A National Adolescent Idiopathic Scoliosis Physical Wellbeing Study

Abstract

Adolescent Idiopathic Scoliosis (AIS) is a spinal deformity affecting 2-3% of adolescents, particularly females. The condition involves a three-dimensional spinal curvature that arises around the time of puberty in adolescents with no prior health issues. The primary aim of all treatment protocols for patients with AIS is to prevent the progression of the curvature in the adolescent years. In the public healthcare system, current treatment protocols for patients with AIS are guided by the severity of spinal curvature and involve observation of those with mild curves, bracing for those with moderate curves, and surgical intervention for those with severe curves. In addition, physiotherapeutic scoliosis-specific exercise programmes, which target spinal curve reduction in patients with mild and moderate AIS, are available in the private health sector. Despite the availability of treatment protocols, significant gaps remain in the literature regarding the extent of functional, cardiorespiratory, and quality of life (QOL) impairments experienced by children and adolescents across the spectrum of mild, moderate, and severe AIS. Existing treatment approaches overlook broader physiological, functional and psychological outcomes. In addition, there is limited evidence of the effectiveness of physiotherapeutic scoliosis-specific exercise (PSSE) programmes, such as Schroth, in addressing these impairments in individuals with mild to moderate AIS. Similarly, it remains unclear whether an individualised, targeted, physiotherapy-led intervention could effectively address residual deficits in post-operative AIS patients. The aims of this thesis were fourfold. First, to establish if exercise rehabilitation improves pulmonary function in children with AIS. Second, to determine if patients with AIS had impairments in muscle strength, power, endurance, exercise capacity, pulmonary function, balance and quality of life, when compared to healthy peers. Third, to compare the care of patients with mild or moderate AIS in the public healthcare pathway with those in the private pathway that included a PSSE programme. Fourth, to investigate whether a targeted, physiotherapy-led intervention can effectively address post-operative impairments in individuals with AIS following surgical correction. To address these objectives, four studies were conducted: a systematic review and meta-analysis (Study 1), a cross-sectional cohort study (Study 2), a prospective cluster design observational study (Study 3) and a prospective interventional cohort study (Study 4). Study 1 (Chapter 2), a systematic review and meta-analysis, established that exercise-based therapies appear to lead to significant improvements in pulmonary function in individuals with AIS. Study 2 (Chapter 4) established that adolescents with AIS exhibit a range of clinically significant functional, pulmonary, cardiovascular and QOL impairments when compared to age-matched healthy controls. This study also found that the prevalence and severity of several impairments appear to be associated with the severity of spinal curvature. Findings from Study 3 (Chapter 5) indicated that while the Schroth programme shows therapeutic potential, it is not sufficient as a stand-alone intervention. Lastly, Study 4 (Chapter 6) a targeted physiotherapy-led intervention effectively addressed most functional impairments in post-operative AIS patients. However, notable deficits in pulmonary function, exercise capacity and QOL still remained when compared to healthy peers. In conclusion, the findings of this thesis demonstrate that children and adolescents with mild, moderate, and severe AIS experience significant functional, cardiovascular, and QOL impairments that are not adequately addressed within current healthcare pathways. There is a clear need for the implementation of a standardised baseline clinical assessment to identify these impairments in a systematic fashion. The results of these assessments would facilitate the development of effective, individualised rehabilitation programmes. The inclusion of a supervised aerobic element in these individualised interventions should be considered and may address the remaining pulmonary and cardiovascular impairments. Furthermore, the involvement of a mental health professional from the point of diagnosis is recommended to address the lower QOL experienced by this population.