Relative efficacy of different single and combined conservative interventions for adolescent idiopathic scoliosis: a systematic review and network meta-analysis

ObjectiveTo systematically evaluate the relative efficacy of different single and combined conservative interventions for adolescent idiopathic scoliosis (AIS), and to provide evidence-based support for individualized conservative treatment strategies in clinical practice.MethodsRandomized controlled trials on conservative interventions for AIS were retrieved from PubMed, Embase, Web of Science, Scopus, and the Cochrane Library from database inception to December 31, 2025. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessment. A network meta-analysis was conducted using Stata 18.0. The main outcomes included Cobb angle, angle of trunk rotation (ATR), and SRS-22 score. The surface under the cumulative ranking curve (SUCRA) was used to rank different interventions.ResultsA total of 26 randomized controlled trials were included, involving 1,384 patients with AIS and 59 study arms. The interventions included Schroth exercises, orthotic treatment, physiotherapeutic scoliosis-specific exercises (PSSE), Scientific Exercises Approach to Scoliosis (SEAS), core stabilization exercises, Pilates, and their combined interventions. The results showed that, for Cobb angle, Schroth exercises combined with hippotherapy, orthotic treatment combined with SEAS, and orthotic treatment alone ranked relatively high; for ATR, Schroth exercises combined with suspension training, Schroth exercises alone, and routine exercise ranked relatively high; for SRS-22 score, Schroth exercises combined with suspension training, Schroth exercises alone, and routine exercise showed relatively high ranking probabilities. Pairwise comparisons showed that Schroth exercises were superior to proprioceptive neuromuscular facilitation (PNF) for ATR. According to the GRADE assessment, the certainty of evidence was moderate for Cobb angle and SRS-22, and low for ATR.ConclusionBoth single and combined conservative interventions showed certain therapeutic value for AIS. Some combined interventions demonstrated higher relative efficacy probabilities in improving Cobb angle, ATR, and quality of life. Schroth-based interventions were relatively well-represented in the eligible RCT network and showed favorable ranking probabilities for some outcomes; however, these findings should not be extrapolated to all PSSE approaches.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261369973, identifier: CRD420261369973.