Knowledge and clinical practices in the conservative management of adolescent idiopathic scoliosis among physical therapists in Saudi Arabia: a national cross-sectional survey.

BACKGROUND: Adolescent idiopathic scoliosis (AIS) is the most common form of structural scoliosis. Contemporary evidence and recommendations from the International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) support physiotherapeutic scoliosis-specific exercises (PSSE) as a key component of conservative management. However, evidence regarding AIS-related knowledge and clinical practices among physical therapists in Saudi Arabia remains limited. This study aimed to evaluate knowledge, clinical practices, and evidence-practice gaps related to the conservative management of AIS among licensed physical therapists in Saudi Arabia. METHODS: A nationwide online cross-sectional survey was conducted among licensed physical therapists in Saudi Arabia using convenience and snowball sampling through professional networks and social media platforms. A structured questionnaire assessed demographic characteristics, scoliosis-specific training, AIS knowledge, clinical decision-making through guideline-based scenarios, clinical practice behaviours, confidence in AIS management, and perceived barriers to evidence-based care. Descriptive and inferential statistics were used to examine associations between professional characteristics and knowledge outcomes. RESULTS: A total of 160 physical therapists were included. The mean AIS knowledge score was 4.75 ± 1.88 out of 6, indicating overall adequate but heterogeneous knowledge. Recommended assessment approaches, including Adam's Forward Bend Test and scoliometer use, were commonly reported. However, important evidence-practice gaps were identified. In a scenario involving a skeletally immature adolescent with a mild curve (18°), only 5.0% selected PSSE, whereas 83.1% recommended observation alone. Furthermore, only 42.6% reported prescribing PSSE often or always in clinical practice, while 21.9% never prescribed PSSE. Participants with scoliosis-specific postgraduate training demonstrated significantly higher knowledge scores than untrained participants (5.31 ± 1.28 vs. 3.95 ± 2.09; p < 0.001). CONCLUSIONS: Saudi physical therapists demonstrated overall adequate but heterogeneous knowledge of AIS; however, clinically important evidence-practice gaps were evident, particularly regarding PSSE implementation and management of mild AIS. Expansion of scoliosis-specific education and development of nationally adapted clinical practice guidelines may help strengthen evidence-based conservative scoliosis care in Saudi Arabia. CLINICAL TRIAL NUMBER: Not applicable.