{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T15:00:40Z","timestamp":1789398040360,"version":"build-2803163510"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T00:00:00Z","timestamp":1764806400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100018588","name":"Yibin Science and Technology Planning Program","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100018588","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity that can impair posture, function, and quality of life. Schroth exercise, a physiotherapeutic scoliosis-specific exercise, has demonstrated benefits in reducing Cobb angle and improving patient-reported outcomes. Traditional Chinese Medicine (TCM) manipulation may modulate musculoskeletal asymmetry and pain, potentially exerting synergistic effects when combined with Schroth therapy. This study aims to evaluate whether TCM manipulation plus Schroth exercise is superior to Schroth exercise alone in improving spinal curvature, patient-centered outcomes, and paraspinal symmetry in AIS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This is a single-center, randomized controlled, two-arm parallel-group superiority trial. Sixty adolescents (aged 10\u201318) with idiopathic scoliosis and Cobb angle 10\u00b0\u201345\u00b0 will be randomized 1:1 to: (1) Schroth therapy alone (control) or (2) TCM manipulation combined with Schroth exercise (intervention). Primary outcome is change in Cobb angle measured by full-length standing anteroposterior spinal radiograph before and after the intervention. Secondary outcomes include Angle of Trunk Rotation (ATR), paraspinal thermal asymmetry assessed by infrared thermography, and health-related quality of life measured by the Scoliosis Research Society-22r (SRS-22r) questionnaire. Participants will be randomly allocated (1:1) using a computer-generated, stratified block randomization sequence with allocation concealed by sealed opaque envelopes. The analysis will follow the intention-to-treat (ITT) principle, and an ANCOVA adjusting for baseline measurements will be used for between-group comparisons. A total sample size of 60 participants (30 per group) was determined\n                      <jats:italic>a priori<\/jats:italic>\n                      to provide 80% power (\n                      <jats:italic>\u03b1<\/jats:italic>\n                      \u2009=\u20090.05,\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.20) to detect a clinically meaningful difference in Cobb angle, allowing for a 20% attrition rate.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>If effective, the combined regimen could offer a non-invasive, integrative therapeutic option for AIS, with implications for conservative management guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The study protocol was approved by the Ethics Committee of Yibin Traditional Chinese Medicine Hospital [Approval No. KY2024 Review (016)]. The trial has been prospectively registered in the International Traditional Medicine Clinical Trial Registry (ITMCTR) on January 6, 2025. The study will be conducted in accordance with the principles of the Declaration of Helsinki (Edinburgh 2000 revision). The trial findings will be disseminated through publication in peer-reviewed journals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>The full trial protocol and statistical analysis plan can be accessed via the ITMCTR website (Registration No. ITMCTR2025000131). Any important modifications to the protocol will be submitted for approval by the institutional ethics committee and updated in the ITMCTR.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2025.1693246","type":"journal-article","created":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T06:34:18Z","timestamp":1764830058000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["The traditional Chinese medicine manipulation combined with Schroth exercises for adolescent idiopathic scoliosis: protocol for a randomized controlled trial"],"prefix":"10.3389","volume":"13","author":[{"given":"Jun","family":"Tao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongjian","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guilong","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rong","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tangyu","family":"Liao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zi","family":"Yin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenqi","family":"Feng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,12,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1527","DOI":"10.1016\/S0140-6736(08)60658-3","article-title":"Adolescent idiopathic scoliosis","volume":"371","author":"Weinstein","year":"2008","journal-title":"Lancet"},{"key":"B2","doi-asserted-by":"publisher","first-page":"676","DOI":"10.1530\/EOR-23-0162","article-title":"Adolescent idiopathic scoliosis in adulthood","volume":"9","author":"Ansari","year":"2024","journal-title":"EFORT Open Rev"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1399049","DOI":"10.3389\/fped.2024.1399049","article-title":"Prevalence of scoliosis in children and adolescents: a systematic review and meta-analysis","volume":"12","author":"Li","year":"2024","journal-title":"Front Pediatr"},{"key":"B4","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"},{"key":"B5","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1177\/0269215515575745","article-title":"The efficacy of three-dimensional Schroth exercises in adolescent idiopathic scoliosis: a randomised controlled clinical trial","volume":"30","author":"Kuru","year":"2016","journal-title":"Clin Rehabil"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e0168746","DOI":"10.1371\/journal.pone.0168746","article-title":"Schroth physiotherapeutic scoliosis-specific exercises added to the standard of care lead to better cobb angle outcomes in adolescents with idiopathic scoliosis\u2014an assessor and statistician blinded randomized controlled trial","volume":"11","author":"Schreiber","year":"2016","journal-title":"PLoS One"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1204","DOI":"10.1007\/s00586-014-3241-y","article-title":"Active self-correction and task-oriented exercises reduce spinal deformity and improve quality of life in subjects with mild adolescent idiopathic scoliosis. Results of a randomised controlled trial","volume":"23","author":"Monticone","year":"2014","journal-title":"Eur Spine J"},{"key":"B8","doi-asserted-by":"publisher","first-page":"409","DOI":"10.12669\/pjms.41.2.11355","article-title":"The effect of Schroth Therapy combined with spinal manipulation for the treatment of adolescent idiopathic scoliosis","volume":"41","author":"Chen","year":"2025","journal-title":"Pak J Med Sci"},{"key":"B9","doi-asserted-by":"publisher","first-page":"e0307955","DOI":"10.1371\/journal.pone.0307955","article-title":"Pelvic rotation correction combined with Schroth exercises for pelvic and spinal deformities in mild adolescent idiopathic scoliosis: a randomized controlled trial","volume":"19","author":"Zhang","year":"2024","journal-title":"PLoS One"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1038973","DOI":"10.3389\/fendo.2022.1038973","article-title":"Benefits on pain and mental health of manual therapy for idiopathic scoliosis: a meta-analysis","volume":"13","author":"Ren","year":"2022","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1500373","DOI":"10.3389\/fped.2024.1500373","article-title":"Traditional Chinese medicine manual therapy for adolescent idiopathic scoliosis: a case report","volume":"12","author":"Zhu","year":"2024","journal-title":"Front Pediatr"},{"key":"B12","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1186\/s13643-025-02893-1","article-title":"Comparative efficacy of conservative interventions for adolescent idiopathic scoliosis: a systematic review and network meta-analysis of randomized controlled trials","volume":"14","author":"Ren","year":"2025","journal-title":"Syst Rev"},{"key":"B13","doi-asserted-by":"publisher","first-page":"e081477","DOI":"10.1136\/bmj-2024-081477","article-title":"SPIRIT 2025 statement: updated guideline for protocols of randomised trials","volume":"389","author":"Chan","year":"2025","journal-title":"Br Med J"},{"key":"B14","doi-asserted-by":"crossref","first-page":"1381","DOI":"10.2106\/00004623-198466090-00010","article-title":"An objective criterion for scoliosis screening","volume":"66","author":"Bunnell","year":"1984","journal-title":"J Bone Joint Surg Am"},{"key":"B15","doi-asserted-by":"publisher","first-page":"e0249492","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"},{"key":"B16","doi-asserted-by":"publisher","first-page":"e2459929","DOI":"10.1001\/jamanetworkopen.2024.59929","article-title":"Digital physiotherapeutic scoliosis-specific exercises for adolescent idiopathic scoliosis: a randomized clinical trial","volume":"8","author":"Yuan","year":"2025","journal-title":"JAMA Netw Open"},{"key":"B17","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1186\/s13013-015-0048-5","article-title":"The effect of Schroth exercises added to the standard of care on the quality of life and muscle endurance in adolescents with idiopathic scoliosis-an assessor and statistician blinded randomized controlled trial: \u201cSOSORT 2015 award winner\u201d","volume":"10","author":"Schreiber","year":"2015","journal-title":"Scoliosis"},{"key":"B18","doi-asserted-by":"publisher","first-page":"904","DOI":"10.4102\/sajp.v75i1.904","article-title":"The effectiveness of Schroth exercises in adolescents with idiopathic scoliosis: a systematic review and meta-analysis","volume":"75","author":"Burger","year":"2019","journal-title":"S Afr J Physiother"},{"key":"B19","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"},{"key":"B20","doi-asserted-by":"publisher","first-page":"7928429","DOI":"10.1155\/2023\/7928429","article-title":"Spinal manual therapy for adolescent idiopathic scoliosis: a systematic review and meta-analysis of randomized controlled trials","volume":"2023","author":"Sun","year":"2023","journal-title":"Biomed Res Int"},{"key":"B21","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1016\/j.jbmt.2018.01.005","article-title":"Manual therapy treatment for adolescent idiopathic scoliosis","volume":"23","author":"Lotan","year":"2019","journal-title":"J Bodyw Mov Ther"},{"key":"B22","doi-asserted-by":"publisher","first-page":"e0302577","DOI":"10.1371\/journal.pone.0302577","article-title":"Effect of adding Schroth physiotherapeutic scoliosis specific exercises to standard care in adolescents with idiopathic scoliosis on posture assessed using surface topography: a secondary analysis of a randomized controlled trial (RCT)","volume":"19","author":"Mohamed","year":"2024","journal-title":"PLoS One"},{"key":"B23","doi-asserted-by":"publisher","first-page":"874","DOI":"10.1186\/s12891-024-07974-1","article-title":"The efficacy of combined physiotherapeutic scoliosis-specific exercises and manual therapy in adolescent idiopathic scoliosis","volume":"25","author":"Wenxia","year":"2024","journal-title":"BMC Musculoskelet Disord"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1613800","DOI":"10.3389\/fmed.2025.1613800","article-title":"Effect of acupuncture and massage on adolescent idiopathic scoliosis and pain severity","volume":"12","author":"Jia","year":"2025","journal-title":"Front Med (Lausanne)"},{"key":"B25","doi-asserted-by":"publisher","first-page":"235","DOI":"10.2165\/00007256-200535030-00004","article-title":"The mechanisms of massage and effects on performance, muscle recovery and injury prevention","volume":"35","author":"Weerapong","year":"2005","journal-title":"Sports Med"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1693246\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T06:34:19Z","timestamp":1764830059000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1693246\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,4]]},"references-count":25,"alternative-id":["10.3389\/fped.2025.1693246"],"URL":"https:\/\/doi.org\/10.3389\/fped.2025.1693246","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,4]]},"article-number":"1693246"}}