Schroth exercises added to bracing for adolescent idiopathic scoliosis: a systematic review and meta-analysis.

Background: Bracing is the principal non-operative treatment for skeletally immature adolescents with idiopathic scoliosis. Schroth exercises are often adjunctively prescribed; however, their incremental value over bracing alone remains uncertain. Objective: To evaluate the effectiveness, safety, adherence, and treatment burden of Schroth or explicitly Schroth-based exercises added to bracing compared with bracing alone. Methods: This PROSPERO-registered systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 principles. Comparative studies of braced adolescents with idiopathic scoliosis were included. The risk of bias was assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2) or risk of bias in non-randomized studies of interventions (ROBINS-I), and certainty was assessed using Grading of Recommendation Assessment, Development and Evaluation (GRADE). Primary continuous synthesis used postintervention/final values within prespecified clinically comparable follow-up and brace-dose contexts; change score, imputed standard deviation, mixed follow-up, abstract-limited, unequal brace dose, and non-randomized analyses were treated as sensitivity and exploratory evidence. Results: Fourteen studies were included, comprising nine randomized and five non-randomized comparative studies. Randomized progression evidence was sparse and inconclusive [risk ratio: 0.44, 95% confidence interval (CI): 0.07-2.82; 71 participants]. Primary endpoint/final-value continuous analyses favored combined treatment for the Cobb angle [mean difference (MD): 3.78°, 95% CI: 2.27-5.29; 330 participants] and angle of trunk rotation (MD: 1.82°, 95% CI: 0.16-3.48; 220 participants), but heterogeneity was substantial and certainty was very low. Harm, adherence, and burden were reported incompletely. Conclusions: Schroth or Schroth-based exercises added to bracing may improve the short-term Cobb angle, while trunk-rotation effects are directionally favorable but uncertain. The evidence was insufficient to determine additional effects on the quality of life, pain, respiratory function, posture, chest-wall or rib-cage mobility, pelvic alignment, balance, gait, long-term progression, surgery, adherence, harm, or treatment burden. Schroth exercises should be framed as adjuncts to prescribed bracing, not as replacements for adequate brace wear or reasons to reduce the brace dose. Future trials should evaluate radiographic, postural, respiratory, functional, adherence, safety, burden, and participation outcomes. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261397961, PROSPERO CRD420261397961.