JMIR Publications

ABSTRACT

Background:

Adolescent idiopathic scoliosis (AIS) is a complex three-dimensional spinal deformity of unknown etiology, for which bracing and physiotherapeutic scoliosis-specific exercises (PSSE) are conservative treatments for individuals with AIS. However, limited access to professional personnel and specialized facilities hinders the effectiveness of PSSE training or bracing, making the integration of digital technologies a promising yet currently under-evidenced solution.

Objective:

This systematic review and meta-analysis aimed to evaluate the therapeutic effects of digital PSSE training combined with or without bracing on Cobb angle, the angle of trunk rotation (ATR), Scoliosis Research Society (SRS) scores, and compliance for individuals with AIS.

Methods:

A comprehensive literature search was conducted across PubMed, Embase, Web of Science, PEDro, the Cochrane Central Register of Controlled Trials, the China National Knowledge Infrastructure (CNKI), Wanfang, and VIP databases for studies published up to August 31, 2026. Studies investigating digital PSSE training with or without bracing were included. The risk of bias for randomized controlled trials (RCTs) was assessed using the Cochrane Risk of Bias 2.0 tool, and the certainty of evidence was evaluated using the GRADE approach. Quasi-experimental studies were assessed using ROBINS-I. A fixed-effect meta-analysis was performed using RevMan 5.4 to pool data on Cobb angle, ATR, SRS score, and compliance for individuals with AIS.

Results:

A total of 7 RCTs and 2 quasi-experimental studies were included in the systematic review, with 7 RCTs included in the meta-analysis. Compared with traditional PSSE training with or without bracing, digital PSSE training with or without bracing yielded a significant reduction in the Cobb angle by 4.02 degrees, showing clear superiority over traditional PSSE training with or without bracing (mean difference (MD): 4.02, 95% confidence interval (95% CI): 3.63 to 4.40, P < .001). Furthermore, digital PSSE training significantly improved SRS scores compared to traditional PSSE training (MD: 2.16, 95% CI: 1.46 to 2.86, P < .001). However, no significant difference was found in ATR improvement between digital and traditional PSSE training. Notably, digital PSSE training effectively improved patient adherence compared to traditional methods.

Conclusions:

This systematic review firstly demonstrates the efficacy of digital PSSE training combined with or without bracing for individuals with AIS. The findings indicate that digital PSSE training with or without bracing for individuals with AIS can effectively improve Cobb angles, SRS scores, and compliance compared to the traditional conservative training model. Future research should focus on optimizing digital healthcare modalities combined with PSSE or bracing, and conducting multi-center, large-sample clinical trials to validate short-, medium-, and long-term therapeutic outcomes. Clinical Trial: PROSPERO CRD420261497979;https://www.crd.york.ac.uk/PROSPERO/view/CRD420261497979