Which specific modes of exercise training are most effective for treating adolescent idiopathic scoliosis? A systematic review and network meta-analysis
Journal of Orthopaedic Surgery and Research · 3 Nov 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is how far this paper should move patient care if its methods hold up; it does not measure the size of a treatment benefit.
Why it matters
Students counselling families of children with mild to moderate scoliosis should know that scoliosis-specific exercise, especially Schroth, has the strongest pooled signal for curve and rotation change, although the trials are small and often at risk of bias.
The evidence
This network meta-analysis pooled 36 randomised trials (1,911 adolescents with idiopathic scoliosis) to compare Schroth exercises, other scoliosis-specific exercises, core stabilization, conventional exercise, and non-exercise controls. For Cobb angle, Schroth exercises ranked highest, with a standardised mean difference of 1.19 (95% CI 0.43 to 1.94) versus conventional exercise and 0.89 (0.22 to 1.57) versus non-exercise controls. Head-to-head differences among the specific exercise types were not significant, and no exercise type significantly improved SRS-22 quality of life scores.
Cobb angle: Smd 1.19 (95% CI 0.43 to 1.94; standard deviations). The interval favours the first group; the size of the benefit needs clinical interpretation.
Why this rigour score?
Network meta-analysisDesign starting point: 53
Raised the score
- Prospectively registered+5.1
- Pools randomised trials+5.1
Lowered the score
No negative adjustments recorded.
Score capped at 64. A critical methodological failure for a review.
Methods at a glance
Recorded assessment- Comprehensive literature searchMet
- Risk of bias assessedMet
- Bias considered in synthesisMet
- Publication bias assessedMet
- Study exclusions justifiedNot met
- Prospective registrationMet
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
See the full score breakdown
- Study design starting point
- 53
- Compared against an accepted alternative
- +1.7
- Prospectively registered
- +5.1
- Pools randomised trials
- +5.1
- Comprehensive literature search
- +3.4
- Risk of bias assessed in the included studies
- +3.4
- Risk of bias carried into the synthesis
- +2.5
- Publication bias assessed
- +2.5
- Methodological cap
- −12.8
- Final rigour score rounded
- 64 / 100
Study design sets the starting point and a ceiling of 90. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
How the clinical score was reached
The question: 6/9. Three judgements of how much it matters to patients, which decision it informs and how closely it fits their care.
Patient consequence: limited (1/3). A surrogate or intermediate outcome whose link to how patients feel or function is uncertain: radiographic or imaging findings, laboratory values, biomechanical or range-of-motion measures, healing on imaging, process or resource measures; or a trivial patient outcome.
Decision relevance: moderate (2/3). Bears on a real decision, but indirectly: an association or risk factor that informs counselling or surveillance, a subgroup or secondary analysis, one component of a pathway, or a comparison that leaves out a main alternative.
Applicability: moderate (3/3). A recognisable practice population, but with a notable restriction: narrow eligibility, a single expert surgeon or centre, or an unusual protocol that would need adapting. Applicability only subtracts for a real mismatch, so moderate counts in full.
What it found: Points one way (×0.86). A verdict without a usable interval, a clear result from a trial the paper itself calls underpowered, or a review whose certainty is low or unrated.
The design ceiling: 94. The most a network meta-analysis can score here, however relevant its question and clear its answer.
Clinical = 94 × 6/9 × 0.86 = 54.
For journal club
1.For a skeletally immature patient with a 20 degree curve, how would you weigh adding Schroth exercise to observation or bracing, given the modest standardised effects and no clear quality of life benefit?
2.If a certified Schroth therapist is unavailable, how would you counsel a family about core stabilization or other scoliosis-specific programmes as alternatives?
Original publication title
Which specific modes of exercise training are most effective for treating adolescent idiopathic scoliosis? A systematic review and network meta-analysis