Comparison of the Efficiency of Schroth Method and Virtual Reality Exercises in Individuals With AIS

The most commonly used method to measure the size of the scoliosis curve is the Cobb angle. As a standard, measurement is made on a posteroanterior spine radiograph taken while standing. To determine the boundaries of scoliosis, a line is drawn parallel to the upper line of the vertebra with the greatest deviation. Similarly, for the lower border, a line is drawn parallel to the lowest vertebra. Vertical lines parallel to these two lines are drawn and the angle between the two lines is recorded. In our study, the Cobb angle will be measured and recorded in the sagittal and frental planes, based on the same vertebral endplates, on the spine x-ray taken at the beginning and after 24 weeks of treatment by the orthopedic and traumatology physician during the routine follow-up of the patient.

Risser sign is defined as the change of the pelvic growth plate from cartilage to bone. Gradual ossification of the growth plate on the iliac apophysis from anterolateral to posteromedial is evaluated. Evaluations will be determined by the orthopedic and traumatology physician during routine follow-ups of the patient based on x-rays.

Trunk rotation angle will be measured with a Bunnell scoliometer. There is a metal sphere inside the scoliometer that moves between 0-30˚ in the water bed. Measurements will be made by placing the scoliometer vertically on the axial axis of the spine, perpendicular to the spinosus processes of the vertebra. The evaluation will be carried out standing, in a forward bending position with hands extended forward. To adjust the distance between the feet, the physiotherapist places one foot between the patient's two feet and the patient is positioned. By moving the scoliometer from the beginning of the thoracic region to the sacrum, the largest rotation angle in the major curvature will be recorded. In our study, trunk rotation angle will be measured and recorded at baseline, at week 12, and after 24 weeks of treatment.

Evaluation of spinal mobility was performed with a portable, computer-aided electromechanical device (the Spinal Mouse System, Idiag, Fehraltorf, Switzerland) called "Spinal Mouse" (SM). The SM is an external, non-invasive measurement device that can evaluate spinal angles and curvatures in the frontal and sagittal planes. It has been reported that SM can be used as a reliable, fast and easy-to-use measurement method with no side effects for clinical research and patient follow-up in AIS. Measurements were made between the spinous process of the 7th cervical vertebra and the top of the anal fold (approximately the level of the sacral 3rd vertebra). Maximum right-left lateral flexion degrees in the frontal plane and maximum flexion-extension degrees in the sagittal plane will be measured and recorded.

In our study, a dual inclinometer (Acumar) with an inter-individual reliability of 0.90 and an inter-test reliability of 0.85 will be used to evaluate the active repositioning sensation of the spine. Active repositioning sensation of participants' thoracic and lumbar spines; It will be measured for flexion, extension and right-left lateral flexion. In addition to these measurements in the thoracic region, right-left rotation movements will also be included in the evaluation. The absolute difference in degrees between two positions is noted as the reposition deviation value. This test is repeated 5 times for each movement. In the evaluation made before, at the 12th week and after the treatment, the average of 5 measurements will be taken and the results will be compared. The decrease in the reposition deviation value is evaluated as the improvement in the reposition feeling.

Evaluation of trunk flexion, extension and right-left lateral flexion isometric muscle strength will be performed with a manual muscle testing device, which is an objective, valid and reliable method. Trunk flexion evaluation will be performed in the 30-degree supine position, trunk extension in the prone position, and lateral flexion in the sitting position.

Three core endurance tests created by McGill, consisting of the lateral bridge test, trunk extension test and trunk flexion test, will be evaluated. Before each test, the required test position will be explained to the participant and he/she will be asked to try the appropriate position.

POTSI is a valid and reliable objective method used in the evaluation of trunk asymmetry. The POTSI parameter is defined as the sum of six indices: three frontal plane asymmetry indices (C7, axilla folds, and waist lines) and three frontal plane height difference indices (acromions, axilla folds, and waist lines). The POTSI score is calculated by placing the indices in the formula on the patient's photograph taken from the posterior. The POTSI score, which indicates complete symmetry, is zero, and a higher score indicates increasing body asymmetry. In our study, SCODIAC (SCOliotic DIAgnostiCs) computer software program will be used to calculate POTSI.

ATSI is another valid and reliable objective method used to evaluate trunk asymmetry, and its use together with POTSI is recommended in studies. It is defined as the sum of six indices determined on the patient's anterior photograph: three frontal plane asymmetry indices (stern notch, axillary folds and waist lines) and three frontal plane height difference indices (acromions, axillary folds and waist lines). Calculation is made by placing the indices into the formula. In our study, SCODIAC (SCOliotic DIAgnostiCs) computer software program will be used to calculate ATSI.

It is a scale developed to evaluate the physical deformity perceived by patients with idiopathic scoliosis. A high score means high deformity. The scale can be completed by the patient, the person responsible for the patient's care, and the clinician performing the evaluation. In our study, this scale will be filled in by the patient.

GRC is used frequently in clinical research, especially in the field of the musculoskeletal system. This scale is designed to determine the extent of improvement or deterioration of the patient over time. It also indicates the effect of an intervention or the clinical course of a condition. In the GRC scale, the patient is asked to indicate the difference between his current health status and his health status before a specific point in time. The questions asked, the number of points on the scale, and the labels assigned to the scale points may vary [29]. A 7-point scale (-3: much worse, -2: worse, -1: slightly worse, 0: the same, 1: slightly better, 2: quite better, 3: much better) will be used in our study.

SRS-22 is a scoliosis-specific quality of life questionnaire with 22 questions and five subgroups. Subgroups of the survey; pain, image/appearance, function/activity, mental health and treatment satisfaction. It is defined as 0 (worst) and 5 (best) points for each question. The form will be filled out by asking patients to mark the answers that apply to them. If they do not understand the questions, the questions will be explained and the answers will be marked.