Archives of Physical Medicine and Rehabilitation
Volume 106, Issue 12p1874-1885December 2025Open access
Rodrigo Mantelatto Andrade, MS
Abstract
Objective
To compare the effects of therapeutic exercises in preventing Cobb angle progression in adolescent idiopathic scoliosis (AIS) compared with other conservative treatments.
Data Sources
Systematic searches were conducted in MEDLINE via PubMed, Embase, centralized database (CENTRAL), Physiotherapy Evidence Database (PEDro), and cumulative index to nursing and allied health literature up to December 14, 2023, and registered in PROSPERO (CRD42020156639).
Study Selection
Randomized controlled trials involving adolescents aged 10-18 years with AIS and a Cobb angle >10° were included.
Data Extraction
Two reviewers independently extracted study data, assessed the risk of bias using the PEDro scale, and the certainty of evidence—using the Grading of Recommendations, Assessment, Development and Evaluation approach.
Data Synthesis
Nineteen studies involving 832 participants met our selection criteria. The PEDro scale score ranged from 3 to 8 points (0-10). The results on Cobb angle progression showed no significant difference in Cobb angle reduction between therapeutic exercises and minimal intervention in the short term (mean difference [MD]=−1.33; 95% confidence interval [CI], −4.87 to 2.22). The specific therapeutic exercises showed greater Cobb angle reduction compared with general exercises in the short term (MD=−2.57; 95% CI, −4.56 to −0.59) and long term (MD=−6.00; 95% CI, −6.88 to −5.12). No significant difference was observed between therapeutic exercise and brace use in the short term (MD=0.20; 95% CI, −1.74 to 2.14); however, bracing was more effective in the long term (MD=2.66; 95% CI, 0.18-5.14). Therapeutic exercises with bracing significantly reduced Cobb angle in the short term compared with bracing alone (MD=2.25; 95% CI, −3.86 to −0.63).
Conclusions
This systematic review and meta-analysis suggest that therapeutic exercises can be effective in preventing Cobb angle progression in AIS. Specifically, targeted therapeutic exercises led to a greater reduction in Cobb angle compared with general exercises both in the short and long term. Although no significant difference was found between therapeutic exercises and minimal intervention in the short term, combining therapeutic exercises with bracing demonstrated a significant short term advantage over bracing alone. In the long term, bracing was found to be more effective than therapeutic exercises in preventing Cobb angle progression. Given the varied outcomes across different interventions and time frames, further high-quality trials are needed to establish optimal treatment protocols for managing AIS.