Appeal type: Experimental/Investigational
Decision: Upheld Decision of Health Plan

Nature of Statutory Criteria/Case Summary: An enrollees parent has requested reimbursement and prospective authorization and coverage for Schroth therapy. Day and colleagues found insufficient evidence to suggest that both Schroth and Scientific Exercise Approach to Scoliosis (SEAS) methods can effectively improve Cobb angles in patients with adolescent idiopathic scoliosis (AIS) compared to no intervention, and limited evidence that the SEAS method is more effective compared to traditional exercises. The authors concluded that there was a noticeable lack of contemporary studies using evidence-based medicine with verifiable results from well-designed and managed research studies, and that more and varied studies of higher quality were needed on the effectiveness of any physiotherapy scoliosis-specific exercises (PSSE). In a non-randomized prospective clinical trial, Fan and colleagues noted that it was the first study to investigate the long-term effects of PSSE in reducing Cobb angles on the basis of major curve location. The authors noted no significant differences in correction between major thoracic and major lumbar curves, and a regression effect and no curve deterioration at the two-year follow-up. Schreiber and colleagues reported that patients undergoing Schroth treatment perceived improved status of their backs, even if the Cobb angle did not improve beyond the conventionally accepted threshold of five degrees. The authors noted that standard of care aims to slow or stop progression while Schroth exercises aim to improve postural balance, signs and symptoms of scoliosis, and that given the very small minimal important difference, perceived improvement in back status was likely due to something other than the Cobb angle. In this case, the patient had diagnoses of low back pain and adolescent idiopathic scoliosis. She reported intermittent daily pain in the left upper back and neck and right lower back. Visit notes reported that the symptoms of left neck pain were aggravated with sitting. The patient presented with a verbal pain rating of three in the left upper trapezius area and right lower back. Functional deficits included an inability to sit for long periods of time without neck and back pain and bruising in the low back due to where the chair hit. On examination, the patient had scoliosis, sitting with a slumped, head forward posture, standing with her left iliac crest slightly higher, and with a pronounced posterior pelvic tilt with no lumbar lordosis, and a left elevated shoulder height. Scoliotic prominence was noted in the upper left thoracic, right lumbar, left pelvic, and right trunk.  Sagittal posture was measured at 15 degrees at T1, 8 degrees at T12, 6 degrees at S1, along with a regional angle of thoracic kyphosis of 23 degrees, and regional angle of lumbar lordosis of 14 degrees. A Cobb angle of 17 degrees in the upper thoracic and 27 degrees in the lumbar with apex L1/L2 was noted. In this clinical setting, current medical literature does not support the use of the services at issue as an effective or safe treatment. Therefore, Schroth therapy was not and is not likely to be more beneficial for treatment of the patients condition than any available standard therapy.Findings:  Two of the three physician reviewers found the Schroth therapy at issue was not and is not likely to be more beneficial for treatment of the patients medical condition than any available standard therapy.Final Result: The reviewers determined that the services at issue were not and are not likely to be more beneficial for treatment of the patients medical condition than any available standard therapy. Therefore, the Health Plans denial should be upheld. Credentials/Qualifications: Physician reviewers 1, 2, and 3 are board certified in orthopedic surgery and are actively practicing. The reviewers are experts in the treatment of the enrollees medical condition and knowledgeable about the proposed treatment through recent or current actual clinical experience treating those with the same or a similar medical condition.