Effect of stabilization exercises in patients with adolescent idiopathic scoliosis – literature review

Uvod: Najpogostejša strukturna deformacija hrbtenice je skolioza. Pri nekaterih pacientih je mogoče določiti osnovni vzrok skolioze, vendar pa vzrok pri večini skolioz ni znan. Izraz idiopatska skolioza se nanaša na paciente, pri katerih ne najdemo jasnega vzroka bolezni. Adolescentna idiopatska skolioza je najpogostejša idiopatska skolioza, ki jo diagnosticiramo kadar je Cobbov kot na rentgenskem posnetku večji od 10°. Dejavniki ki napovedujejo povečanje patološke krivine hrbtenice so: zrelost (kronološka starost, menarha, skeletna zrelost, Risserjev znak), velikost, tip in lokacija krivine. Cilj konservativnega kot tudi operativnega zdravljenja skolioze je preprečiti napredovanje ukrivljenosti hrbtenice. Kot pomemben del konservativnega zdravljenja so se izkazale tudi stabilizacijske vaje, ki se pogosto uporabljajo pri zdravljenju adolescentne idiopatske skolioze. Namen: Namen diplomskega dela je, na podlagi pregleda strokovne in znanstvene literature, ugotoviti učinkovitost stabilizacijskih vaj pri pacientih z adolescentno idiopatsko skoliozo. Metode dela: Raziskave so bile izbrane v elektronski podatkovni zbirki PubMed s ključnimi besedami »adolescent scoliosis AND stabilization exercise«. Izbrane so bile raziskave, ki so ustrezale sledečim vključitvenim merilom: članki s prosto dostopnim celotnim besedilom, raziskave, ki so bile objavljene po letu 2012, randomizirane kontrolirane raziskave, raziskave, v katerih so ocenjevali učinkovitost stabilizacijskih vaj pri pacientih z adolescentno idiopatsko skoliozo. Rezultati: V pregled literature je bilo vključenih pet raziskav. V štirih raziskavah je bila učinkovitost stabilizacijske vadbe primerjana z drugo obliko vadbe (za skoliozo specifične fizioterapevtske vaje, vaje za osnovno zavedanje telesa, Schroth pristop), v eni raziskavi pa sta bili primerjani nadzorovana, vodena stabilizacijska vadba s strani strokovnjaka in nenadzorovana stabilizacijska vadba, izvajana samostojno v domačem okolju. V večini izbranih raziskav so ugotovili statistično značilno izboljšanje rezultatov meritev rotacije trupa s skolimetrom, Cobbovega kota, intenzitete bolečine, kakovosti življenja, vizualnega in haptičnega zaznavanja, zaznavanja položaja telesa, subjektivne zaznave deformacije trupa in izboljšanje periferne mišične moči. Večinoma so bile v teh raziskavah ugotovljene statistično značilne izboljšave znotraj posameznih intervencijskih skupin. Vse raziskave pa niso pokazale statistično značilnih razlik med različnimi vadbenimi pristopi, zato je potrebno nadaljnje raziskovanje. Razprava in zaključek: Rezultati pregledanih raziskav kažejo, da ima stabilizacijska vadba pozitivne učinke pri zmanjševanju intenzitete bolečine, povezane s skoliozo, preprečuje napredovanja skolioze, zmanjša asimetrijo in deformacijo hrbtenice ter vpliva na kakovost življenja posameznika s skoliozo. V prihodnjih raziskavah bi bilo potrebno upoštevati naslednja priporočila: vključiti večje število preiskovancev, daljše vadbene programe, uporabiti enotna merilna orodja za vrednotenje rezultatov in spremljati dolgoročne vplive vadbe.Introduction: Scoliosis is the most common structural deformity of the spine. In some patients, the underlying cause of scoliosis can be determined, but the cause of most scoliosis is unknown. Idiopathic scoliosis refers to patients in whom no clear cause of the disease is found. Adolescent idiopathic scoliosis is the most common idiopathic scoliosis and is diagnosed when the Cobb angle on the radiograph is greater than 10⁰. Factors predictive of increase in the pathological curvature of the spine are: maturity (chronological age, menarche, skeletal maturity, Risser sign), size, type and location of curvature. The aim of conservative as well as operative treatment of scoliosis is to prevent the progression of spinal curvature. Stabilisation exercises, which are commonly used in the treatment of adolescent idiopathic scoliosis, have proven to be an important part of conservative treatment. Purpose: The aim of this diploma work is to determine the effectiveness of stabilisation exercises in patients with adolescent idiopathic scoliosis based on a review of the literature. Methods: Studies were selected if they met the following inclusion criteria: articles with freely available full text, studies published after 2012, randomised controlled trials, studies evaluating the effectiveness of stabilisation exercises in patients with adolescent idiopathic scoliosis. Results: Five studies were included in the literature review. Four studies compared the effectiveness of stabilisation exercise with another form of exercise (Scientific Exercises Approach to Scoliosis, basic body awareness therapy, Schroth exercises) and one study compared supervised, guided stabilisation exercise with unsupervised stabilisation exercise performed independently in the home environment. Most studies found statistically significant results within-group differences for measures of trunk rotation with a scoliometer, Cobb angle, pain intensity, quality of life, visual and haptic perception, body position perception, subjective perception of trunk deformity, peripheral muscle strength. However, not all studies showed the same statistically significant differences between the different exercise approaches, so further investigation is needed. Discussion and conclusion: The results of reviewed research suggest that stabilisation exercise has positive effects in reducing the intensity of pain associated with scoliosis, preventing scoliosis progression, reducing asymmetry and spinal deformity, and affects on the quality of life of individuals with scoliosis. Future research should consider the following recommendations: include a larger number of subjects, longer exercise programmes, use uniform measurement tools to evaluate the results and monitor the long-term effects of exercise