Is Scoliosis Associated with Dance Injury in Young Recreational Dancers? A Large-Scale Cross‑Sectional Epidemiological Study

Efficacy and safety of the orthopaedic manipulation techniques of the Lin School of Lingnan Region in the treatment of adolescent idiopathic scoliosis: protocol of a participant-and-assessor-blinded randomized controlled study

BACKGROUND

Adolescent idiopathic scoliosis (AIS) is the most common developmental spine disorder among children. It is characterized by a lateral deviation of the spine that gives rise to the distinctive "S" or "C" shaped bending of the spine. The Lin School of Lingnan Region (LSLR), one of the prominent schools for bare-handed orthopaedic manipulation in southern China, provides preliminary evidences that the orthopaedic manipulation techniques help to correct deviations of the spine. Previous research found that Orthopaedic Manipulation Techniques of LSLR (OMT-LSLR) could reduce the Cobb's angles in patients with AIS. Therefore, the current study aims to investigate the effectiveness and safety of the OMT-LSLR in treating teenagers with AIS.

METHODS

In this participant-and-assessor-blinded randomized controlled clinical trial, 50 participants identified AIS without surgical indications will be recruited and randomized into two groups to receive physiotherapy scoliosis-specific exercises training with either orthopaedic manipulation or sham manipulation treatment for 16 weeks, followed by post-treatment visits at week 24. Primary outcome measure is the change of Scoliosis Research Society-22 (SRS-22) questionnaire score. Secondary outcome measures include Traditional Chinese version of Spinal Appearance Questionnaire (TC-SAQ) score, Italian Spine Youth Quality of Life (ISYQOL) score, the change of Cobb's angle measured by Xray, and the change of Cobb's angle, spinal rotation and muscle volume measured by three-dimensional (3D) ultrasound. The trial will be conducted at the Chinese University of Hong Kong Chinese Medicine Specialty Clinic cum Clinical Teaching and Research Centre in Hong Kong (CUHK-CMSCTRC).

DISCUSSION

The results of this study will establish comprehensive clinical evidence about the efficacy and safety of the Orthopaedic Manipulation Techniques of the Lin School of Lingnan Region in the Treatment of Adolescent Idiopathic Scoliosis. One of the characteristics of this trial is that it is a participant-and-assessor-blinded randomized controlled clinical trial with sham manipulation. The study would also apply three-dimensional (3D) ultrasound technology to investigate the relationship between the change of the muscle volume and the spinal curve.

TRIAL REGISTRATION

The trial is registered on ClinicalTrials.gov (Identifier: NCT05639023 ) on December 6, 2022.

Psychosocial interventions for teenagers with adolescent idiopathic scoliosis: A systematic literature review

OBJECTIVES

Psychosocial interventions can improve teenagers' self-esteem, mental health and bracing compliance. There is a need to compile available evidence of psychosocial care in adolescent idiopathic scoliosis. This systematic review aimed to identify and evaluate the effects of existing interventional studies of psychosocial care for the adolescent idiopathic scoliosis population.

METHODS

A comprehensive search of relevant literature published from the inception to March 2023 was conducted using nine databases. A google scholar search was performed on 1 July 2023, to update the searching results. Two reviewers independently assessed the methodological quality and extracted details of the included studies. Given the heterogeneity of the selected articles, the findings were synthesized narratively without conducting a meta-analysis.

RESULTS

Four randomized controlled trials reported in six articles involving 385 teenagers were included. The interventions appeared acceptable with high recruitment rates and low dropout rates reported. Psychosocial interventions had shown significant positive effects on postoperative pain, engagement in daily and social activities as well as brace use, coping abilities and anxiety.

CONCLUSION

Psychosocial interventions are generally feasible and acceptable among the adolescent idiopathic scoliosis population and have produced positive effects on a variety of physical and psychosocial outcomes. Study findings need to be interpreted with caution due to the limited number of available articles and the methodological concerns of the reviewed articles.

PRACTICAL IMPLICATIONS

Well-designed clinical trials are warranted in people from cultural backgrounds to develop and implement effective psychosocial interventions for teenagers with adolescent idiopathic scoliosis, not only for those at the post-surgery stage but also for those receiving conservative treatment.

Cross-Cultural Adaptation and Psychometric Properties of the Traditional Chinese Version of the Italian Spine Youth Quality of Life (ISYQOL) Questionnaire

The Italian Spine Youth Quality of Life (ISYQOL) is a validated health-related quality of life (HRQOL) questionnaire for teenagers with adolescent idiopathic scoliosis (AIS). We culturally-adapted ISYQOL to traditional Chinese (ISYQOL-TC) and then recruited 133 conservatively treated teenagers with AIS to complete the ISYQOL-TC and the Chinese version of the Scoliosis Research Society-22 revised (SRS-22r) questionnaire, nine-item Patient Health Questionnaire (PHQ-9), seven-item Generalized Anxiety Disorder scale (GAD-7), and numeric pain rating scale (NPRS). They repeated ISYQOL-TC two weeks later. The internal consistency, unidimensionality, and test-retest reliability were measured using the Cronbach's alpha, Rasch measurement models, and intra-class correlation coefficients (ICC3,1), respectively. The concurrent validity of the ISYQOL-TC with SRS-22r, and its construct validity with other questionnaires were evaluated using Spearman correlation coefficients. The ISYQOL-TC demonstrated good internal consistency (Cronbach's alpha 0.90 and 0.89 for items 1-13 and items 1-20), and excellent test-retest reliability (ICC3,1 = 0.95-0.96). The Rasch analysis supported the unidimensionality of all 20 items in ISYQOL-TC. The ISYQOL-TC percentage scores were positively correlated with SRS-22r total scores (r = 0.65; p < 0.05), but were negatively related to PHQ-9, GAD-7, and NPRS scores (r = -0.46 to -0.39; p < 0.01). Collectively, the ISYQOL-TC is a reliable and valid instrument for evaluating HRQOL in Chinese teenagers with AIS.

Associations Between Physical Activity and Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-analysis

OBJECTIVE

To investigate the associations between adolescent idiopathic scoliosis (AIS) and physical activity (PA).

DATA SOURCES

MEDLINE, EMBASE, AMED, SPORTDiscus, Cochrane Library, and CINAHL electronic databases were searched from inception to August 2022/plus citation tracking.

STUDY SELECTION

Observational studies of participants with radiographically confirmed AIS with ≥10° lateral spinal curvature (Cobb method) and comparator groups without AIS that measured PA were selected by 2 reviewers.

DATA EXTRACTION

Data were extracted independently and cross-checked by 2 reviewers. Risk of bias was evaluated using Newcastle Ottawa Scales and overall confidence in the evidence using the GRADE approach.

DATA SYNTHESIS

Sixteen studies with 9627 participants (9162, 95% women) were included. A history of vigorous PA significantly reduced the odds of being newly diagnosed with AIS by 24% (odds ratio [OR] 0.76, 95% confidence interval [CI] 0.65-0.89) (high certainty). Moderate PA reduced odds by 13% (moderate certainty) and light PA increased odds by 9% (low certainty), but neither analysis was statistically significant. Ballet or gymnastics (OR 1.47, 95% CI 3.08 (1.90, 5.00) were the only individual sports significantly associated with AIS diagnosis (moderate certainty). Case-control studies of people with and without AIS provided greater evidence that having AIS reduces vigorous PA and sports participation, and less evidence light PA and walking are affected.

CONCLUSION

Adolescents who participate in more vigorous PA are less likely to be diagnosed with AIS. Ballet and gymnastics are associated with AIS diagnosis, but the direction of this association is uncertain. People with AIS are likely to do less vigorous physical and sporting activity compared with those without AIS, which could negatively affect health and quality of life. Further research is warranted into the inter-relations between PA and AIS, studies need to be of sufficient size, include men, and evaluate vigorous including higher-impact PA compared with moderate or light PA.

Prevalence of idiopathic scoliosis in athletes: a systematic review and meta-analysis

Objective

This study aimed to determine the prevalence of idiopathic scoliosis (IS) in child, adolescent and adult athletes of all sports activity levels.

Design

Systematic review with meta-analysis.

Data sources

Electronic databases (PubMed, Scopus, ProQuest, Sage journals, ScienceDirect, Google Scholar and Springer) were systematically searched up from inception to 28 September 2021.

Eligibility criteria for selecting studies

Observational investigations were included to evaluate the prevalence of IS in athletes (engaged in any type of individual and team sports). Congenital scoliosis, neuromuscular scoliosis, Scheuermann’s kyphosis and de novo scoliosis were not included. The risk of bias was assessed using the tool developed by Hoy et al.

Results

Twenty-two studies were included (N=57 470, range 15–46544, participants), thirteen studies were of high-quality. The estimated prevalence of IS in athletes was 27% (95% CI 20% to 35%, I²=98%), with a 95% prediction interval (1% to 69%). The prevalence of IS was significantly higher in female athletes (35%, 95% CI 27% to 34%, I²=98%). Ballet dancers showed a high IS prevalence (35%, 95% CI 24% to 47%, I²=98%). Recreational athletes showed a higher IS prevalence (33%, 95% CI 24% to 43%, I²=98%) than at competitive-level athletes (0.05%, 95% CI 0.03% to 0.08%, I²=98%), followed by elite (20%, 95% CI 13% to 27%, I²=98%).

Conclusions

The prevalence of IS in athletes was similar or higher to that as seen in other studies of the general population. IS prevalence may have a U-shaped relationship relative to level of competition. Further studies are required to determine which sports have the highest IS prevalence.