Virtual Reality-based Schroth Exercise Versus Traditional Schroth Exercise on Trunk Kinematics in Scoliosis

Virtual Reality-based Schroth Exercise Versus Traditional Schroth Exercise on Trunk Kinematics and Quality of Life in Scoliosis

The study will be conducted to compare three-dimensional trunk kinematics (rotation, tilt, and flexion/extension) and quality of life among adolescents with idiopathic scoliosis receiving traditional Schroth physiotherapeutic scoliosis-specific exercises, Schroth exercises combined with immersive virtual reality using Meta Quest 2 (OhShape), and Schroth exercises combined with low-cost mobile virtual reality using Google Cardboard with a gaze-controlled game.

Physiotherapeutic scoliosis-specific exercises (PSSE), particularly the Schroth method, are widely recommended as a first-line conservative treatment for adolescent idiopathic scoliosis and have demonstrated effectiveness in reducing curve progression, improving posture, and enhancing quality of life. However, the long-term success of Schroth rehabilitation is highly dependent on patient adherence and the accurate execution of complex three-dimensional corrective postures, which remain challenging for adolescents to maintain outside supervised clinical settings.

Poor adherence to traditional Schroth programs has been reported, with rates ranging between 30% and 50%, limiting the real-world effectiveness of conservative scoliosis management. Adolescents frequently report low motivation, boredom, and difficulty understanding or maintaining corrective postures without continuous feedback, which compromises motor learning and postural control.

Digital rehabilitation technologies, particularly virtual reality (VR), have emerged as promising tools to enhance engagement, motivation, and motor learning in rehabilitation programs. VR-based exercise has demonstrated positive effects on adherence, movement accuracy, and postural awareness in neurological and musculoskeletal rehabilitation. Immersive VR platforms provide real-time visual and auditory feedback and promote task-oriented training in an engaging gaming environment, which is particularly suitable for adolescent populations.

To date, no randomized controlled trial has directly compared immersive high-end VR platforms with low-cost mobile VR solutions for the delivery of scoliosis-specific exercises, nor has any study quantified real-time trunk kinematics during VR-guided Schroth rehabilitation using Wearable inertial measurement units (IMUs) technology. Evaluating these interventions may provide clinicians with valuable insight into cost-effective, scalable, and engaging rehabilitation strategies for adolescents with idiopathic scoliosis, particularly in resource-limited healthcare settings

Inclusion Criteria:

• Age: 10-19 years.
• Diagnosed adolescent idiopathic scoliosis (AIS) confirmed by spinal radiography .
• Cobb angle between 20° and 35° (moderate curve, below surgical threshold).
• No prior spinal surgery.
• Ability to perform Schroth exercises independently.
• Ability to use a virtual reality headset.
• No prior virtual reality experience.
• Free from pain or pain less than 8 on visual analogue scale.
• Type of curve (thoracolumbar s scoliosis).

Exclusion Criteria:

• Secondary scoliosis (neuromuscular or post-surgical scoliosis).
• Severe structural deformity (Cobb angle >50° or severe vertebral rotation).
• Neurological or neuromuscular disorders affecting balance or proprioception.
• Active orthopedic injury or recent surgery (<2 years) involving the spine or lower extremities.
• Severe cardiopulmonary disease contraindicating exercise.
• Uncontrolled pain (Visual Analog Scale >8).
• Current participation in another structured spinal rehabilitation program or participation within the last 6 months.
• History of severe cybersickness or prior intolerance to virtual reality exposure.
• Vision or hearing impairment preventing interaction with virtual reality--based games