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

August 26, 2026 updated by: hend samy saeed hassan, Cairo University

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.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

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

Study Type

Interventional

Enrollment (Estimated)

54

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child
  • Adult

Accepts Healthy Volunteers

No

Description

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

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

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

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Traditional supervised exercise group
participants will perform traditional supervised Schroth physiotherapeutic scoliosis-specific exercises for 45 minutes.
Other: Traditional schroth supervised exercise
participants will perform traditional supervised Schroth physiotherapeutic scoliosis-specific exercises. The intervention consists of two supervised sessions per week, 45 minutes each, for 12 weeks
Experimental: Schroth scoliosis-specific exercises and OhShape virtual reality group
Participants will perform identical Schroth physiotherapeutic scoliosis-specific exercises in addition of integration into the OhShape virtual reality gameplay environment for 45 minutes
Other: Traditional schroth supervised exercise
participants will perform traditional supervised Schroth physiotherapeutic scoliosis-specific exercises. The intervention consists of two supervised sessions per week, 45 minutes each, for 12 weeks
Other: OhShape virtual reality gameplay environment
OhShape is a posture-matching rhythm-based VR game that requires users to perform precise trunk and body movements in response to visual and auditory cues, thereby promoting postural awareness, motor coordination, and movement accuracy. The Meta Quest 2 headset provides a fully immersive virtual reality experience with six degrees of freedom (6DOF) head and body tracking, allowing real-time spatial interaction and posture-based feedback during exercise execution.
Experimental: Schroth scoliosis specific exercise and Google Cardboard Mobile virtual reality Zombie Shooter
Participants will perform identical Schroth physiotherapeutic scoliosis-specific exercises in addition of a low-cost mobile virtual reality intervention delivered via Google Cardboard for 45 minutes.
Other: Traditional schroth supervised exercise
participants will perform traditional supervised Schroth physiotherapeutic scoliosis-specific exercises. The intervention consists of two supervised sessions per week, 45 minutes each, for 12 weeks
Other: Google Cardboard Mobile Virtual reality Zombie Shooter
It is a low-cost mobile virtual reality (VR) intervention delivered via Google Cardboard. A custom Unity-based zombie-shooting VR game will be used, in which participants are required to maintain the corrected Schroth posture while engaging in a gaze-controlled shooting task, using head and trunk alignment to aim and interact with virtual targets. Mobile VR platforms such as Google Cardboard provide three degrees of freedom (3DOF) tracking and represent an accessible, low-cost alternative to high-end immersive VR systems.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Trunk kinematics: Trunk rotation angle (Yaw)
Time Frame: 16 weeks
Derived from gyroscope data(gyroZ) using wearable inertial measurement units (IMUs) to measure dynamic rotation toward midline during exercise execution.
16 weeks

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Trunk kinematics: trunk tilt angle (roll/ pitch)
Time Frame: 16 weeks
derived from accelerometer data (accX, accY) using IMUs to assess frontal plane trunk asymmetry correction during exercise execution.
16 weeks
Trunk Kinematics: Trunk flexion/ extension angle
Time Frame: 16 weeks
Derived from accelerometer data relative to gravity using wearable inertial measurement unit (IMUs) to monitor sagittal plane alignment during exercise execution.
16 weeks
Corrected posture holding time
Time Frame: 16 weeks
The cumulative duration (seconds ) and percentage of session time during which participants maintain the predefined curve specific corrected trunk posture within acceptable angular deviation threshold, quantified via real-time 50 Hz.
16 weeks
Health related quality of life (SRS-22r)
Time Frame: 16 weeks
Assessed using the scoliosis research society-22r questionnaire mean domain scores evaluating pain, self image, function, mental health and satisfaction. The score is graded from 1 to 5; 1 means the worst and 5 means the best quality of life.
16 weeks
pediatric health utility (EQ-5D-Y and EQ-VAS)
Time Frame: 16 weeks
Assessed using the EuroQol 5 dimention youth version utility scores and the self rated EuroQol visual analogue scale (0-100) to measure overall health status. 0 means the worst and 100 means the best health.
16 weeks
Trial retention rate
Time Frame: 16 weeks
To assess feasibility, calculated as the percentage of randomized participants who successfully complete post treatment assessment and follow-up periods.
16 weeks
intervention adherence rate
Time Frame: 16 weeks
Quantified using clinic attendance logs calculated as (attended sessions / scheduled sessions)*100 to categorize participants into high, moderate or low adherence.
16 weeks
Safety and incidence of adverse events
Time Frame: 16 weeks
Percentage of participants experiencing treatment related adverse events such as muscle strain or safe withdrawals from the study.
16 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Cairo University

Investigators

  • Study Chair: Enas youssef, professor, Cairo University

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

September 1, 2026

Primary Completion (Estimated)

February 20, 2027

Study Completion (Estimated)

February 28, 2027

Study Registration Dates

First Submitted

August 26, 2026

First Submitted That Met QC Criteria

August 26, 2026

First Posted (Actual)

August 31, 2026

Study Record Updates

Last Update Posted (Actual)

August 31, 2026

Last Update Submitted That Met QC Criteria

August 26, 2026

Last Verified

August 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • P.T.REC/012/006415

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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