World-wide variation in Schroth therapists’ clinical reasoning and exercise prescription for adolescents with idiopathic scoliosis
This thesis addresses the gap in the literature regarding knowledge of the current standard of care offered by Schroth therapists to adolescents with idiopathic scoliosis (AIS). Currently, Schroth based training and certification courses are delivered to health professionals world-wide however there is no research exploring how Schroth is prescribed in practice for AIS, nor consideration of the factors that influence this prescription. Therefore this thesis aimed to explore world-wide variation in Schroth therapists’ clinical reasoning and exercise prescription for AIS.
Current understanding of Schroth therapy for AIS is based on a small number of studies that assess the efficacy of Schroth therapy for outcomes such as progression of Cobb angle. While randomised controlled trials exist, there is limited detailed reporting of the methodology, particularly in regard to details of the exercise prescription. Current Schroth studies, like many exercise based studies, have been conducted as per a protocol set by the authors, which may not necessarily mirror a realistic setting for patients. The transferability of any exercise protocols is still difficult to determine when information regarding the factors influencing prescription are also missing.
A mixed methods study was conducted to explore how Schroth therapists world-wide are prescribing Schroth exercise to AIS, and to better understand the factors influencing this exercise prescription. To better understand Schroth exercise prescription a survey was sent to 945 therapists who were listed as certified on two publicly available databases of schools that offer Schroth-based training. The 173 respondents (18% response rate) answered questions regarding demographics, exercise selection, exercise progression, frequency and dosages of treatment and the inclusion of any adjunctive methods to their Schroth treatment programs. Once the data was analysed, seven survey participants participated in semi-structured interviews on Zoom, to explore the factors influencing this prescription in their own clinical setting. The data collected from both the survey and interviews allowed for analysis of the current standard of care being offered by Schroth therapists to AIS world-wide.
The findings suggest that Schroth therapists are combining multiple methods of treatment, depending on the extent of their training and experience, for AIS. While Schroth therapy is the primary method chosen, Schroth therapists are adapting their prescription according to the needs and characteristics of the adolescent (physical, emotional and mental), the dynamics of the parent-adolescent relationship, their own clinical experience as a therapist and the system in which they work. They are using an adaptive, personalised approach to their treatment, with consideration of available evidence, their own clinical experience and the needs and values of the patient.
These findings suggest that future researchers should consider the realities of the application of Schroth to ensure that research findings are applicable in a real clinical setting. One way to achieve this would be through an adaptive, rather than the typical per protocol (using existing randomised controlled trials as a paradigm of ‘per protocol’ treatment) , research study that factors in the realities of Schroth therapy application described in this thesis, to better understand the effectiveness of such approaches. Given that Schroth therapists are adding adjunctive therapies to their treatment of AIS it is necessary to explore the effectiveness of such approaches to help guide the direction of therapist training.