Table 4. Content (PICO) characteristics of included reviews.
| title, reference, year | Participants/condition(s) | Intervention(s) | Comparator(s) | Outcome measure(s) |
| EXERCISE TREATMENTS: | ||||
| Physical exercises as a treatment for adolescent idiopathic scoliosis. A systematic review. 2003; [51]; (SR 1 of 3)1 | patients with AIS, Risser sign <5 (skeletally immature) | any type of treatment with SSEs3, but not mixed with other treatments | any type, or no treatment | Cobb angle/curve progression |
| Exercises reduce the progression rate of adolescent idiopathic scoliosis: results of a comprehensive systematic review of the literature. 2008; [52]; (SR 2 of 3)1 | patients with AIS, Risser sign <5 (skeletally immature) | any type of treatment with SSEs3, but not mixed with other treatments | any type, or no treatment | Cobb angle/curve progression |
| Physical exercises in the treatment of adolescent idiopathic scoliosis: an updated systematic review. 2011; [53]; (SR 3 of 3)1 | patients with AIS, Risser sign <5 (skeletally immature) | any type of treatment with SSEs3, but not mixed with other treatments | any type, or no treatment | Cobb angle/curve progression |
| Efficacy of exercise therapy for the treatment of adolescent idiopathic scoliosis: a review of the literature. 2012; [54] | patients with AIS | exercise therapy (as a sole therapy) | different, reported individually for the included controlled studies | inclusion criterion: “minimum of one defined outcome measure; outcome measures reported individually for the included studies |
| Exercises for adolescent idiopathic scoliosis. 2012; [33]; Cochrane review | AIS, age from 10 years to skeletal maturity (Risser sign or ages between 15–17 years in girls or 16–19 years in boys) | all types of SSEs2; | no treatment, different types of SSEs, usual physiotherapy, doses and schedules of exercises, other non-surgical treatments | “a review of the effect of the exercise on a radiological observation rather than a clinical syndrome”; primary outcomes: curve progression, cosmetic issues, QoL and disability, back pain, psychological issues; secondary outcomes: adverse effects; |
| MANUAL THERAPY: | ||||
| Manual therapy as a conservative treatment for adolescent idiopathic scoliosis. 2008; [6] | patients with AIS | “manipulative therapeutic methods”: osteopathic, chiropractic, massage techniques | none of the included studies had a control group/comparator intervention | curve progression (Cobb angle) |
| The use of spinal manipulative therapy for pediatric health conditions: a systematic review of the literature. 2012 [55] | IS (among various clinical conditions affecting children); age ≤18 years | “manual, high-velocity low-amplitude thrusting spinal manipulations” | standard medical care or sham manipulation | “studies using some type of outcome measure for determining the effect of chiropractic care”; the AIS study: Cobb angle, QoL |
| Myofascial release as a treatment for orthopaedic conditions: a systematic review. 2013; [56] | IS among other orthopaedic conditions | indirect and passive myofascial release (MFR) | not applicable – one case study included | OMs not defined as inclusion criteria for the SR; OMs from the included IS case study: pain, pulmonary function, QoL, range of motion |
| Osteopathic manipulative treatment for pediatric conditions: a systematic review. 2013; [7] | adolescents with IS (IS among other paediatric conditions) | OMT3 (performed by osteopaths) as a sole treatment; studies on chiropractic manipulations excluded; the OMT technique used in the AIS study described in detail | any type of controls admissible; control in the AIS study – no treatment | any outcome measures in RCTs investigating the effect of OMT (e.g. hospital stay, spine flexibility, FEV1– reported for individual studies), also in conjunction with other treatment, on paediatric conditions, included; |
| BRACING: | ||||
| Surgical rates after observation and bracing for adolescent idiopathic scoliosis: an evidence-based review. 2007; [25] | patients with AIS, and no other conditions responsible for curvature: 20–45°Cobb, Riser 0–2, age <15 years, follow-up to skeletal maturity | bracing as a sole treatment (e.g. without physical therapy): TLSOs, bending braces, but not Milwaukee, SpinalCor, Triac; | observation | surgery; recommended surgery; curve progression >50° |
| Braces for idiopathic scoliosis in adolescents. 2010; [16]; Cochrane review | patients with AIS, aged from 10 years to skeletal maturity | all types of braces, “worn for a specific number of hours a day for a specific number of years”; | any control interventions and comparisons | primary: pulmonary disorders, disability, back pain, QOL, psychological and cosmetic issues; secondary: cob angle and progression >5° before, at the end of bone maturity, in adulthood; adverse effects |
| Effectiveness and outcomes of brace treatment: A systematic review. 2011; [57] | patients with AIS | bracing (any type) | observation; exercises; LESS; casting; surgery | curve progression; surgery; pulmonary function; QoL; “psychological state” |
| Efficacy of bracing versus observation in the treatment of idiopathic scoliosis. 2011; [43] | patients with AIS | bracing (any type/method); | observation | surgery rates, failure rates, QoL, curve angle changes |
| Bracing in adolescent idiopathic scoliosis, surrogate outcomes, and the number needed to treat. 2012; [36] | patients with AIS | bracing | natural history | 6° curve progression – surrogate outcome vs need for surgery in NNTs; efficacy of different braces |
| DIFFERENT COMBINATIONS OF NON-SURGICAL INTERVENTIONS: | ||||
| Effectiveness of non-surgical treatment for idiopathic scoliosis. Overview of available evidence. 1991; [58] | juveniles and adolescents with IS | natural history; non-surgical treatment: LESS, bracing (Milwaukee and/or Boston or Wilmington, full-time or part-time), posture training device, exercises (not specified) | Non-treated controls in one included study; other studies non-controlled | progression (>5°Cobb); failure of treatment (>45°Cobb or surgery) |
| A meta-analysis of the efficacy of non-operative treatments for idiopathic scoliosis. 1997; [26] | juveniles and adolescents with IS | bracing: Milwaukee, TLSO: 8, 16 and 23 hours/day; Charleston; LESS; observation | only one included study had a control group (bracing vs no treatment) | type of treatment, level of maturity (Risser sign), criterion to determine progression (or failure of treatment): 3°, 5°, 6° or 10°Cobb, duration of brace wear |
| Effect of bracing and other conservative interventions in the treatment of idiopathic scoliosis in adolescents: a systematic review of clinical trials. 2005; [37] | IS, patients aged <18 years | bracing: Boston, Milwakee, Chêneau, Charlston, TLSO, underarm plastic, 3-valve orthosis; different types and wearing times; exercise+brace; exercise program; Side-Shift; SSE+ES; LESS; night-time ES; behaviourally posture-oriented training; traction; fixed traction at night | different control interventions, or combinations of interventions, individual trials included | measures of effectiveness, depending of the study included: Cobb angle, rotation component, loads on instrumented pads (Milwakee brace, throat mold design); surgery rate (number of surgeries undertaken); success rate |
| The treatment of adolescent idiopathic scoliosis (AIS) according to present evidence. A systematic review. 2008; [17] | patients with AIS | physiotherapy, rehabilitation, bracing, surgery4 | observation | not specified |
| USUAL PHYSICAL ACTIVITY: | ||||
| Is physical activity contraindicated for individuals with scoliosis? A systematic literature review. 2009 [59] | people with all types of scoliosis | usual physical and sports activities; treatment options: observation, bracing (type of brace not reported as a criterion), surgery4; therapeutic exercise(s): exclusion criterion | physical activity of healthy subjects – in 2 included case-controlled studies; other studies uncontrolled | any measures related to appropriateness of physical/sports activity |
| ADVERSE EFFECTS: | ||||
| Low-bone mineral status in adolescent idiopathic scoliosis. 2008; [60] | adolescents with IS | the association between brace wear and bone mineral density were evaluated | different, reported individually for the included controlled studies | low bone mass in idiopathic scoliosis |
| Scoliosis and dental occlusion: a review of the literature. 2011; [61] | adolescents with malocclusion and scoliosis | the paper concentrated on prevalence and coincidence of malocclusion and scoliosis, but also on effects of bracing intervention (bracing) on malocclusion5 | non-scoliosis subjects in the individual controlled primary studies (reported separately), but uncontrolled studies also included | any descriptions of outcomes of interest: primary: “incidence and description of malocclusion of people with scoliosis” secondary: “clinical consequences associated with treatments of malocclusion or scoliosis” |
AIS – adolescent idiopathic scoliosis; FEV1– forced expiratory volume in 1 second; NA – not addressed; NNT - Number Needed to Treat; OM – outcome measure; QoL – quality of life; SIR – “scoliosis inpatient rehabilitation”; SR – systematic review;
1
series of updates, analysed in concert or separately, depending on how the authors addressed individual study characteristics (also explained in Table S1);
2
SSE – scoliosis specific exercise: “curve-specific movements performed with a therapeutic aim of reducing the deformity” [33];
3
OMT - Osteopathic manipulative treatment, defined in [7] as “the therapeutic application of manually guided forces by an osteopathic physician to improve physiologic function and/or support homeostasis that has been altered by somatic dysfunction”;
4
recommendations related to surgically treated patients not analysed here;
5
malloclusion – “Imperfect positioning of the teeth when the jaws are closed” [http://www.oxforddictionaries.com/definition/english/malocclusion].