Table 5. Methodological characteristics of included systematic reviews.
| title, reference, year | searching | included studies | method of synthesis | remarks | |
| number, type | quality assessment | ||||
| EXERCISE TREATMENTS: | |||||
| Physical exercises as a treatment for adolescent idiopathic scoliosis. A systematic review. 2003; [51]; (SR 1 of 3)1 | MEDLINE, EMBASE, CINAHL, Cochrane Library (no particular database reported), PEDro | n = 11∶5 uncontrolled before-after; 6 controlled (2 with a historical control) | 11 quality criteria assessed; not referred to any validated scoring tool | study characteristic in tables and figures; individual studies described narratively | |
| 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 | MEDLINE, EMBASE, CINAHL, Cochrane Library (no particular database reported), PEDro; hand searching | n = 8 new: 1 RCT, 3 other controlled, 4 uncontrolled | 11 quality criteria assessed; not referred to any validated scoring tool | study characteristic in tables and figures; individual studies described narratively | |
| Physical exercises in the treatment of adolescent idiopathic scoliosis: an updated systematic review. 2011; [53; (SR 3 of 3)1 | MEDLINE, EMBASE, CINAHL, Cochrane Library (no particular database reported), PEDro; hand searching | n = 1 new PC | characteristic of individual studies | descriptive characteristics; studies not assessed for heterogeneity | study design not an inclusion criterion |
| Efficacy of exercise therapy for the treatment of adolescent idiopathic scoliosis: a review of the literature. 2012; [54] | PubMed; MEDLINE (separately from PubMed, with different results reported); EMBASE; Cochrane Library | n = 12∶9 PC (3 controlled); 2 RC; 1 CS | LoE for each study defined; characteristic of individual studies | characteristic of individual studies in tables and narratively | |
| Exercises for adolescent idiopathic scoliosis. 2012; [33]; Cochrane review | CENTRAL, MEDLINE, EMBASE, CINAHL, SportsDiscus, PsycInfo, PEDro; reference lists; trial registries; grey literature; contacts with authors and investigators | n = 2∶1 RCT; 1PC | quality scoring tools: Cochrane risk of bias tool for RCTs and CCTs; NOS scale for PCs;clinical relevance: 5 standard questions;characteristic of individual studies | dichotomous outcomes: RR for each trial; continuous outcomes: MD and SMD; two studies included and assessed for clinical heterogeneity, therefore no meta-analysis performed; overall quality of evidence for each outcome: adapted GRADE approach | |
| MANUAL THERAPY: | |||||
| Manual therapy as a conservative treatment for adolescent idiopathic scoliosis. 2008; [6] | MEDLINE, EMBASE, CINAHL, Cochrane Library, PEDro, ICL, Osteomed, Osteopathic Research Web, NCCAM | n = 3∶1 C; 1 CS; 1 pilot/feasibility study; additionally, 3 CS discussed | characteristics of individual studies; clinical relevance of studies assessed using five questions recommended by Cochrane Back Review Group | descriptive characteristics of included studies | types of manipulation techniques not defined/diversified; studies described narratively; no formal quality assessment and data synthesis; |
| The use of spinal manipulative therapy for pediatric health conditions: a systematic review of the literature. 2012 [55] | ICL, PubMed; reference lists of previously published reviews | n = 1 pilot RCT on AIS (17 studies regarding other conditions) | 10 item quality assessment tool developed by Sackett, maximal score 50 points; characteristics of individual studies | characteristics of individual studies in a table and narratively | quality score not used to draw conclusions regarding AIS; conclusions based on 1 small feasibility pilot study |
| Myofascial release as a treatment for orthopaedic conditions: a systematic review. 2013; [56] | MEDLINE, CINAHL, Cochrane Library, PEDro, Academic Search Premier | n = 1 CS on AIS (4 RCTs and 5CSs regarding other conditions) | quality scoring tool: PEDro scale for RCTs (4 studies assessed); LoE (CEBM Oxford) for each of 10 studies defined; characteristic of individual studies | characteristic of individual studies in a table and narratively | the paper is in part a report of an SR of experimental studies (RCTs, as we conclude from the LoEs stated and quality appraisal tool used), and in part a narrative analysis of case studies |
| Osteopathic manipulative treatment for pediatric conditions: a systematic review. 2013; [7] | AMED, CINAHL, Embase, Medline, OSTMED.DR, PsycINFO, Cochrane Library, PEDro, ISI Web of Knowledge, Osteopathic Research Web, Rehabdata; reference lists of retrieved studies and key SRs of OMT | n = 1 RCT on OMT in mild AIS (16 RCTs regarding other conditions) | Cochrane risk of bias tool; characteristic of individual studies | effect sizes for the effect of OMT on any type of OM calculated by using Cohen’s d formulas; characteristic, quality and limitations of included RCTs discussed both in concert, and separately for each study | |
| BRACING: | |||||
| Surgical rates after observation and bracing for adolescent idiopathic scoliosis: an evidence-based review. 2007; [25] | MEDLINE, Web of Science, CENTRAL, Clinical Evidence, reference lists | bracing n = 15∶4 R comparison studies, 8 R CS, 2 P CS, 1 P/R CS; observation n = 3 R comparison studies | rating system (LoE); characteristics of individual studies | pooled prevalence estimates of surgery in untreated and brace treated patients; pooled prevalence for surgery by type of brace, curve type, skeletal maturity and dose (full time vs part time wear) | search limited to English language; quality assessment not conducted; one reviewer selected studies and extracted data; studies not tested for heterogeneity |
| Braces for idiopathic scoliosis in adolescents. 2010; [16]; Cochrane review | CENTRAL, MEDLINE, CINAHL, up to July 2008; reference lists; trial registries; grey literature; contacts with authors and investigators | n = 2∶1 RCT; 1 multicentre international PC | Quality scoring tools: Cochrane risk of bias tool for RCTs and CCTs; NOS for PCs; characteristic of individual studies | Meta-analysis not performed as only 1 RCT and 1 PC included; overall quality of evidence for each outcome assessed with an adapted GRADE approach | |
| Effectiveness and outcomes of brace treatment: A systematic review. 2011; [57] | PubMed | n = 20∶2 CCT; 18 C–C | 11 criteria of methodological quality (Cochrane Back Review Group) | characteristics of individual studies; CCTs and C–C assessed with the same criteria, and analysed collectively; LoE ratings provided, but not used | low quality of reporting: different papers included (selected) and different ones analysed in “discussion” section |
| Efficacy of bracing versus observation in the treatment of idiopathic scoliosis. 2011; [43] | PubMed, Cochrane Collaboration database (no particular database reported), NGC; references of “key articles” | n = 8∶5 PC; 3 RC comparison studies | characteristic of individual studies, addressing QoL, curve angle and surgery rates; rating system: SoE | pooling of data impossible due to heterogeneity; pooled surgical rates and between groups risk differences calculated from study-level data; treatment effects calculated by subtracting change scores; descriptive characteristics of individual studies; | Comparison (analytic design) cohort studies included; RCT an inclusion criterion – no RCTs found; findings based on “the highest” obtainable (comparison studies), but still “very low to low” level of evidence |
| Bracing in adolescent idiopathic scoliosis, surrogate outcomes, and the number needed to treat. 2012; [36] | Cochrane Database (not stated, which particular one), PubMed Clinical Queries | two separate searches: question 1: bracing efficacy: n = 6 (3SRs, 2 P (1 RCT), 1 R CS); question 2: studies comparing different braces: n = 11 (1 RCT, 1 CCT, 2 SRs, 9 R comparison studies) | included studies of various types discussed shortly in a narrative; LoEs reported as quality of evidence analysis | included studies characterised individually in a narrative, including methodological assessment of some of them; one cohort study analysed in detail, with NNTs calculated and discussed | review of studies of various types, including SRs; one CS analysed in detail; the manuscript consists partly of the report of SR of studies of various types, and partly of an educational presentation of the issue of NNTs and surrogate outcomes |
| DIFFERENT COMBINATIONS OF NON-SURGICAL INTERVENTIONS | |||||
| Effectiveness of non-surgical treatment for idiopathic scoliosis. Overview of available evidence. 1991; [58] | MEDLINE, 1975–1987; reference lists | natural history n = 17∶4 PC, 3 RC; bracing n = 10∶7 RC, 1 PC, 2 unclear data; bracing+exercise: n = 1 PC; LESS: n = 5∶3 PC, 1 RC, 1 unclear P | characteristics of individual studies | pooled proportions of data; descriptive characteristics of included studies; | searching incomprehensive; lack of quality appraisal of the included studies; only uncontrolled studies included; data from studies on juvenile and adolescent IS mixed |
| A meta-analysis of the efficacy of non-operative treatments for idiopathic scoliosis. 1997; [26] | Campbell’s Operative Pediatric Orthopedics, 2nd ed., 1995; 2 publications added by authors | n = 19∶18P and 1R: 13 on bracing; 6 on LESS; 1 on observation; 18 published (1 thesis); 1 unpublished | characteristics of individual studies | number of failures of treatment and mean proportion of success determined for each study; then data combined in meta-analysis; Q test to assess homogeneity; other tests to determine the contribution of variables | one data source searched, details of searching lacking; limited data on included studies and their quality; results not adjusted for compliance to brace wear; potential differences in LESS technique not considered |
| Effect of bracing and other conservative interventions in the treatment of idiopathic scoliosis in adolescents: a systematic review of clinical trials.2005; [37] | Cochrane, CINAHL, PubMed, PEDro | n = 13∶3 RCTs: 2 on bracing+exercises; 1 on traction; 10 CCTs: 7 on different rigid braces; 1 on side-shift therapy; 1 on behaviourally posture-oriented training; 1 on LESS | quality scoring tool: Delphi list, quality scores; rating system (LoE); characteristics of individual studies | quality of individual studies assessed; where possible, relative risks calculated; studies assessed for homogeneity | some AMSTAR items scored “N”, but criteria partially met (Table 2); many interventions and outcomes considered, with few weak quality primary studies available |
| The treatment of adolescent idiopathic scoliosis (AIS) according to present evidence. A systematic review. 2008; [17] 2 | PubMed, MEDLINE, Web of Science, EMBASE, DH-DATA, Allied and Complementary Medicine, British Nursing Index, CENTRAL, CINAHL, PsycInfo; reference lists | physiotherapy: n = 6 “level III studies with control groups and cohort studies”, n = 2 SRs; bracing: n = 2 “level II studies” –1 P controlled multicenter, 1 P controlled long-term follow-up; 26 R or uncontrolled series, 1 meta-analysis | discussion of chosen papers, general impression of the LoEs | general assumption of the LoEs (Oxford CEBP) from the included studies; descriptive characteristics of some of the included studies | search strategy reported, but only keywords provided; quality appraisal: only levels of evidence mentioned, but appraisal/scale/scoring not addressed or reported; the paper is in part a report from an SR of evidence, and in part a narrative review |
| USUAL PHYSICAL ACTIVITY: | |||||
| Is physical activity contraindicated for individuals with scoliosis? A systematic literature review. 2009; [59] | PubMed, CINAHL, ICL, NGC, reference lists; websites of organisations | n = 11∶3 C–C; 1 CS; 1 survey; 6 narrative reviews | rating system (LoE) used (but reported as quality assessment); characteristic of individual studies | descriptive characteristics of included studies | study type not an inclusion criterion −6 out of 11 papers included were narrative reviews; opinion-based recommendations rather than evidence-synthesis |
| ADVERSE EVENTS: | |||||
| Low bone mineral status in adolescent idiopathic scoliosis. 2008; [60] | MEDLINE; EMBASE; CINAHL; All EBM Reviews (Cochrane DSR, CCTR, DARE, ACP Journal Club); reference lists | 5 brace studies of different characteristic (no details on design provided) | no formal quality assessment due to “wide variations”across studies; characteristics of individual studies | pooling of data not performed due to heterogeneity; descriptive characteristics of included studies | lack of clear information on the types of included studies; no quality assessment performed |
| Scoliosis and dental occlusion: a review of the literature. 2011; [61] | MEDLINE, EMBASE, Cochrane Oral Health Group Trial Register, handsearching: orthodontic journals, reference lists | n = 2 referenced, 1 (CCT ?) regarding the effect of Milwaukee brace on dentofacial growth analysed narratively | design, number and age of participants, and type of control group | descriptive characteristics of the included study | low quality of reporting: e.g. errors in referencing, “discussion” and “conclusions” sections do not address results of the evidence synthesis |
B – bracing; Ex – exercises; O – observation; Surgery; NR – not reported; P –prospective study; R – retrospective study; C - cohort study; CS – case series; LESS – lateral electrical stimulation; ES – electrical stimulation; RCT – randomised controlled trial; CCT – controlled clinical trial; C–C – case-control study; NCCAM – National Centre for Complementary and Alternative Medicine; ICL – the Index to Chiropractic Literature; NGC – National Guideline Clearinghouse; QoL – quality of life; CENTRAL – the Cochrane Central Register of Controlled Trials; NOS scale – the Nottingham-Ottawa scale; LoE – level of evidence; SoE – strength of evidence; SR – systematic review; SSE - scoliosis-specific exercises; ATR – angle of trunk rotation; RR – risk ratio; MD – mean difference; SMD – standardised mean difference; OMT – osteopathic manipulative treatment;
1
series of updates, analysed in concert or separately, depending on how the authors addressed individual study characteristics (also explained in Table S1);
2
the review has a section on surgical treatment, not reported here.