Technology-Supported Exercise Rehabilitation for Pediatric and Adolescent Scoliosis: A Systematic Review and Bayesian Meta-analysis

Abstract

Background: Conservative management of pediatric and adolescent scoliosis often relies on long-term exercise rehabilitation and continuous follow-up. Conventional in-person rehabilitation is limited by therapist availability, travel burden, and variable home-exercise quality. Technology-supported approaches, including telerehabilitation, mobile applications, video-guided exercise, and digital monitoring, have increasingly been used to support scoliosis exercise rehabilitation; however, their overall effects and implementation characteristics remain unclear. This study aims to systematically evaluate the effects of technology-supported exercise rehabilitation on clinical outcomes, adherence, and safety in children and adolescents with scoliosis. Methods: A systematic review and Bayesian meta-analysis were conducted in accordance with PRISMA 2020. PubMed, Embase, Web of Science Core Collection, CENTRAL, Scopus, and CNKI were searched from inception to February 2026. Eligible studies included pediatric or adolescent participants with scoliosis receiving technology-supported exercise rehabilitation. The primary outcome was Cobb angle. Secondary outcomes included angle of trunk rotation (ATR) and quality of life. Bayesian three-level random-effects models were used for quantitative synthesis. Methodological quality was assessed using a modified Downs and Black checklist. Results: Eight studies published between 2021 and 2026 were included. A total of 442 children and adolescents entered allocation or intervention, and 418 completed follow-up or were included in the final analyses. Bayesian meta-analysis showed no definitive pooled effect on Cobb angle (standardized mean difference [SMD] = -0.44, 95% credible interval [CrI]: -1.04 to 0.19), ATR (SMD = -0.26, 95% CrI: -1.08 to 0.57), or quality of life (SMD = 0.01, 95% CrI: -0.48 to 0.59). I² values for Cobb angle, ATR, and quality of life were 64.4%, 78.8%, and 56.5%, respectively. Narrative synthesis suggested that digital systems, real-time video supervision, and remote monitoring may support exercise performance and brace/exercise adherence, although safety and implementation processes were insufficiently reported. Conclusions: Current evidence suggests that technology-supported exercise rehabilitation is feasible for conservative management of pediatric and adolescent scoliosis and may improve accessibility, supervision, and adherence. However, pooled results do not yet confirm a stable advantage over comparator interventions for Cobb angle, ATR, or quality of life. Further well-designed, adequately powered randomized controlled trials with longer follow-up and standardized reporting are needed.