Pre-op Exercise for AIS Surgery

Pre-operative Flexibility Exercises for Surgery for Adolescent Idiopathic Scoliosis

The goal of this clinical trial is to determine if pre-operative scoliosis-specific exercises have a beneficial effect on the health outcomes of surgery for adolescent idiopathic scoliosis. Adolescent idiopathic scoliosis affects adolescents between the age of 10-18.

The main questions this study aims to answer are:

• Can pre-operative exercises help reduce curve progression prior to surgery?
• Can pre-operative exercises help improve the surgery outcomes, such as a lower number of vertebrae needing fusion, increased curve correction, reduced surgery length, and shorter length of stay in the hospital?
• Can a pre-operative exercise intervention result in a reduction of the cost of surgery?

Researchers will compare the current standard of care (the control group) to an intervention group (with pre-op exercises) to see if pre-op exercises have an effect on these outcomes.

Participants will:

• visit the clinic every 3 months to complete ultrasound imaging scans and questionnaires
• if given an exercise intervention, aim to complete it for roughly 30 minutes a day

Study Overview

• Status: Enrolling by invitation
• Conditions: Adolescent Idiopathic Scoliosis (AIS)
• Intervention / Treatment: Behavioral: Pre-op Exercise Program

• Study Type: Interventional
• Enrollment (Estimated): 40
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Alberta
    • Edmonton, Alberta, Canada, T6G 2R8
      • Clinical Science Building, University of Alberta

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• diagnosis of adolescent idiopathic scoliosis
• aged 10 to 18
• curve angle >40 degrees
• waitlisted for posterior spinal fusion surgery at the Stollery Hospital

Exclusion Criteria:

• previous surgeries
• current use of scoliosis-specific exercises

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Standard of Care (Control); The Standard of Care (Control) Group is the group that will receive the current standard of care offered in the process of treating AIS with surgery.
Experimental: Pre-op Exercise Intervention; The Pre-op Exercise Intervention Group will receive the current standard of care offered when treating AIS with surgery, and will also be offered the intervention by the research team that is a pre-op exercise program aimed to increase flexibility of the spine and reduce scoliosis progression.	Behavioral: Pre-op Exercise Program; The pre-op exercise group will complete a 6-month supervised pre-op exercise program. This program is adapted from the Schroth exercise program we tested for moderate scoliosis, showing good effect on curve angles, muscle endurance, posture, curve severity, and in self-reported pain and QOL scores. This physiotherapy will individualize exercises to specific spinal curvature(s). Exercises will focus on elongating and derotating the spine to improve the flexibility before surgery. The corrective movements required, the targeted curve type, the level of passive support involved, and the dosages recommended, have been published previously. A Schroth curve classification algorithm and algorithms to guide the prescription for the curve type will help standardize treatment. The program begins with 5 supervised visits in the first 2 weeks to help learn the exercises. The following month has supervised visits weekly and then every other week. The aim is to exercise 30mins per day 5x/week.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of levels fused	The number of vertebrae levels fused during surgery for AIS. This is an indicator of the amount of flexibility afforded to participants post-op, their risk of adverse wear and tear on unoperated levels, and also can indicate significant cost savings to the hospital and health system.	Indicated during surgical planning, completed during surgery (where it may change from plans)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Italian Spine Youth Quality of Life (ISYQOL) questionnaire	The Italian Spine Youth Quality of Life questionnaire contains 20 questions with the first 13 answered by all patients with scoliosis and the next 7 answered only by those wearing a brace. The raw sum score of the items is converted to a 0 to 100 quality of life score where 100 indicates the best quality of life.	Baseline, 3 months, 6 months, and at first routine follow-up post-surgery (6 weeks post-op)
Spinal Appearance Questionnaire (SAQ) v1.1 Appearance score	The SAQ v1.1 is a questionnaire consisting of 14 items with the first 10 items producing an appearance score reflecting the self-perceived torso appearance. The appearance score ranges from 10 to 50 with low scores indicating better perceived appearance.	Baseline, 3 months, 6 months, and at first routine follow-up post-surgery (6 weeks post-op)
Spinal Appearance Questionnaire (SAQ) v1.1 expectation score	The SAQ v1.1 is a questionnaire consisting of 14 items with the last 4 items producing an expectation score reflecting the desire to be more even on some asymmetry features. The expectation score ranges from 4 to 20 with low scores indicating less desire to change the appearance.	Baseline, 3 months, 6 months, and at first routine follow-up post-surgery (6 weeks post-op)
Spinal Appearance Questionnaire (SAQ) v1.1 total score	The SAQ v1.1 is a questionnaire consisting of 14 items producing a score from 14 to 70 with low scores indicating better perceived appearance.	Baseline, 3 months, 6 months, and at first routine follow-up post-surgery (6 weeks post-op)
Pre-operative flexibility measured by 3D Ultrasound Imaging	The degree (amount) to which the frontal scoliotic curve is reduced during side-bending compared to standing in a radiograph or ultrasound imaging is the curve's flexibility. These will be taken in ultrasound scanning images of participants.	Baseline, 3 months, and 6 months
Other Surgery-related Outcomes	Other surgical outcomes include: length (duration) of surgery in minutes, length of stay in hospital post-surgery, percentage of curve correction.	During surgery & immediately post-surgery
Truncal Anterior Asymmetry Scoliosis Questionnaire (TAASQ) Breast	The TAASQ assesses patient-perceived anterior truncal appearance. This consists of 14 individual questions that fall into a Breast (questions 4 a, b, c; 12; 13; 14) main domain. The TAASQ uses a combination of Likert scales and free text responses. Each multiple-choice question features answer options ranging from 1 to 5, where 5 corresponds to the least amount of concern or asymmetry and 1 corresponds to the most concern. The average score is then calculated for each domain and sub-domain. Higher scores on the TAASQ indicate better quality of life.	Baseline, 3 months, 6 months, and first routine follow-up post-surgery (6 weeks post-op)
Truncal Anterior Asymmetry Scoliosis Questionnaire (TAASQ) Clothing	The TAASQ assesses patient-perceived anterior truncal appearance. This consists of 14 individual questions that fall into three main domains including the Clothing (1; 2 a, b, c, d, e; 3; 8 a, b, c; 9) domain. The TAASQ uses a combination of Likert scales and free text responses. Each multiple-choice question features answer options ranging from 1 to 5, where 5 corresponds to the least amount of concern or asymmetry and 1 corresponds to the most concern. The average score is then calculated for each domain and sub-domain. Higher scores on the TAASQ indicate better quality of life.	Baseline, 3 months, 6 months, and first routine follow-up post-surgery (6 weeks post-op)
Truncal Anterior Asymmetry Scoliosis Questionnaire (TAASQ) Appearance	The TAASQ assesses patient-perceived anterior truncal appearance. This consists of 14 individual questions that fall into three main domains: including Appearance (5; 6; 7; 10; 11)., Each multiple-choice question features answer options ranging from 1 to 5, where 5 corresponds to the least amount of concern or asymmetry and 1 corresponds to the most concern. The average score is then calculated for each domain and sub-domain. Higher scores on the TAASQ indicate better quality of life.	Baseline, 3 months, 6 months, and first routine follow-up post-surgery (6 weeks post-op)
Truncal Anterior Asymmetry Scoliosis Questionnaire (TAASQ) Breast Location	The TAASQ assesses patient-perceived anterior truncal appearance. The Breast domain can be categorized into a Breast location (Q4c, 13) subdomain scored from 1 to 5, where 5 corresponds to the least amount of concern or asymmetry and 1 corresponds to the most concern. The average score is then calculated for each domain and sub-domain. Higher scores on the TAASQ indicate better quality of life.	Baseline, 3 months, 6 months, and first routine follow-up post-surgery (6 weeks post-op)
Truncal Anterior Asymmetry Scoliosis Questionnaire (TAASQ) Breast shape	The TAASQ assesses patient-perceived anterior truncal appearance. The Breast domain can be categorized into a Breast Shape (Q4b, 12) subdomain scored from 1 to 5, where 5 corresponds to the least amount of concern or asymmetry and 1 corresponds to the most concern. The average score is then calculated for each domain and sub-domain. Higher scores on the TAASQ indicate better quality of life.	Baseline, 3 months, 6 months, and first routine follow-up post-surgery (6 weeks post-op)
Truncal Anterior Asymmetry Scoliosis Questionnaire (TAASQ) Breast size	The TAASQ assesses patient-perceived anterior truncal appearance. The Breast domain can be categorized into a Breast size (Q4a, 14). subdomain scored from 1 to 5, where 5 corresponds to the least amount of concern or asymmetry and 1 corresponds to the most concern. The average score is then calculated for each domain and sub-domain. Higher scores on the TAASQ indicate better quality of life.	Baseline, 3 months, 6 months, and first routine follow-up post-surgery (6 weeks post-op)
Truncal Anterior Asymmetry Scoliosis Questionnaire (TAASQ) Clothing General	The TAASQ assesses patient-perceived anterior truncal appearance. This consists of 14 individual questions that fall into a Clothing-General (Q1, 3, 8a, 9) subdomain. Each multiple-choice question features answer options ranging from 1 to 5, where 5 corresponds to the least amount of concern or asymmetry and 1 corresponds to the most concern. The average score is then calculated for each domain and sub-domain. Higher scores on the TAASQ indicate better quality of life.	Baseline, 3 months, 6 months, and first routine follow-up post-surgery (6 weeks post-op)
Truncal Anterior Asymmetry Scoliosis Questionnaire (TAASQ) Clothing Specific	The TAASQ assesses patient-perceived anterior truncal appearance. This consists of 14 individual questions that fall into a Clothing-Specific (Q2, 8b, 8c, 8d) subomain. Each multiple-choice question features answer options ranging from 1 to 5, where 5 corresponds to the least amount of concern or asymmetry and 1 corresponds to the most concern. The average score is then calculated for each domain and sub-domain. Higher scores on the TAASQ indicate better quality of life.	Baseline, 3 months, 6 months, and first routine follow-up post-surgery (6 weeks post-op)

Collaborators and Investigators

• Sponsor: Eric Parent
• Collaborators: Women and Children's Health Research Institute (WCHRI)

Publications and helpful links

General Publications

• Calman R, Smithers T, Rowan R. Impact of surgical waiting time on paediatric spinal deformity patients. ANZ J Surg. 2013 Dec;83(12):929-32. doi: 10.1111/ans.12196. Epub 2013 May 8.
• Fan Y, To MKT, Kuang GM, Lou N, Zhu F, Tao H, Li G, Yeung EHK, Cheung KMC, Cheung JPY. Five days of inpatient scoliosis-specific exercises improve preoperative spinal flexibility and facilitate curve correction of patients with rigid idiopathic scoliosis. Spine Deform. 2025 Jan;13(1):165-175. doi: 10.1007/s43390-024-00965-1. Epub 2024 Sep 26.

Study record dates

Study Major Dates

• Study Start (Actual): November 26, 2025
• Primary Completion (Estimated): December 1, 2028
• Study Completion (Estimated): December 1, 2028

Study Registration Dates

• First Submitted: March 26, 2026
• First Submitted That Met QC Criteria: March 31, 2026
• First Posted (Actual): April 8, 2026

Study Record Updates

• Last Update Posted (Actual): April 8, 2026
• Last Update Submitted That Met QC Criteria: March 31, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: scoliosis; flexibility; Schroth; Adolescent idiopathic scoliosis; AIS
• Additional Relevant MeSH Terms: Bone Diseases; Musculoskeletal Diseases; Spinal Diseases; Spinal Curvatures; Scoliosis
• Other Study ID Numbers: Pro00150871

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No