Adolescent idiopathic scoliosis (AIS) is a complex deformity of the spine, and its cause remains unknown. AIS can have negative physical, psychological, and social effects on an individual's health. There are two main treatment options for AIS: surgical and conservative approaches, including observation, exercise, and bracing. Scoliosis-specific exercises (SSE) refer to globally recognized, evidence-based exercise approaches.
In this study, the Scientific Exercise Approach to Scoliosis (SEAS), one of the SSE methods, will be used. SEAS consists of individualized active self-correction exercises combined with functional movements. Additionally, the Basic Body Awareness Therapy (BBAT) method will also be applied. BBAT is a body-focused, comprehensive approach that incorporates slow, rhythmic movements and breath control.
Both groups will attend supervised sessions in the clinic once a week, and home exercises will be assigned for the remaining days. Participants in the SEAS group will receive only SEAS treatment, while those in the BBAT group will receive both SEAS and additional BBAT exercises.
The goal of this clinical study is to investigate the effects of BBAT in addition to a rehabilitation program including SSE, on posture, spatial orientation, trunk proprioception, scoliosis-specific parameters, quality of life, and body in adolescents with IS aged between 10 and 17 years.
The research hypotheses for this study are as follows:
H1: Basic Body Awareness Therapy has an effect on posture in adolescents with idiopathic scoliosis.
H2: Basic Body Awareness Therapy has an effect on spatial orientation in adolescents with idiopathic scoliosis.
H3: Basic Body Awareness Therapy has an effect on trunk proprioception in adolescents with idiopathic scoliosis.
H4: Basic Body Awareness Therapy has an effect on scoliosis-specific clinical parameters in adolescents with idiopathic scoliosis.
H5: Basic Body Awareness Therapy has an effect on both general and scoliosis-specific quality of life in adolescents with idiopathic scoliosis.
H6: Basic Body Awareness Therapy has an effect on body awareness in adolescents with idiopathic scoliosis.
Being diagnosed with adolescent idiopathic scoliosis
Being between the ages of 10 and 17
Having scoliosis of 15° or greater
Not having received previous treatment for scoliosis and not receiving any other treatment during this study
Having any spinal/bone deformity in addition to scoliosis (such as hyperkyphosis, pectus, etc.)
Wearing a brace
Having congenital scoliosis
Having any rheumatological, neuromuscular, neurological, cardiovascular, or pulmonary pathology
Parallel
Scoliosis Specific Exercise
Other interventionIn the first session, the individual and their family will learn about AIS, the specific curvature, and the treatment process. They will also be taught correct posture and active self-correction, which means finding the best alignment in three planes. Once the individual becomes confident in their self-correction, they will start exercises. In the SEAS method, exercises begin in a sitting position, and as the individual improves, the exercises will be made more challenging and suited to their level. The rehabilitation protocol includes exercises in standing, squatting, single-leg stance, and on the floor. In each session, previous exercises will be reviewed, and new ones will be added. Individuals will be reminded to practice active self-correction during exercises and daily activities. In literature, there is no fixed protocol for exercise duration and frequency, but it is recommended to do exercises 2-3 times a week for 45 minutes or 20 minutes daily.
Basic Body Awareness Therapy
Other interventionBody awareness movements will be performed in lying, sitting, and standing positions. Then, they will be varied by incorporating walking, running, and voice use. The patient will be asked to perform these movements with a specific rhythm and coordination. BBAT aims to enhance body awareness and create a more realistic body image by normalizing posture, balance, and muscle tension. The training process will involve gradually increasing awareness of the relationship with the floor, the vertical axis, centering, breathing, and flow. During this therapy process, the goal is to improve the individual's awareness of themselves and their surroundings, helping them adopt the "here and now" experience and later apply it in daily life. At the end of each session, time will be given for the patient to respond to their experience and express their thoughts. There is variability in the application duration in the literature.
Trunk Proprioception
To evaluate trunk proprioception, three tests will be used. Measurements will be repeated three times for each test, and the average value will be calculated. The obtained angle will be recorded in degrees and referred to as the error angle.
Posture ( perception of deformity severity)
For posture assessment, the Spinal Appearance Questionnaire will be used first. It will be completed by the participant, their parent, and the physiotherapist. In this way, the perception of deformity severity will be measured. It is a valid measure for assessing self-image in adolescents with idiopathic scoliosis. This questionnaire includes 11 standardized drawings that represent different severity levels of spinal deformity perception. Additionally, it consists of 22 Likert-scale questions reflecting the patient's impressions and expectations regarding their appearance. Patients select one of five response options for each drawing, with 1 indicating the best and 5 indicating the worst perception. The total score is the sum of all responses, and a higher score indicates a more severe deformity.
Postural Symmetry for Anterior Trunk
Anterior Trunk Symmetry Index (ATSI) is another objective method used to assess postural asymmetry in the anterior trunk. Similar to POTSI, ATSI calculations are based on photographs taken in the optimal standing posture. Although reference values for ATSI are available for different age groups, a definitive normal value has not been established. Higher ATSI values indicate increased asymmetry.
Postural Symmetry for Posterior Trunk
Posterior Trunk Symmetry Index (POTSI) is an objective and comprehensive method used to evaluate an individual's postural asymmetry. For the calculation of POTSI, photographs will be taken in the optimal standing posture for assessment. The ideal value of the POTSI index is 0, indicating that the trunk is symmetric, while values above 0 represent asymmetry.
Quality of life related to scoliosis
In this study, the Japanese Scoliosis Questionnaire-27 (SJ-27) will be used to assess the quality of life specific to scoliosis in individuals. This questionnaire evaluates the quality of life in patients with Adolescent Idiopathic Scoliosis from a broad perspective, including pain and psychosocial issues. Consisting of 27 items, the questionnaire is scored on a scale from 0 (none) to 4 (severe/very high). To calculate the total score, the answers are summed up, with a higher score indicating a lower quality of life. The minimum score a participant can obtain from this questionnaire is 0, and the maximum score is 108. It includes five areas: pain, discomfort while dressing, appearance-related discomfort, anxiety, and difficulty participating in activities. There are 4 questions related to back pain, 7 questions on discomfort while dressing, 4 on physical activity, 6 on self-consciousness, and 6 questions addressing psychological issues such as depression.
General quality of life
The Pediatric Quality of Life Inventory (PedsQL) will be administered to both the child and the parent to assess general quality of life. PedsQL is an assessment questionnaire that measures the impact of both the disease and treatment on the individual's physical, psychological, and social functioning, as well as the effect of disease- and treatment-specific symptoms on quality of life. Scales are available for various age ranges. Two forms are required for the individuals in this study, based on their age. Two different parallel versions will be used for children aged 8-12 years and 13-18 years. Both forms have the same content, but the wording in the 8-12 years form is simplified for this age group. The child form, written in the third-person language, will also be filled out by the parent. It consists of 3 domains and 23 items. As the total PedsQL score increases, so does the quality of life. As the total PedsQL score increases, the quality of life improves.
Evaluation of treatment compliance
Adherence to home exercise programs during the 16-week treatment period will be evaluated on a scale from 0 to 100. At the end of the treatment, the patient's adherence to exercises will be assessed for both groups with the question, 'During the 16 weeks, what percentage of your daily home exercises did you follow?' and the responses will be recorded.
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Gözde Yagci (Gür)
Lead sponsor
Hacettepe University
Sponsor institution
Hacettepe University
Collaborator
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