The goal of this clinical trial is to determine if pre-operative scoliosis-specific exercises have a beneficial effect on the health outcomes of surgery for adolescent idiopathic scoliosis. Adolescent idiopathic scoliosis affects adolescents between the age of 10-18. The main questions this study aims to answer are: * Can pre-operative exercises help reduce curve progression prior to surgery? * Can pre-operative exercises help improve the surgery outcomes, such as a lower number of vertebrae needing fusion, increased curve correction, reduced surgery length, and shorter length of stay in the hospital? * Can a pre-operative exercise intervention result in a reduction of the cost of surgery? Researchers will compare the current standard of care (the control group) to an intervention group (with pre-op exercises) to see if pre-op exercises have an effect on these outcomes. Participants will: * visit the clinic every 3 months to complete ultrasound imaging scans and questionnaires * if given an exercise intervention, aim to complete it for roughly 30 minutes a day
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
40
The pre-op exercise group will complete a 6-month supervised pre-op exercise program. This program is adapted from the Schroth exercise program we tested for moderate scoliosis, showing good effect on curve angles, muscle endurance, posture, curve severity, and in self-reported pain and QOL scores. This physiotherapy will individualize exercises to specific spinal curvature(s). Exercises will focus on elongating and derotating the spine to improve the flexibility before surgery. The corrective movements required, the targeted curve type, the level of passive support involved, and the dosages recommended, have been published previously. A Schroth curve classification algorithm and algorithms to guide the prescription for the curve type will help standardize treatment. The program begins with 5 supervised visits in the first 2 weeks to help learn the exercises. The following month has supervised visits weekly and then every other week. The aim is to exercise 30mins per day 5x/week.
Clinical Science Building, University of Alberta
Edmonton, Alberta, Canada
Number of levels fused
The number of vertebrae levels fused during surgery for AIS. This is an indicator of the amount of flexibility afforded to participants post-op, their risk of adverse wear and tear on unoperated levels, and also can indicate significant cost savings to the hospital and health system.
Time frame: Indicated during surgical planning, completed during surgery (where it may change from plans)
Italian Spine Youth Quality of Life (ISYQOL) questionnaire
The Italian Spine Youth Quality of Life questionnaire contains 20 questions with the first 13 answered by all patients with scoliosis and the next 7 answered only by those wearing a brace. The raw sum score of the items is converted to a 0 to 100 quality of life score where 100 indicates the best quality of life.
Time frame: Baseline, 3 months, 6 months, and at first routine follow-up post-surgery (6 weeks post-op)
Spinal Appearance Questionnaire (SAQ) v1.1 Appearance score
The SAQ v1.1 is a questionnaire consisting of 14 items with the first 10 items producing an appearance score reflecting the self-perceived torso appearance. The appearance score ranges from 10 to 50 with low scores indicating better perceived appearance.
Time frame: Baseline, 3 months, 6 months, and at first routine follow-up post-surgery (6 weeks post-op)
Spinal Appearance Questionnaire (SAQ) v1.1 expectation score
The SAQ v1.1 is a questionnaire consisting of 14 items with the last 4 items producing an expectation score reflecting the desire to be more even on some asymmetry features. The expectation score ranges from 4 to 20 with low scores indicating less desire to change the appearance.
Time frame: Baseline, 3 months, 6 months, and at first routine follow-up post-surgery (6 weeks post-op)
Spinal Appearance Questionnaire (SAQ) v1.1 total score
The SAQ v1.1 is a questionnaire consisting of 14 items producing a score from 14 to 70 with low scores indicating better perceived appearance.
Time frame: Baseline, 3 months, 6 months, and at first routine follow-up post-surgery (6 weeks post-op)
Pre-operative flexibility measured by 3D Ultrasound Imaging
The degree (amount) to which the frontal scoliotic curve is reduced during side-bending compared to standing in a radiograph or ultrasound imaging is the curve's flexibility. These will be taken in ultrasound scanning images of participants.
Time frame: Baseline, 3 months, and 6 months
Other Surgery-related Outcomes
Other surgical outcomes include: length (duration) of surgery in minutes, length of stay in hospital post-surgery, percentage of curve correction.
Time frame: During surgery & immediately post-surgery
Truncal Anterior Asymmetry Scoliosis Questionnaire (TAASQ) Breast
The TAASQ assesses patient-perceived anterior truncal appearance. This consists of 14 individual questions that fall into a Breast (questions 4 a, b, c; 12; 13; 14) main domain. The TAASQ uses a combination of Likert scales and free text responses. Each multiple-choice question features answer options ranging from 1 to 5, where 5 corresponds to the least amount of concern or asymmetry and 1 corresponds to the most concern. The average score is then calculated for each domain and sub-domain. Higher scores on the TAASQ indicate better quality of life.
Time frame: Baseline, 3 months, 6 months, and first routine follow-up post-surgery (6 weeks post-op)
Truncal Anterior Asymmetry Scoliosis Questionnaire (TAASQ) Clothing
The TAASQ assesses patient-perceived anterior truncal appearance. This consists of 14 individual questions that fall into three main domains including the Clothing (1; 2 a, b, c, d, e; 3; 8 a, b, c; 9) domain. The TAASQ uses a combination of Likert scales and free text responses. Each multiple-choice question features answer options ranging from 1 to 5, where 5 corresponds to the least amount of concern or asymmetry and 1 corresponds to the most concern. The average score is then calculated for each domain and sub-domain. Higher scores on the TAASQ indicate better quality of life.
Time frame: Baseline, 3 months, 6 months, and first routine follow-up post-surgery (6 weeks post-op)
Truncal Anterior Asymmetry Scoliosis Questionnaire (TAASQ) Appearance
The TAASQ assesses patient-perceived anterior truncal appearance. This consists of 14 individual questions that fall into three main domains: including Appearance (5; 6; 7; 10; 11)., Each multiple-choice question features answer options ranging from 1 to 5, where 5 corresponds to the least amount of concern or asymmetry and 1 corresponds to the most concern. The average score is then calculated for each domain and sub-domain. Higher scores on the TAASQ indicate better quality of life.
Time frame: Baseline, 3 months, 6 months, and first routine follow-up post-surgery (6 weeks post-op)
Truncal Anterior Asymmetry Scoliosis Questionnaire (TAASQ) Breast Location
The TAASQ assesses patient-perceived anterior truncal appearance. The Breast domain can be categorized into a Breast location (Q4c, 13) subdomain scored from 1 to 5, where 5 corresponds to the least amount of concern or asymmetry and 1 corresponds to the most concern. The average score is then calculated for each domain and sub-domain. Higher scores on the TAASQ indicate better quality of life.
Time frame: Baseline, 3 months, 6 months, and first routine follow-up post-surgery (6 weeks post-op)
Truncal Anterior Asymmetry Scoliosis Questionnaire (TAASQ) Breast shape
The TAASQ assesses patient-perceived anterior truncal appearance. The Breast domain can be categorized into a Breast Shape (Q4b, 12) subdomain scored from 1 to 5, where 5 corresponds to the least amount of concern or asymmetry and 1 corresponds to the most concern. The average score is then calculated for each domain and sub-domain. Higher scores on the TAASQ indicate better quality of life.
Time frame: Baseline, 3 months, 6 months, and first routine follow-up post-surgery (6 weeks post-op)
Truncal Anterior Asymmetry Scoliosis Questionnaire (TAASQ) Breast size
The TAASQ assesses patient-perceived anterior truncal appearance. The Breast domain can be categorized into a Breast size (Q4a, 14). subdomain scored from 1 to 5, where 5 corresponds to the least amount of concern or asymmetry and 1 corresponds to the most concern. The average score is then calculated for each domain and sub-domain. Higher scores on the TAASQ indicate better quality of life.
Time frame: Baseline, 3 months, 6 months, and first routine follow-up post-surgery (6 weeks post-op)
Truncal Anterior Asymmetry Scoliosis Questionnaire (TAASQ) Clothing General
The TAASQ assesses patient-perceived anterior truncal appearance. This consists of 14 individual questions that fall into a Clothing-General (Q1, 3, 8a, 9) subdomain. Each multiple-choice question features answer options ranging from 1 to 5, where 5 corresponds to the least amount of concern or asymmetry and 1 corresponds to the most concern. The average score is then calculated for each domain and sub-domain. Higher scores on the TAASQ indicate better quality of life.
Time frame: Baseline, 3 months, 6 months, and first routine follow-up post-surgery (6 weeks post-op)
Truncal Anterior Asymmetry Scoliosis Questionnaire (TAASQ) Clothing Specific
The TAASQ assesses patient-perceived anterior truncal appearance. This consists of 14 individual questions that fall into a Clothing-Specific (Q2, 8b, 8c, 8d) subomain. Each multiple-choice question features answer options ranging from 1 to 5, where 5 corresponds to the least amount of concern or asymmetry and 1 corresponds to the most concern. The average score is then calculated for each domain and sub-domain. Higher scores on the TAASQ indicate better quality of life.
Time frame: Baseline, 3 months, 6 months, and first routine follow-up post-surgery (6 weeks post-op)
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