Lung volumes and respiratory function of the participants.
Total group |
Able-bodied |
Scoliotics |
|
Scoliotics |
| ||
---|---|---|---|---|---|---|---|
Mild |
Moderate |
||||||
TLC % |
|
|
|
.06 |
|
|
.91 |
VC % |
|
|
|
.11 |
|
|
.61 |
FVCex % |
|
|
|
.66 |
|
|
.28 |
FVCin % |
|
|
|
.09 |
|
|
.83 |
Data are presented as mean ± SD; %: percentage of the European Respiratory Society’s predicted value; TLC: total lung capacity; VC: vital capacity; FVCex: forced vital capacity in exertion; FVCin: forced vital capacity in insertion; A: actual value in litres;
We used the WHO Quality of Life-BREF (WHOQOL-BREF) questionnaire. It comprises 26 items, which measure the following broad domains: physical health, psychological health, social relationships, and functioning in environment. The WHOQOL-BREF is a shorter version of the original instrument (WHOQOL100). The questionnaires were designed to assess the individual’s perceptions in the context of their culture and value systems and their personal goals, standards, and concerns [
To measure the subjects’ permanent disability associated with low back pain, we used the revised Oswestry Disability Index (also known as the Oswestry Low Back Pain Disability Questionnaire (ODQ)) [
The participants reported back pain severity on a Visual-Analogue Scale, on five-day recall basis, labelled from “no pain” to “maximal pain I can imagine” on a 100 mm line.
We used descriptive statistics for the demographic and clinical characteristics of the subjects. To assess intergroup differences for subsequent characteristics and individual ODQ severity ranges, we applied the maximum-likelihood chi-square test. The differences regarding subsequent demographic and clinical characteristics in relation to the pain severity (VAS scale) scores were computed with the median
The subsequent WHOQOL-BREF domains, in scores transformed to 0–100 values, ranged from
Low back functional disability as presented within the ODQ categories, related to subsequent variables. ODQ categories: 0–20% minimal; 21–40% moderate; 41–60% severe disability; 61–80% crippled; 81–100% bed-bound or patients exaggerating their symptoms.
The majority of the participants, both able-bodied and with AIS, regardless the magnitude of the deformity, did not report severe back pain, with the greatest VAS scores not exceeding
Tables
As we anticipated, variables that could be linked with the general health and well-being (age, marital status, education, and gender) appeared to be significantly associated with the ODQ scores (Table
The study involved adult participants, divided into subgroups of able-bodied (Cobb angle ≤10°) and scoliotic subjects, with a history of either SSE treatment,or observation for adolescent scoliosis. The intergroup differences as regards demographic characteristics were nonsignificant (Table
Restrictions in lung volumes, as measured with body plethysmography (TLC), but also estimated with more accessible spirometric measurements (FVC) [
Respiratory function of smokers and nonsmokers.
Not smoking |
Smoking |
| |
---|---|---|---|
TLC % |
|
|
.91 |
VC % |
|
|
.75 |
FVCex % |
|
|
.89 |
FVCin % |
|
|
.85 |
ODQ and WHOQOL-BREF scores-intergroup and intragroup comparisons.
Measures and domains |
Total group |
Able-bodied |
Scoliotics |
|
Scoliotics |
| |
---|---|---|---|---|---|---|---|
11–24°Cobb |
25–40°Cobb |
||||||
ODQ total score |
|
|
|
|
|
|
.50 |
WHOQOLBREF domains | |||||||
Physical health |
|
|
|
|
|
|
.60 |
Psychological |
|
|
|
|
|
|
.88 |
Social relationships |
|
|
|
|
|
|
.96 |
Environment |
|
|
|
|
|
|
.99 |
Data are presented as mean ± SD; median.
Self-reported pain severity (VAS scores) as related to different independent variables.
Independent variables | Pain severity [VAS score, millimeters] |
|
---|---|---|
Gender | ||
Males |
|
.39 |
Females |
|
|
Place of residence | ||
Rural |
|
.52 |
Urban |
|
|
Scoliosis | ||
Able-bodied |
|
.82 |
Mild |
|
|
Moderate |
|
|
Intervention | ||
Exercise treatment |
|
.06 |
Observation |
|
|
Marital status | ||
Single |
|
.56 |
Married |
|
|
Education | ||
Vocational |
|
.13 |
Preuniversity/college |
|
|
University |
|
|
Employment | ||
Employed |
|
.18 |
Unemployed |
|
Data are presented as mean ± SD; median; VAS score range: 0–100.
Multiple regression analysis for ODQ scores: (a) the count model of the Poisson model analysis for the ODQ scores exceeding zero and (b) the binominal zero inflation model for ODQ scores of zero.
Total ODQ score | Parameter estimate | Standard error |
|
Odds ratio | 95% CI |
---|---|---|---|---|---|
Age (older) | .033 | .014 | .02 |
.01 | .01–.06 |
Gender (male) | −.003 | .097 | .98 | .009 | .02–.19 |
Place of residence (rural) | −.088 | .054 | .11 | .009 | .001–.02 |
Scoliosis (≤10°Cobb) | .140 | .091 | .13 | .01 | .03–.32 |
Intervention (observation) | −.024 | .093 | .80 | .009 | .01–.16 |
Marital status (single) | −.213 | .096 | .03 |
.008 | .001–.03 |
Employment (employed) | −.128 | .152 | .40 | .008 | .004–.17 |
Education (lower level) | −.131 | .065 | .04 |
.008 | .002-.003 |
Total ODQ score | Parameter estimate | Standard error |
|
Odds ratio | 95% CI |
---|---|---|---|---|---|
Age (older) | .103 | .071 | .15 | .01 | .03–.24 |
Gender (male) | .893 | .447 | .04 |
.02 | .01–1.77 |
Place of residence (rural) | .289 | .417 | .49 | .01 | .2–1.10 |
Scoliosis (<10°Cobb) | −.028 | .434 | .95 | .009 | .8–1.83 |
Intervention (observation) | 1.177 | .483 | .01 |
.03 | .1–2.12 |
Marital status (single) | −1.207 | .491 | .01 |
.02 | .02–.24 |
Employment (unemployed) | .487 | .687 | .48 | .01 | .8–1.83 |
Education (lower level) | .850 | .420 | .04 |
.02 | .2–1.67 |
Multiple regression analysis for WHOQOL-BREF social relationships domain scores: the backward elimination model.
Variable | Parameter estimate | Standard error |
|
---|---|---|---|
Intervention (observation) | 5.15 | 3.03 | .09 |
Employment (employed) | −12.49 | 4.82 | .01 |
There are many generic, condition-specific, and even superspecific measures of self-reported HRQoL and body image of patients with scoliosis developed [
Haefeli et al. [
Despite considerably large body of evidence regarding HRQoL and subjective functioning of adults with AIS [
For those reasons, the presented paper reports findings of the first investigation regarding this subject matter and was believed to enhance the body of knowledge in this subject. We refrained from discussing findings of other authors, as they do not correspond directly with our study and have been broadly discussed by other authors [
We present data obtained from an uncontrolled observational study with a long follow-up of 16.5 years, a comparatively low level of evidence study design [
In conclusion, self-perceived health-related quality of life and disability due to low back pain in adult persons who in adolescence took part in an intensive scoliosis-specific exercise programme did not differ significantly from their peers who were only under observation due to scoliosis. Nonetheless, treatment undergone in adolescence, but also current factors, such as employment, marital status, and education, were associated with self-perceived quality of life and levels of physical disability corresponding with back pain. This study did not contribute to the body of evidence as regards effectiveness of scoliosis-specific exercise programmes, but in our opinion, may enhance the body of knowledge as regards possible lasting side effects of these interventions. Further studies, possibly with longer follow-up period, are necessary to better explore this subject matter.
The project has been granted ethical approval by the Senate Research Ethics Committee, University School of Physical Education, Warsaw, Poland, May 20, 2009.
The authors declare that there is no conflict of interests regarding the publication of this paper.
Maciej Płaszewski is the main author who obtained funding, planned and participated in designing and conducting the study, data collection, and analysis, performed the literature review, and drafted the paper. Igor Cieśliński participated in designing the study and performed the statistical analysis. Roman Nowobilski and Aleksandra Truszczyńska participated in conceiving and designing the study. Igor Cieśliński and Paweł Kowalski participated in data collection and analysis. The authors read and accepted the final version of the paper.
This report was funded by Research Project DS.168, University School of Physical Education, Warsaw, and sponsored by the Ministry of Science and Higher Education, Poland. The authors thank Doctor Ryszard Batycki for his involvement in the orthopedic measurements and Dr. Jacek Terech for supervising patients during TLC and spirometric examinations and interpreting data. They would also like to thank the participants for accepting their invitation for this study. This project has been registered at ClinicalTrials.gov, with registration no.