{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T08:57:02Z","timestamp":1763629022058,"version":"3.45.0"},"reference-count":68,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T00:00:00Z","timestamp":1763424000000},"content-version":"unspecified","delay-in-days":17,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"the Natural Science Foundation of Hubei Province","award":["2025AFD623"],"award-info":[{"award-number":["2025AFD623"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,10,28]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Adolescent idiopathic scoliosis (AIS) involves three-dimensional structural spinal changes, frequently accompanied by scapular dyskinesis (SD) and proprioceptive dysfunction. Although physiotherapeutic scoliosis-specific exercises effectively correct spinal alignment, their efficacy in addressing SD and associated sensorimotor deficits remains underexplored. This randomised controlled trial (RCT) will evaluate whether integrating upper limb proprioceptive neuromuscular facilitation (PNF) with conventional physical therapy yields synergistic improvements in scapular kinematics and proprioceptive function in AIS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This single-centre RCT will be conducted at the Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. 48 adolescents with AIS will be randomly assigned to either a control group (n=24) receiving conventional physical therapy or an experimental group (n=24) receiving combined conventional therapy and upper limb PNF interventions. Both groups will follow a structured 60 min rehabilitation programme, administered five sessions per week for 8 weeks (including two outpatient sessions and three home training sessions per week). Follow-up assessments will be conducted at 12 weeks postintervention to evaluate the maintenance of therapeutic effects. Primary outcomes will include the scapular balance angle and the active relocation test for shoulder proprioception. Secondary outcomes will comprise the scapular index, the lateral scapular slide test, normalised surface electromyography (root mean square, %muscle activation degree) of the upper trapezius, lower trapezius, serratus anterior, posterior deltoid and infraspinatus during standardised tasks, posture analysis, Cobb angle, angle of trunk rotation and the Simplified Chinese version of the Scoliosis Research Society-22 questionnaire for health-related quality of life. Data will be analysed using Analysis of Covariance and linear mixed-effects models, adjusted for baseline values, following the intention-to-treat principle.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The study protocol has been approved by the Ethics Committee of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (Approval No. TJ-IEB2025-018) and has been registered on ClinicalTrials.gov. The findings will be disseminated through peer-reviewed journal publications, conference presentations and media releases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>ChiCTR2500099252.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-106848","type":"journal-article","created":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T08:52:09Z","timestamp":1763628729000},"page":"e106848","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of adding proprioceptive neuromuscular facilitation to conventional physiotherapy on scapular balance and shoulder proprioception in adolescents with idiopathic scoliosis: a randomised controlled trial protocol"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-4180-6020","authenticated-orcid":false,"given":"Yanzi","family":"Xu","sequence":"first","affiliation":[{"name":"Graduate School, Wuhan Sports University, Wuhan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mengying","family":"Feng","sequence":"additional","affiliation":[{"name":"Graduate School, Wuhan Sports University, Wuhan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruidi","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Huazhong University of Science and Technology, Wuhan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Huazhong University of Science and Technology, Wuhan, China"},{"name":"World Health Organization Cooperative Training and Research Center in Rehabilitation, Wuhan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhaoyi","family":"Yang","sequence":"additional","affiliation":[{"name":"Graduate School, Wuhan Sports University, Wuhan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ziyu","family":"Wang","sequence":"additional","affiliation":[{"name":"Hubei Key Laboratory of Exercise Training and Monitoring, Wuhan Sports University, Wuhan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhenghong","family":"Kang","sequence":"additional","affiliation":[{"name":"Hubei Key Laboratory of Exercise Training and Monitoring, Wuhan Sports University, Wuhan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lingfeng","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Huazhong University of Science and Technology, Wuhan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hua","family":"Liu","sequence":"additional","affiliation":[{"name":"Hubei Key Laboratory of Exercise Training and Monitoring, Wuhan Sports University, Wuhan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,11,19]]},"reference":[{"key":"2025112000505473000_15.11.e106848.1","doi-asserted-by":"crossref","first-page":"1850","DOI":"10.1002\/jbmr.4137","article-title":"Idiopathic Scoliosis as a Rotatory Decompensation of the Spine","volume":"35","author":"Castelein","year":"2020","journal-title":"J Bone Miner Res"},{"key":"2025112000505473000_15.11.e106848.2","doi-asserted-by":"crossref","first-page":"2521","DOI":"10.4103\/0366-6999.217081","article-title":"Scoliosis in China: History and Present Status","volume":"130","author":"Qiu","year":"2017","journal-title":"Chin Med J (Engl)"},{"key":"2025112000505473000_15.11.e106848.3","doi-asserted-by":"crossref","first-page":"512","DOI":"10.2340\/16501977-2240","article-title":"Epidemiological study of adolescent idiopathic scoliosis in Eastern China","volume":"49","author":"Zheng","year":"2017","journal-title":"J Rehabil Med"},{"key":"2025112000505473000_15.11.e106848.4","doi-asserted-by":"crossref","DOI":"10.1016\/j.bone.2020.115563","article-title":"From genetics to epigenetics to unravel the etiology of adolescent idiopathic scoliosis","volume":"140","author":"P\u00e9rez-Machado","year":"2020","journal-title":"Bone"},{"key":"2025112000505473000_15.11.e106848.5","unstructured":"V\u00e1clav B , Martin K , Peter V . 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