September 18, 2019
What Happened to Scoliosis School Screening?
The Cobb angle is used to measure the size of the scoliosis curve. It is often a major fixation for the patient and/or the parent. The Cobb angle is often used as a way of measuring success of treatment seeing the main goal is often to correct or stop curve progression. The Scoliosis Research Society (SRS) identifies the Cobb angle as the primary outcome of treatment. However The Society of Scoliosis and Orthopaedic Rehabilitation Treatment (SOSORT) identifies the Cobb angle as less important, listing is below aesthetic perception, quality of life, disability, pain and psychological well being. So, what do patients think about all this? Before we look into this let’s look at the current conservative treatment options for scoliosis.
Conservative treatment options are outlined in the SOSORT guidelines. Schroth and SEAS (Scientific Exercise Approach to Scoliosis) are two of the therapies listed that could be used for some patients with scoliosis. Bracing is also used for some patients. Beyond the conservative approach some patients require, or opt for, surgery. Conservative therapy involves exercise. Schroth is one of the programs. While Cobb angle improvements may occur, it is not always the main focus of treatment. As stated above, SOSORT places greater emphasis on other outcomes over Cobb angle. Schroth aims to improve postural balance, and other signs and symptoms of scoliosis.
A study by Schreiber et al conducted a study to determine what the patients considered an improvement after treatment with Schroth. Results of this study showed that patients undergoing Schroth treatment ‘perceived a positive change in the state of their backs even if the Cobb angle did not improve beyond the arbitrary accepted threshold of 5 degrees.’ Furthermore they stated that ‘The perceived improvement in the overall state of their backs appears to be due to improved outcomes other than the two-dimensional Cobb angle.’ While further study is needed this is a good sign that patients often have other goals other goals other than just improving the Cobb angle. Stabilisation and improvement of Cobb angle is a great outcome, however the focus for patients should be holistic with major focuses including working towards improved aesthetics, quality of life, disability, pain and psychological well being.