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Rehabilitation

 

Scientific Research

''Dr Weiss has written many research articles on various areas of scoliosis and his treatment methods. Unfortunately his articles (where available) are published in German, but the summaries on some of his papers have given me invaluable information and enabled me to put together these overall comments on a few of the scientific researches carried out on the Katharina Schroth 'Rehabilitation' treatment.''

The articles can be found by searching for 'weiss hr, scoliosis' at http://www.ncbi.nlm.nih.gov/entrez/query.fcgi.

The influence of an in-patient exercise program on a scoliotic curve - 1992
The 813 patients with idiopathic scoliosis who completed their first rehabilitation program at the Katharina-Schroth Clinic between 1984 and 1987 had their vital capacity measured prior and post treatment. The results were divided into four age groups. In Group I (10-13 years), vital capacity in patients treated for the first time improved by 18.94%. In Group II (14-17 years), the average increase in vital capacity after initial treatment was 16.33%. In Groups III (18-24 years) and IV (24+ years), the corresponding increases were 15.11% and 13.77%, respectively. In the 256 patients receiving repeat treatment, the increases in vital capacity by half again and the average increase in chest expansion was more than 20% in all groups. These findings show that a course of in-patient treatment by the Schroth method can lead to an increase in vital capacity and chest expansion so that, even in adult scoliosis patients, effective treatment of breathing restrictions caused by scoliosis is possible.

Effects of Schroth's rehabilitation program on the self-concept of scoliosis patients - 1994
A total of 37 scoliotic patients, aged 20-57 years, participated in a pre-/post-interview study on the basis of the Frankfurt self-concept scales. The patients stayed at the Katharina-Schroth Clinic for 4 to 6 weeks, with questionnaires to be filled in 2 days after admission (pre-interviewing) and 2 days before discharge (post-interviewing). The study findings indicated a positive impact of the in-patient treatment relative to a variety of patient self-concepts. This is clearly suggested by the self-ratings concerning: general coping ability; own sensitivity and mood; own self-assertion towards groups; perceived appreciation by others; feelings towards and relationship with others; general self-worth; and own ability to make contact and interact. The statistical changes were in a positive direction for 70% of the patients undertaking the survey (the other 30% remained unchanged). Therefore the effect of the in-patient treatment has, on the whole, increased emotional stabilization in most patients, which certainly would be considered an essential precondition for their continued capacity for work.

Preliminary results and worst-case analysis of in patient scoliosis rehabilitation - 1997
The purpose of this study was to assess the effectiveness of a scoliosis-specific rehabilitation programme as it is carried out in the Katharina-Schroth Clinic. Physiotherapy in the treatment of scoliosis patients is still regarded as ineffective since the study by the American Orthopedic Association in 1941, which showed that general exercises could not influence the natural history of scoliosis. However, specific exercise programmes were not known in the USA at that time. A total of 181 scoliosis patients, with an average age of 12.7 years and an average angle of curvature of 27% according to Cobb, were included in this study. The Cobb angle of the major curve was measured in a standardized way prior treatment, post treatment and prior 'top-up' treatment.
The results of our preliminary study were compared to natural history as known from literature. For the worst-case analysis a questionnaire was sent to the non-repeaters treated at our centre at the same time as the patient sample described above, taking into account the same inclusion criteria except measurement prior top-up treatment. Results showed that progression as usually defined (increase in curvature of 5 degrees or more per year) has not been found in the preliminary study. The patient sample of this study was divided into different age groups and different groups of curve magnitude, for comparison with other studies.
Additional to the patient sample of the preliminary study, 116 of the patients from the years 1989 and 1990 fulfilled the inclusion criteria of the preliminary study with the exception of the measurement prior top-up treatment. These patients formed the questionnaire sample for the worst-case analysis showing that the progression rate of the 181 patients from the preliminary study and the 116 patients of the questionnaire sample together was still better than natural history even if all drop-outs were considered to be failures. The fact that there was no relative progression in our patients sample treated solely by physiotherapy (preliminary study), seems to show the effectiveness of the inpatient rehabilitation programme even in cases with a bad prognosis, severe angles of curvature and unfavourable curvature patterns. A worst-case analysis does not prevent this conclusion, even if all dropouts from the non-repeaters group were considered as failures.

Quality of Life in Women With Idiopathic Scoliosis - 2002
226 female patients with idiopathic scoliosis completed an age-appropriate health-related quality of life questionnaire (either the 36-Item Short-Form Health Status Survey, SF-36, or the Berner Questionnaire for Well-Being). The aim of this questionnaire was to analyse whether age, Cobb angle, and brace use had an impact on health-related quality of life of a scoliosis patient. Compared with the age-matched general population norm, juvenile patients with idiopathic scoliosis were unhappier with their lives, they reported more physical complaints, had lower self-esteem and higher depression scores.
Adult patients reported more psychological and physical impairment than in the population norm. These results were largely independent of age and Cobb angle. The results show that health-related quality of life can be impaired in patients with idiopathic scoliosis. Previous studies using generic health measures, functional status, body image, and self-image have also demonstrated that scoliosis may lead to multiple physical and psychosocial impairments depending on its severity. They also conclude that the health-related quality of life in patients with idiopathic scoliosis is still lacking. Therefore, the psychosocial situation should be taken into account in the treatment of these patients.

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