In 1941, a committee of the American Orthopaedic Association undertook a study of methods and results of treatment of idiopathic scoliosis, by interviewing clinicians at sixteen clinics in the United States . Case histories of 425 patients, followed for >1 year after treatment, were evaluated. The goal of the study was to 'establish the present status of this condition, and to clarify, in so far as possible, what can be expected from the present methods of treatment.'
At that time, most clinics prescribed a regime of specialized exercises and/or surgery . Short term results obtained with surgery and with exercise were similar, with little or no improvement obtained for most patients. Among 214 patients treated with spinal fusion, significant loss of correction occurred in 92% of patients, and in 30% of cases the curvature was the same or worse after surgery than before. Long term complications were not available but at short-term followup, the results in 69% of treated patients were rated as 'fair' or 'poor.' Among 185 patients treated with exercise at the 16 clinics surveyed, 69% either remained unchanged or increased by 5–15 degrees, 27% increased by ≥20 degrees, and one curve improved by >10 degrees. Questionnaires revealed that 'most men agree that postural improvement can be expected from a regime of exercises, but the curve itself cannot be decreased by this means.'
In the ensuing decades since this study was published, the routine use of exercise for patients in the United States was largely eliminated (e.g., 65–78). Meanwhile, an ongoing global effort to develop effective surgical methods is reflected in >10,000 peer reviewed articles published, in English, since 1950 and listed in Medline and other searches for scholarly articles. Unfortunately, the lack of success with exercise reported in 1941, unlike the failure of surgery, has not led to a corresponding effort to define improved methods for using physical therapy to treat patients with scoliosis: A parallel search of Medline reveals that fewer than 100 articles exploring the use of exercise-based approaches in the treatment of scoliosis in patients, of any age, have been published.
The routine use of exercise has remained central to therapeutic approaches in many countries . To date, however, the body of literature available to patients and clinicians is of limited use . The relatively limited literature in part reflects clinical traditions which have not placed a high priority on publication. Perhaps more important, a diversity of approaches, standards, and languages limits how accessible and interpretable the available information is to colleagues with common interests : Among several hundred reports of clinical outcome published in recent decades (>600), no fewer than ten different languages were used. The establishment of a scientific society dedicated to research into scoliosis rehabilitation, and a venue for rigorous peer review of results from specialists, are critical first steps in defining the role of physical therapy in treatment of scoliosis.