Investigation of the Effects of Lumbopelvic Rhythm on Postural Control, Daily Living Activities, and Quality of Life in Adolescent Individuals With Idiopathic Scoliosis
Conditions: Adolescence Idiopathic Scoliosis
Sponsor: Hacettepe University

OFFICIAL TITLE OF THE STUDY 
 
Investigation of The Effects of Lumbopelvic Rhythm on Postural Control, Daily Living 
Activities and Quality of Life in Adolescent Individuals with Idiopathic Scoliosis 
 
 
 
 
 
 
 
 
 
NCT NUMBER 
 
NCT Number: Not yet assigned 
 
 
 
 
DOCUMENT DATE: 
 
23 January 2026 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

WORKING PROTOCOL  
 
1. Name of the Study 
Investigation of the Effect of Lumbopelvic Rhythm and Postural Control on Activities of Daily Living 
and Quality of Life in Adolescent Idiopathic Scoliosis 
2. Rationale and Purpose of the Research 
Adolescent idiopathic scoliosis (AIS) is a condition that develops during adolescence and causes a 
three-dimensional deformity of the spine. This deformity can include deviations in the frontal, sagittal, 
and axial planes and can negatively affect individuals' physical functions and balance control 
mechanisms. (1). Lumbopelvic rhythm refers to the coordination of spinal and pelvic movements and 
is a critical factor for postural stability. Scoliosis can alter lumbopelvic rhythm by affecting pelvic and 
lumbar region movements (2). In individuals with AIS, changes such as decreased trunk flexion-
extension movements and pelvic and hip movements during walking, overactivity of muscles in the 
spine and pelvis, increased energy consumption, impaired balance and gait have been observed (3,4). 
Abnormalities in vestibular and proprioceptive inputs have also been observed, leading to changes in 
balance control (5 , 6 ). Postural control requires the integration of sensory and motor systems to 
maintain body balance. Changes in postural control mechanisms in individuals with scoliosis can 
reduce mobility. In postural control assessments, individuals with scoliosis have been found to exhibit 
greater deviation and acceleration reactions from the center of pressure compared to healthy 
individuals (7 , 8 ). This can lead to difficulties in daily living activities, increased pain levels, and 
decreased quality of life (9, 10). While there are studies in the literature on muscle activation, range 
of motion, pelvic position, gait, and balance in individuals with AIS, no studies have been found that 
examine changes in lumbopelvic rhythm and their relationship with the type, localization, and severity 
of the curve, and the effect of lumbopelvic rhythm on postural control and quality of life in individuals 
with AIS. Therefore, evaluating lumbopelvic rhythm in individuals with AIS can contribute to 
understanding the changes in movement patterns due to scoliosis and guide clinical diagnosis and 
treatment approaches. 
The purpose of this study is; 
- To identify possible differences by comparing the lumbopelvic rhythm characteristics of individuals 
with AIS to those of healthy individuals. 
- To investigate the effects of localization, type, and severity of curvature on lumbopelvic rhythm in 
individuals with AIS. 
-To examine the lumbopelvic rhythm in individuals with AIS during daily living activities such as 
trunk flexion and extension, sitting down, standing up, and walking. 
-The aim is to examine the relationship between lumbopelvic rhythm and postural control, daily living 
activities, and quality of life. 
 
Hypotheses; 
H1: Lumbopelvic rhythm differs in individuals with AIS compared to healthy individuals. 
H2: Lumbopelvic rhythm in individuals with AIS It is related to the localization, type, and severity of 
the curvature. 
H3: In individuals with AIS, lumbopelvic rhythm is associated with postural control. 
H4: In individuals with AIS, the lumbopelvic rhythm differs in terms of curvature localization, type, 
and severity during sitting, standing, and walking. 
H5: Lumbopelvic rhythm is related to quality of life in individuals with AIS. 
3. Research Materials and Methods 
3.1. Location of the Research 

Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Movement Analysis 
Laboratory 
3.2 . Timing of the Research 
The study begins on May 15, 2025, and ends on November 15, 2026.  
3.3. Characteristics of Individuals to be Included in the Study and Sample Size Calculation 
The study group will consist of individuals diagnosed with AIS who apply to the Faculty of Physical 
Therapy and Rehabilitation at Hacettepe University. Participants in the healthy group will be selected 
using a snowball method from among the relatives of patients or researchers who apply to the Faculty 
of Physical Therapy and Rehabilitation. The number of individuals to be included in the study will be 
determined by a power analysis after analyzing the data of 10 individuals diagnosed with AIS and 10 
healthy individuals who meet the inclusion criteria. 
 
AIS group inclusion criteria: 
Those diagnosed with AIS, 
Between the ages of 10 and 18, 
Having a Cobb angle greater than 10°, 
Pain intensity < 3 
Volunteer individuals 
Exclusion Criteria: 
Male gender, 
Body mass index ≥30, 
The presence of additional pathologies affecting the lumbopelvic region (disc herniation, 
spondylolisthesis, hip dysplasia, rheumatic diseases, etc.), 
Chronic pain lasting longer than 3 months, 
Lower extremity length difference > 2 cm 
Orthopedic or neurological problems affecting the lower or upper extremities. 
A history of acute injury, 
History of spinal surgery, 
Individuals with vestibular pathology or severe balance disorders 
Control Group Inclusion Criteria: 
Those who have no diagnosed or known illness, 
Between the ages of 10-18 
Has similar demographic characteristics to the AIS Group. 
Volunteer individuals 
Exclusion Criteria: 
Male gender, 
Body mass index ≥30 
Individuals with acute injury or pain will be excluded from the study. 
3.4. Type of Research (Place an 'X' in the relevant column) 
Cross-sectional 
X 
 
Case Studies 
 
 
Cohort Studies 
Retrospectiv
e 
 
 
Prospective 
 
 
Qualitative 
 
 
Other (write in place of the cross)  
 

3.5 . Research Methodology 
Data collection will be carried out at the Movement Analysis Laboratory of the Faculty of Physical 
Therapy and Rehabilitation, Hacettepe University. 
  
Participants' demographic data such as gender, age, height, and weight, as well as age at scoliosis 
diagnosis, age at menarche, and treatment processes, will be collected through individual self-
reporting using a structured questionnaire specifically designed for this study. The questionnaire will 
be explained to each participant before the research process begins, and after obtaining the necessary 
consent, it will be completed through face-to-face interviews. The data provided by the participants 
will be used only for research purposes in accordance with confidentiality principles, and data security 
will be ensured. All data obtained during the study process will be analyzed only by the research team.  
 
Curve pattern information obtained from the individuals' existing anteroposterior radiographic images 
will be recorded along with the spinal region (cervical, thoracic, lumbar) and the measured Cobb angle 
degrees. Axial trunk rotations will be measured with a scoliometer and added to the form. The severity 
of the patients' curvature will be evaluated using the Cobb angle method, which SOSORT and SRS 
consider a primary outcome of treatment and accept as a standard for measuring deformity in scoliosis. 
Measurements will be taken using data from the patient's existing anteroposterior radiographic image. 
The Cobb angle is defined as the angle between a line drawn from the upper edge of the upper vertebra 
with the greatest curvature and a line drawn from the lower plate of the lower vertebra with the greatest 
curvature. This will be measured using a computer program and recorded in degrees on the form. 
According to the SRS classification, the curve pattern is determined by the location of the apex. The 
primary curve apex is between the 2nd thoracic vertebra and the 11th-12th thoracic vertebrae. 
Individuals with curves in the intervertebral disc space are classified as thoracic, those between the 
12th thoracic vertebra and the 1st lumbar vertebra are classified as thoracolumbar, those between the 
1st-2nd lumbar intervertebral disc and the 4th lumbar vertebra are classified as lumbar, and curves in 
both the thoracic and lumbar regions are classified as double curves (19). In our study, the curves will 
be named according to this classification and recorded in the form. 
included in the study will be performed using an Inertial Measurement Unit (IMU). Data will be 
collected using Movella DOT wearable sensors (Movella Inc. , Henderson, NV, USA) at a sampling 
rate of 60 Hz. IMU sensors will be placed at C7, the thoracolumbar junction, the lumbosacral junction, 
and the lateral midpoints of both thighs, and secured to the skin with a flexible band. This placement 
will allow for the acquisition of lumbar and hip movements. The device will be calibrated before 
measurements begin for each participant . The device's zero point will be determined while 
participants stand upright barefoot. Participants will be asked to follow a standardized movement 
protocol. This protocol includes: maximum trunk flexion by leaning forward while standing, 
maximum trunk extension by leaning backward while standing, maximum right and left trunk rotation 
while standing, and right and left lateral trunk flexion while standing, as well as standing up and 
walking. Participants will be asked to repeat each movement 3 times, and the average of the data will 
be taken (11,12). The movement patterns of the lumbopelvic region will be analyzed using raw data 
on acceleration and angular velocity obtained from the IMU device . 
Postural control will be assessed using the Bertec Balance Check Screener™ strength platform 
(BP5050 Bertec Co. , Columbus, OH, USA) (13). The participant will be positioned on the platform 
with their feet parallel to each other and the distance between their feet being half shoulder width (14). 
In a static stance, the participant will be asked to remain as still as possible on hard and soft surfaces 
with their eyes open and closed, and the amount of anterior-posterior and right-left postural sway will 
be determined. Participants will be asked to move forward, backward, right, and left as far as they can 
on a hard surface with their eyes open and their feet in the same position, without breaking contact 
between their feet and the platform, and the amount of displacement of the center of gravity forward, 

backward, right, and left (stability limits) will be recorded in cm (15,16). Each measurement will be 
performed 3 times, and the 3rd measurement will be used in the analysis (17).To assess quality of life, 
the 
Scoliosis  
Research Society's Health-Related Quality of Life-22 (SRS-22) questionnaire will be used. The SRS-
22 questionnaire is a quality of life scale specific to scoliosis. The SRS-22 is a 22-question scale with 
a 5-point Likert scale, divided into five subgroups: pain, general appearance/image, spinal function, 
mental health, and treatment satisfaction. Each question has responses ranging from negative to 
positive. The most negative response is worth 1, and the most positive is worth 5. The scores from 
each section are added together and divided by the number of questions answered to obtain the scores 
for the subgroups and the total score. The lowest possible score is 1, and the highest is 5. A higher 
score on the scale indicates improved quality of life, while a lower score indicates a lower quality of 
life. This shows that it has decreased. The validity and reliability study of the Turkish version of the 
questionnaire, which has been shown to be valid and reliable in many languages, was carried out by 
Alanay et al. in 2005 (19). 
 
Pain assessment will be performed using a visual analog scale (VAS). Participants will indicate the 
intensity of their pain on a scale of 0 to 10 , where 0 represents no pain and 10 represents unbearable 
pain. 
 
A project application will be submitted to the TÜBİTAK 1002-A Rapid Support Program for the 
procurement of the Movella DOT wearable sensors to be used in this study. 
 
3.6. Statistical Analysis of the Research 
Descriptive statistics will be used for participants' demographic and clinical characteristics (age, 
gender, type of scoliosis, Cobb angle, etc.). The study results will be analyzed using the “Statistical 
Package for Social Sciences” (SPSS) Version 16.0 statistical program. Standard deviation, mean, 
minimum, and maximum values will be calculated. A 95% confidence interval will be used to evaluate 
the reliability of the analysis results. The normality of the distribution of variables will be examined 
using Kolmogorov-Smirnov/Shapiro-Wilk tests and histogram graphs. For comparisons of 
lumbopelvic rhythm and postural control between the scoliosis and control groups, an independent 
samples t-test will be used if the data show a normal distribution, and the Mann-Whitney U test will 
be used if the data do not show a normal distribution. Pearson correlation analyses will be performed 
for normally distributed data and Spearman correlation analyses for non-normally distributed data to 
examine the relationships between lumbopelvic rhythm, postural control, pain level, and quality of 
life in the AIS group. The significance level will be considered to be p<0.05.