Following completion of the study period, 206 students had attempted the questionnaire and met the required inclusion criteria, with 165 completing the questionnaire fully and thus being included in all further analysis. The students were spread across 12 different universities in the UK, encompassing Scotland, England, Wales and Northern Ireland.
To remain in-line with the methods used by Drake et al. [3], and to enable a direct comparison between the results of these two studies, the 31 students that responded ‘I Do Not Know’ were removed from the analysis of that question. Therefore in order to allow comparison to previous research, the ‘% of Correct Responses’ when discussed within each item section below was the percentage of students who selected the commonly accepted answer to each question, posed against those who provided an attempted response and removing ‘I Do Not Know’ as an option (Column F). The table below for reference also has an analysis of those subjects who answered as ‘I Do Not Know’ as a demonstration of ignorance to the topic and a more true representation of correct responses for future research (Column E) (Table 1).
Table 1 Results of survey per question
Question 1 (definition): what is idiopathic scoliosis?
Within this question, students were asked to recognise that scoliosis is a 3-dimensional deformity [6]. One hundred and forty-five of the 164 students (88%) who attempted an answer to this question selected scoliosis to either be a 2-dimensional or a lateral curvature of the spine (Fig. 1).
Question 2 (cause): what causes idiopathic scoliosis?
When considering the potential aetiology specifically to ‘idiopathic scoliosis’, 52% of respondents highlighted that the accepted cause of IS is unknown [7] (Fig. 2).
Question 3 (development): when does idiopathic scoliosis commonly develop?
One area well recognised by the students within the study was the period within which IS most commonly develops and is diagnosed. When given the options of either a period in adulthood, childhood/adolescence, in utero or as compensation to another disease, the students did correctly recognise that IS most commonly develops between a period in childhood and adolescence. Thus, they were able to identify correctly the patient group at most risk of diagnosis [8] (Fig. 3).
Question 4 (prevalence): how prevalent is idiopathic scoliosis among patients with scoliosis?
Nearly a quarter (24%) of participants correctly identified the prevalence of IS within the scoliosis population as 80%. This figure is significant as it shows that when a patient is diagnosed with scoliosis, only in 20% of cases will the therapist/practitioner be able to identify a definite cause towards the development of the condition [9] (Fig. 4).
Question 5 (diagnosis): how is the diagnosis of idiopathic scoliosis commonly confirmed?
In order to diagnose IS formally, a patient must present with a minimum of 10° of lateral curvature on radiography, alongside an evident and measurable amount of axial rotation [10]. The use of the Cobb angle is widely accepted as the diagnostic tool taken from radiographs, but for a conclusive diagnosis, the Cobb angle should be considered alongside a physical assessment and analysis of the structural rotation of the patient’s spine [1]. This strict procedure will limit any false-positive diagnostics and also provide the therapist and practitioner with more accurate information regarding the development and severity of the patient’s condition. Only 12% of respondents were able to recognise these diagnostic criteria (Fig. 5).
Question 6 (treatment): what should the treatment of idiopathic scoliosis using therapeutic exercise include?
There are currently, and have been historically, many different approaches to conservative management of scoliosis internationally. The wide variation in approaches and lack of availability of treatment facilities has resulted in a dilution of correct information and loss of clear management and treatment pathways in scoliosis care (Fig. 6).
With this wide gulf in different approaches, it is still largely accepted that all therapeutic exercise should be based on the recognised methods with addition of new ideas, but all based upon correction in 3-dimensions with the aim of preventing or limiting progression [11].
There is yet to be any universal approach and any self-limiting therapy such as stretching of concavities or core stabilisation exercises should always be developed with consideration to the 3-dimensional aspect of scoliosis [1].
Just 7% of respondents recognised this specific accepted view that all exercises should be based around 3-dimensional correction and aim at limiting/preventing progression.
Question 7 (bracing): when is bracing recommended for patients with idiopathic scoliosis?
Following a multi-centred, partially randomised study in 2014 [12], bracing has become an integral and decisive part of conservative management of scoliosis and its correct application is key to the benefit achieved. It is widely accepted that patients should be recommended for bracing treatment if their Cobb angle is greater than 20° and their condition is highlighted as having an elevated risk of progression, whether this be through their age, maturity level, degree of angle or physical characteristics [13] (Fig. 7).
Fifty-four percent of respondents recognised the potential use of bracing in patients with a moderate and potentially progressive curvature when offered with alternatives such as a leg length discrepancy, severe curvature (> 45°) and mild curvatures (5–10°). As bracing therapy use alongside physiotherapy has been neglected in the past, it is essential that therapists and practitioners recognise when this approach is recommended [14].
Point of interest
As an opinion-based end point for the survey, the students within the study were asked three questions to highlight which physical activity they felt was most beneficial, and conversely least beneficial, for patients with scoliosis. It was also used to evaluate the participant’s knowledge of the treatment modalities highlighted as being recommended by the 2011 SOSORT guidelines. The results are highlighted in Figs. 8, 9 and 10. Subjects believed Pilates and swimming to be the most beneficial and gymnastics and martial arts to be the most detrimental and this study also demonstrates that students’ knowledge of the SOSORT recommended modalities for conservative management was very minimal. SOSORT has developed a review looking at seven different, widely accepted scoliosis schools, but 84% of students were unable to recognise any of the four most popular methods [15].