{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T23:09:42Z","timestamp":1793315382332,"version":"4.5.0"},"reference-count":43,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n The effectiveness of a training support program of individually tailored physiotherapeutic scoliosis-specific exercises (PSSEs) delivered via a digital care system is unclear.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine the effectiveness of a digital care program in which patients receive PSSE supervision and guidance via the Healbone Intelligent Rehabilitation System and educational videos compared with a conventional intervention involving 3 treatment sessions conducted by qualified physiotherapists at outpatient clinics or specialized orthopedic institutions and unsupervised home-based PSSE training.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This randomized clinical trial recruited patients aged 9 to 17 years from Peking Union Medical College Hospital in Beijing, China, who had adolescent idiopathic scoliosis with a primary curve Cobb angle of 10\u00b0 or greater and skeletal immaturity (as determined via the Risser grading system). The trial was conducted from June 1, 2023, to August 10, 2024.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Patients were randomly assigned to a digital care (DC) group, in which each patient received fully remote and home-based PSSE training supported by a digital care system, or a usual care group, in which each patient completed 3 treatment sessions conducted by qualified physiotherapists at outpatient clinics or specialized orthopedic institutions and home-based PSSE training without supervision.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n \n The primary outcome was a change in the Cobb angle of the major curve between baseline and month 6 of the intervention. Primary and secondary outcomes were evaluated using an independent samples\n t<\/jats:italic>\n test. The proportion of patients who exhibited disease progression or improvement in the Cobb angle between the 2 groups was compared using a \u03c7\n 2<\/jats:sup>\n test.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Of 591 patients assessed for eligibility, 436 did not meet the eligibility criteria, 12 declined to participate, and 15 withdrew before randomization. The remaining 128 patients were randomized to 2 parallel groups, with 64 patients in each group (mean [SD] age, 11.1 (2.2) years; 97 female [75.8%]), all of whom completed the baseline assessment and 6-month follow-up. The mean difference in the improvement of the Cobb angle between the DC group and the usual care group after a 6-month intervention was \u22124.23\u00b0 (95% CI, \u22126.08\u00b0 to \u22122.39\u00b0) in the intention-to-treat analysis and \u22124.01\u00b0 (95% CI, \u22125.68\u00b0 to \u22122.35\u00b0) in the per-protocol analysis. The posttreatment Cobb angle was adjusted by using analysis of covariance, and the mean of the difference in the adjusted posttreatment Cobb angle between 2 groups was \u22124.24\u00b0 (95% CI, \u22126.09\u00b0 to \u22122.38\u00b0).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this randomized clinical trial, the effectiveness of individually tailored PSSE training support delivered via a digital care system was superior to that of a conventional PSSE training model in improving the Cobb angle. This mode of exercise may be an effective and convenient alternative for individuals with adolescent idiopathic scoliosis.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n Chinese Clinical Trial Registry Identifier:\n ChiCTR2300076563<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.59929","type":"journal-article","created":{"date-parts":[[2025,2,18]],"date-time":"2025-02-18T11:07:00Z","timestamp":1739876820000},"page":"e2459929","source":"Crossref","is-referenced-by-count":23,"title":["Digital Physiotherapeutic Scoliosis-Specific Exercises for Adolescent Idiopathic Scoliosis"],"prefix":"10.1001","volume":"8","author":[{"given":"Wangshu","family":"Yuan","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weihong","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lixia","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Di","family":"Liu","sequence":"additional","affiliation":[{"name":"Jiakang Zhongzhi Technology Company, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ye","family":"Lin","sequence":"additional","affiliation":[{"name":"The University of Chicago, Pritzker School of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qing","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiandong","family":"Lu","sequence":"additional","affiliation":[{"name":"Tianjin Binhai Vocational Institute of Automotive Engineering, Tianjin, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Houqiang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiyang","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huiling","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Digital Care Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wangshu","family":"Yuan","sequence":"additional","affiliation":[{"name":"for the Digital Care Study Group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weihong","family":"Shi","sequence":"additional","affiliation":[{"name":"for the Digital Care Study Group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lixia","family":"Chen","sequence":"additional","affiliation":[{"name":"for the Digital Care Study Group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Di","family":"Liu","sequence":"additional","affiliation":[{"name":"for the Digital Care Study Group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ye","family":"Lin","sequence":"additional","affiliation":[{"name":"for the Digital Care Study Group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qing","family":"Li","sequence":"additional","affiliation":[{"name":"for the Digital Care Study Group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiandong","family":"Lu","sequence":"additional","affiliation":[{"name":"for the Digital Care Study Group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Houqiang","family":"Zhang","sequence":"additional","affiliation":[{"name":"for the Digital Care Study Group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiyang","family":"Feng","sequence":"additional","affiliation":[{"name":"for the Digital Care Study Group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huiling","family":"Zhang","sequence":"additional","affiliation":[{"name":"for the Digital Care Study Group"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,2,18]]},"reference":[{"issue":"4","key":"zoi241672r1","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1097\/CM9.0000000000000652","article-title":"Research progress on the etiology and pathogenesis of adolescent idiopathic scoliosis.","volume":"133","author":"Peng","year":"2020","journal-title":"Chin Med J (Engl)"},{"issue":"1","key":"zoi241672r2","first-page":"19","article-title":"Adolescent idiopathic scoliosis: common questions and answers.","volume":"101","author":"Kuznia","year":"2020","journal-title":"Am Fam Physician"},{"key":"zoi241672r3","doi-asserted-by":"publisher","first-page":"15030","DOI":"10.1038\/nrdp.2015.30","article-title":"Adolescent idiopathic scoliosis.","volume":"1","author":"Cheng","year":"2015","journal-title":"Nat Rev Dis Primers"},{"issue":"6","key":"zoi241672r4","doi-asserted-by":"publisher","first-page":"947","DOI":"10.1016\/j.spinee.2020.01.008","article-title":"Prevalence of adolescent idiopathic scoliosis in Turkey: an epidemiological study.","volume":"20","author":"Yilmaz","year":"2020","journal-title":"Spine J"},{"issue":"49","key":"zoi241672r5","first-page":"875","article-title":"Idiopathic scoliosis.","volume":"107","author":"Trobisch","year":"2010","journal-title":"Dtsch Arztebl Int"},{"issue":"13","key":"zoi241672r6","doi-asserted-by":"publisher","first-page":"1006","DOI":"10.1097\/BRS.0000000000000952","article-title":"Prediction of curve progression in idiopathic scoliosis: validation of the Sanders Skeletal Maturity Staging System.","volume":"40","author":"Sitoula","year":"2015","journal-title":"Spine (Phila Pa 1976)"},{"key":"zoi241672r7","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1186\/s13013-017-0145-8","article-title":"2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth.","volume":"13","author":"Negrini","year":"2018","journal-title":"Scoliosis Spinal Disord"},{"issue":"1","key":"zoi241672r8","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1186\/1748-7161-7-3","article-title":"2011 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth.","volume":"7","author":"Negrini","year":"2012","journal-title":"Scoliosis"},{"issue":"5","key":"zoi241672r9","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1177\/02692155211070452","article-title":"Corrective exercise-based therapy for adolescent idiopathic scoliosis: systematic review and meta-analysis.","volume":"36","author":"G\u00e1miz-Berm\u00fadez","year":"2022","journal-title":"Clin Rehabil"},{"issue":"1","key":"zoi241672r10","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.52492","article-title":"Nighttime bracing or exercise in moderate-grade adolescent idiopathic scoliosis: a randomized clinical trial.","volume":"7","author":"Charalampidis","year":"2024","journal-title":"JAMA Netw Open"},{"issue":"3","key":"zoi241672r11","doi-asserted-by":"publisher","first-page":"440","DOI":"10.23736\/S1973-9087.17.04461-6","article-title":"Effects of the Schroth exercise on idiopathic scoliosis: a meta-analysis.","volume":"54","author":"Park","year":"2018","journal-title":"Eur J Phys Rehabil Med"},{"key":"zoi241672r12","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1016\/j.physio.2023.07.005","article-title":"The effects of physiotherapeutic scoliosis-specific exercise on idiopathic scoliosis in children and adolescents: a systematic review and meta-analysis.","volume":"121","author":"Ma","year":"2023","journal-title":"Physiotherapy"},{"issue":"8","key":"zoi241672r13","doi-asserted-by":"publisher","first-page":"1024","DOI":"10.3390\/medicina58081024","article-title":"The effects of short- and long-term spinal brace use with and without exercise on spine, balance, and gait in adolescents with idiopathic scoliosis.","volume":"58","author":"da Silveira","year":"2022","journal-title":"Medicina (Kaunas)"},{"issue":"2","key":"zoi241672r14","doi-asserted-by":"publisher","first-page":"228","DOI":"10.23736\/S1973-9087.23.07654-2","article-title":"The effectiveness of Schroth method in Cobb angle, quality of life and trunk rotation angle in adolescent idiopathic scoliosis: a systematic review and meta-analysis.","volume":"59","author":"Ceballos-Laita","year":"2023","journal-title":"Eur J Phys Rehabil Med"},{"issue":"4","key":"zoi241672r15","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0249492","article-title":"The effectiveness of two different exercise approaches in adolescent idiopathic scoliosis: a single-blind, randomized-controlled trial.","volume":"16","author":"Kocaman","year":"2021","journal-title":"PLoS One"},{"issue":"1","key":"zoi241672r16","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1038\/s41746-023-00841-8","article-title":"Digital health technology in clinical trials.","volume":"6","author":"Mittermaier","year":"2023","journal-title":"NPJ Digit Med"},{"issue":"2","key":"zoi241672r17","doi-asserted-by":"publisher","first-page":"759","DOI":"10.1007\/s00431-023-05340-2","article-title":"The effect of Pilates-based exercise applied with hybrid telerehabilitation method in children with adolescent idiopathic scoliosis: a randomized clinical trial.","volume":"183","author":"Manzak Dursun","year":"2024","journal-title":"Eur J Pediatr"},{"issue":"12","key":"zoi241672r18","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.32779","article-title":"Idiopathic scoliosis trends one year after COVID-19: a retrospective study.","volume":"14","author":"Pereira","year":"2022","journal-title":"Cureus"},{"issue":"2","key":"zoi241672r19","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1177\/21925682221109565","article-title":"The relationship between compliance of physiotherapeutic scoliosis specific exercises and curve regression with mild to moderate adolescent idiopathic scoliosis.","volume":"14","author":"Fan","year":"2024","journal-title":"Global Spine J"},{"issue":"3","key":"zoi241672r20","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1007\/s43390-020-00253-8","article-title":"Completion of a formal physiotherapeutic scoliosis-specific exercise training program for adolescent idiopathic scoliosis increases patient compliance to home exercise programs.","volume":"9","author":"Simhon","year":"2021","journal-title":"Spine Deform"},{"issue":"15","key":"zoi241672r21","doi-asserted-by":"publisher","first-page":"1039","DOI":"10.1097\/BRS.0000000000003451","article-title":"Effects of specific exercise therapy on adolescent patients with idiopathic scoliosis: a prospective controlled cohort study.","volume":"45","author":"Liu","year":"2020","journal-title":"Spine (Phila Pa 1976)"},{"issue":"20","key":"zoi241672r22","doi-asserted-by":"publisher","first-page":"2191","DOI":"10.1001\/jama.2013.281053","article-title":"World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects.","volume":"310","author":"World Medical Association","year":"2013","journal-title":"JAMA"},{"issue":"3","key":"zoi241672r23","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1007\/s00586-018-5821-8","article-title":"The \u201cRisser+\u201d grade: a new grading system to classify skeletal maturity in idiopathic scoliosis.","volume":"28","author":"Troy","year":"2019","journal-title":"Eur Spine J"},{"key":"zoi241672r24","doi-asserted-by":"publisher","DOI":"10.1155\/2019\/9758273","article-title":"Differences in nonspecific low back pain between young adult females with and without lumbar scoliosis.","volume":"2019","author":"Yuan","year":"2019","journal-title":"Pain Res Manag"},{"issue":"22","key":"zoi241672r25","doi-asserted-by":"publisher","first-page":"E836","DOI":"10.1097\/BRS.0b013e318187bb10","article-title":"Comparison of reliability between the PUMC and Lenke classification systems for classifying adolescent idiopathic scoliosis.","volume":"33","author":"Qiu","year":"2008","journal-title":"Spine (Phila Pa 1976)"},{"issue":"9","key":"zoi241672r26","doi-asserted-by":"publisher","first-page":"1518","DOI":"10.1016\/j.spinee.2019.03.008","article-title":"Modified PUMC classification for adolescent idiopathic scoliosis.","volume":"19","author":"Zhuang","year":"2019","journal-title":"Spine J"},{"key":"zoi241672r28","doi-asserted-by":"publisher","DOI":"10.2196\/45207","article-title":"The effectiveness of digital apps providing personalized exercise videos: systematic review with meta-analysis.","volume":"25","author":"Davergne","year":"2023","journal-title":"J Med Internet Res"},{"key":"zoi241672r29","doi-asserted-by":"publisher","DOI":"10.1016\/j.msksp.2024.102952","article-title":"Comparison of the efficacy of Schroth and Lyon exercise treatment techniques in adolescent idiopathic scoliosis: a randomized controlled, assessor and statistician blinded study.","volume":"72","author":"B\u00fcy\u00fckturan","year":"2024","journal-title":"Musculoskelet Sci Pract"},{"issue":"21","key":"zoi241672r30","doi-asserted-by":"publisher","first-page":"2589","DOI":"10.1097\/CM9.0000000000001799","article-title":"Schroth exercises improve health-related quality of life and radiographic parameters in adolescent idiopathic scoliosis patients.","volume":"134","author":"Gao","year":"2021","journal-title":"Chin Med J (Engl)"},{"issue":"2","key":"zoi241672r31","doi-asserted-by":"publisher","first-page":"520","DOI":"10.1177\/03635465211053869","article-title":"The minimal clinically important difference: a review of clinical significance.","volume":"51","author":"Bloom","year":"2023","journal-title":"Am J Sports Med"},{"issue":"13","key":"zoi241672r32","doi-asserted-by":"publisher","first-page":"1342","DOI":"10.1001\/jama.2014.13128","article-title":"Minimal clinically important difference: defining what really matters to patients.","volume":"312","author":"McGlothlin","year":"2014","journal-title":"JAMA"},{"issue":"9","key":"zoi241672r33","doi-asserted-by":"publisher","first-page":"2025","DOI":"10.1007\/s00586-019-06067-1","article-title":"Characterization of trunk motion in adolescents with right thoracic idiopathic scoliosis.","volume":"28","author":"Pesenti","year":"2019","journal-title":"Eur Spine J"},{"key":"zoi241672r34","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1109\/RBME.2018.2807182","article-title":"A review on accelerometry-based gait analysis and emerging clinical applications.","volume":"11","author":"Jarchi","year":"2018","journal-title":"IEEE Rev Biomed Eng"},{"issue":"1","key":"zoi241672r35","first-page":"3","article-title":"Gait analysis advancements: rehabilitation value and new perspectives from forensic application.","volume":"27","author":"Mangone","year":"2023","journal-title":"Eur Rev Med Pharmacol Sci"},{"issue":"6","key":"zoi241672r36","doi-asserted-by":"publisher","first-page":"1634","DOI":"10.1177\/0962280216666564","article-title":"Multiple imputation by chained equations for systematically and sporadically missing multilevel data.","volume":"27","author":"Resche-Rigon","year":"2018","journal-title":"Stat Methods Med Res"},{"issue":"6","key":"zoi241672r37","article-title":"Braces for idiopathic scoliosis in adolescents.","volume":"2015","author":"Negrini","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"issue":"3","key":"zoi241672r38","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1519\/JPT.0000000000000262","article-title":"Long-term efficacy of treatment effects after a kyphosis exercise and posture training intervention in older community-dwelling adults: a cohort study.","volume":"44","author":"Katzman","year":"2021","journal-title":"J Geriatr Phys Ther"},{"issue":"3","key":"zoi241672r39","doi-asserted-by":"publisher","DOI":"10.2196\/mhealth.8518","article-title":"Patient involvement with home-based exercise programs: can connected health interventions influence adherence?","volume":"6","author":"Argent","year":"2018","journal-title":"JMIR Mhealth Uhealth"},{"issue":"55","key":"zoi241672r40","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3310\/hta19550","article-title":"Active Treatment for Idiopathic Adolescent Scoliosis (ACTIvATeS): a feasibility study.","volume":"19","author":"Williams","year":"2015","journal-title":"Health Technol Assess"},{"key":"zoi241672r41","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1186\/1748-7161-5-27","article-title":"\u201cRehabilitation schools for scoliosis\u201d thematic series: describing the methods and results.","volume":"5","author":"Rigo","year":"2010","journal-title":"Scoliosis"},{"issue":"1","key":"zoi241672r42","doi-asserted-by":"publisher","DOI":"10.2196\/15688","article-title":"Economic advantages of telehealth and virtual health practitioners: return on investment analysis.","volume":"3","author":"Snoswell","year":"2020","journal-title":"JMIR Perioper Med"},{"key":"zoi241672r43","doi-asserted-by":"publisher","DOI":"10.2196\/56580","article-title":"The physical and psychological effects of telerehabilitation-based exercise for patients with nonspecific low back pain: prospective randomized controlled trial.","volume":"12","author":"Shi","year":"2024","journal-title":"JMIR Mhealth Uhealth"},{"key":"zoi241672r27","unstructured":"RANDOM.ORG. 1998. Accessed May 19, 2023. https:\/\/www.random.org\/"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2830349\/yuan_2025_oi_241672_1738950513.55324.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,18]],"date-time":"2025-02-18T11:07:07Z","timestamp":1739876827000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2830349"}},"subtitle":["A Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2025,2,18]]},"references-count":43,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025,2,3]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2024.59929","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,18]]}}}