Basic Body Awareness Therapy Added to Scoliosis-Specific Exercise in Adolescents With Scoliosis

The Body Awareness Questionnaire (BAQ) is a self-reported instrument originally developed by Shields et al. in 1989. The Turkish version has been shown to be valid and reliable in healthy individuals. The questionnaire assesses awareness of bodily processes, including sensitivity to bodily responses, prediction of bodily reactions, sleep-wake cycles, and the onset of illness. The BAQ consists of 18 items grouped into four subdomains and is rated on a 7-point Likert scale, ranging from 1 ("not at all true for me") to 7 ("completely true for me"). Total scores are calculated by summing item responses, with higher scores indicating greater body awareness.

The Awareness Body Chart (ABC) is a simple, easy-to-use, and low-cost instrument developed by Danner et al. in 2017. It demonstrates high internal consistency and test-retest reliability. The chart consists of schematic anterior and posterior drawings of the human body, divided into 51 regions and 14 body parts based on anatomical structures. Participants are asked to perceive each body region and indicate their level of awareness by coloring the corresponding areas according to predefined categories. Higher scores reflect greater body awareness. The ABC also includes a pain intensity scale ranging from 0 (no pain) to 100 (unbearable pain), and participants are instructed to mark painful areas on the chart.

The Pediatric Quality of Life Inventory (PedsQL) is used to assess general health-related quality of life from both the child's and the parent's perspectives. It evaluates the impact of disease and treatment on physical, emotional, social, and school functioning.The scale consists of 23 items rated on a Likert-type scale, and higher total scores indicate better quality of life. The Turkish version of the PedsQL has demonstrated acceptable validity and reliability.

Age-appropriate versions of the questionnaire are used for children aged 8-12 and 13-18 years, with parallel forms containing the same items but adapted language for each age group. Parent-proxy versions are also administered to obtain the parent's perspective.

The Japanese Scoliosis Questionnaire-27 (JSQ-27) is used to assess scoliosis-specific quality of life in individuals with adolescent idiopathic scoliosis. It evaluates a broad range of domains, including pain, discomfort while wearing clothes, concerns about physical appearance, anxiety, and difficulties in daily activities. The questionnaire consists of 27 items scored on a 5-point scale ranging from 0 ("none") to 4 ("severe"). Total scores are calculated by summing item responses, with higher scores indicating worse scoliosis-specific quality of life. The JSQ-27 has been validated in individuals with adolescent idiopathic scoliosis, and the Turkish version has demonstrated good validity and internal consistency.

Cobb angle method is used as the standard measure of curve severity in adolescent idiopathic scoliosis. Measurements are obtained from anteroposterior spinal radiographs. The angle is defined as the intersection between lines drawn along the upper endplate of the most tilted superior vertebra and the lower endplate of the most tilted inferior vertebra. Values are recorded in degrees.

Axial trunk rotation (ATR) is assessed using a scoliometer during the Adam's forward bending test. Participants are instructed to bend forward from a standing position with knees extended and hands together. ATR is measured at the level of maximum trunk prominence and recorded in degrees. The scoliometer is used as an inclinometer to quantify trunk asymmetry and rotational deformity.

The Posterior Trunk Symmetry Index (POTSI) is used to assess posterior trunk asymmetry. Standardized photographs are obtained in an upright standing position, and anatomical landmarks such as the C7 spinous process and acromion are marked. POTSI scores are calculated based on asymmetry indices derived from these landmarks, with higher scores indicating greater asymmetry.

The Anterior Trunk Symmetry Index (ATSI) is used to assess anterior trunk asymmetry. Measurements are performed using standardized photographs with landmarks such as the suprasternal notch and acromion identified. ATSI scores are calculated based on asymmetry indices, with higher scores indicating greater trunk asymmetry.

Exercise adherence is assessed monthly by asking participants to report the percentage of prescribed exercises they complete. Adherence is expressed as a percentage, and the mean adherence rate over the intervention period is calculated for analysis.