Archives of Physical Medicine and Rehabilitation, Jun 1, 2015
We compliment Longworth et al 1 for their article that we read with interest and would like to co... more We compliment Longworth et al 1 for their article that we read with interest and would like to comment on. Recently, we published an article that applied a similar methodology and showed an association between swimming, spinal deformities, and low back pain. 2 Even though we used a cutoff of 7 Bunnell Q2 that is usually applied in the most selective school screening, 3 we did not report any association between scoliosis and swimming, because we did not perform radiography to confirm the diagnosis. We called these findings "trunk asymmetries." 4 We think that this should also be the case in this study of dance. By applying a cutoff of 5 Bunnell in our study, we found 43
Introduction: SpineCor is a dynamic brace that showed good results in scoliosis treatment. But da... more Introduction: SpineCor is a dynamic brace that showed good results in scoliosis treatment. But data suggest that its efficacy is reduced as curves magnitude increase, and no comparisons exist versus exercise alone. The objective of this double study is to compare the short term results of the SpineCor versus SEAS exercises and versus rigid SpoRT brace for AIS. Study design: 2 retrospective controlled studies. Population 1: 56 consecutive AIS patients (39 female; age 13±1, Cobb 21±4°; ATR 11±4°): 28 patients (19 females; age 13±1; TRACE 6; Cobb angle 22±4°; ATR 12±4°, Risser 0-3) treated by SpineCor 20/24 hours; 28 patients (20 females; age 13±1; TRACE 5; Cobb angle 20±4°; ATR 9±3°, Risser 0-3) treated by SEAS exercises. Population 2: 103 consecutive AIS patients from our prospective database (85 females; age 13±1, Cobb 24±5°; ATR 8±4°): 29 patients (19 females; age 13±1; TRACE 6; Cobb angle 22±5°; ATR 9±3°, Risser 0-3) treated by SpineCor 20/24 hours per day; 74 patients (66 females; age 13±1; TRACE 5; Cobb angle 25±4°; ATR 8±4°, Risser 0-3) treated by SPoRT Brace 18 to 23 hours per day. The short term results of treatment, both clinical and radiographic, were evaluated after 18 months. Outcome measures: N° of rigid brace prescribed, TRACE, Cobb angle (changes > ±5), ATR (changes > ±2). Results: Study 1: the N° of patients prescribed with a rigid brace was not significantly different in the 2 groups. TRACE was stable for SEAS while decreased for SpineCor (p<0.05). Considering the number of patients changed > ±5° Cobb in the SEAS Group we found 39.3% improved and 14.3% worsened vs 25% and 21.4% in SpineCor (NS); no differences for ATR. Study 2: Both the treatment showed to be effective in improving the TRACE. Considering the other parameters, the SPoRT brace seems to be slightly more effective than the SpineCor both for the Cobb angle and the ATR. Conclusion: Short term results showed the SpineCor's efficacy to be between rigid brace and exercise for treatment efficacy for AIS.
Aim: Rehabilitation of adolescent idiopathic scoliosis (AIS) requires a careful choice from among... more Aim: Rehabilitation of adolescent idiopathic scoliosis (AIS) requires a careful choice from among the possible treatments, such as bracing and exercises, according to the patient's needs. According to the literature, there is little evidence regarding the efficacy of these rehabilitation instruments. During the past few years, a full series of studies has been carried out to investigate their efficacy. The aim of this paper was to summarize all these results. Methods: Three systematic reviews (two on exercises and one on manual therapy), and four cohort prospective studies were performed. The prospective studies included two trials with a prospective control group on exercises (one to avoid bracing and one in preparation to bracing) and two trials with retrospective control group on a new brace developed by the Authors (Sforzesco brace and SPoRT concept of correction versus Lyon brace and Risser cast). Results: Results show that in literature there is proof of level 1b on exercises but no studies on manual therapy. High quality exercises like Scientific Exercises Approach to Scoliosis (SEAS) have more efficacy than usual physiotherapy, significantly reducing brace prescription in one year from 25% of cases to 6%. Moreover, such exercises help to obtain the best results in bracing first correction. The Sforzesco brace has proved to have more efficacy than the Lyon brace, whereas it has the same efficacy--but reduced side effects and impact on quality of life--than the Risser brace. Conclusion: With an efficient management of data collection, it is possible to develop a set of studies aimed at verifying the efficacy of clinical daily rehabilitation approaches.
Diagnosis of low back pain (LBP) is made by exclusion of secondary spinal diseases, identifiable ... more Diagnosis of low back pain (LBP) is made by exclusion of secondary spinal diseases, identifiable in the first month of pain (acute LBP-ALBP) through the so-called "reds flags", and only if pain persists over 4 weeks (sub-acute LBP-SALBP) using diagnostic exams. LBP classification is actually based on the localization (LBP and sciatica) and duration of pain: ALBP, SALBP, and chronic (CLBP) when it lasts over 6 months. ALBP prognosis is very good because it is auto-resolving in most of the cases; on the contrary, CLBP has a bad prognosis (very low rate of resolution even with treatment). The stage of most interest is SALBP, in which it is possible to identify risk factors ("yellow flags") of chronicity and to avoid the development of a series of vicious cycles that, according to a bio-psycho-social model of illness, can lead the patient to CLBP. In CLBP it's mandatory to make the patient able to manage his problem, so to increase his quality of life and decrease disability and pain. Treatment approach to ALBP consist of reassuring the patient and providing accurate preventive information, recommendations to remain as active as possible, to avoid bed rest. In SALBP and CLBP, a multidisciplinary team rehabilitation approach is the most important one, combining educational, cognitive-behavioural and physical exercise treatments according to the individual needs. Pain killer therapies can be proposed, but bearing in mind their short-term effects.
The aim of this prospective controlled study is to present end-growth results of different exerci... more The aim of this prospective controlled study is to present end-growth results of different exercise for Hyperkyphosis.
Background: The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Trea... more Background: The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT), that produced its first Guidelines in 2005, felt the need to revise them and increase their scientific quality. The aim is to offer to all professionals and their patients an evidence-based updated review of the actual evidence on conservative treatment of idiopathic scoliosis (CTIS). Methods: All types of professionals (specialty physicians, and allied health professionals) engaged in CTIS have been involved together with a methodologist and a patient representative. A review of all the relevant literature and of the existing Guidelines have been performed. Documents, recommendations, and practical approach flow charts have been developed according to a Delphi procedure. A methodological and practical review has been made, and a final Consensus Session was held during the 2011 Barcelona SOSORT Meeting. Results: The contents of the document are: methodology; generalities on idiopathic scoliosis; approach to CTIS in different patients, with practical flow-charts; literature review and recommendations on assessment, bracing, physiotherapy, Physiotherapeutic Specific Exercises (PSE) and other CTIS. Sixty-five recommendations have been given, divided in the following topics: Bracing (20 recommendations), PSE to prevent scoliosis progression during growth (8), PSE during brace treatment and surgical therapy (5), Other conservative treatments (3), Respiratory function and exercises (3), Sports activities (6), Assessment (20). No recommendations reached a Strength of Evidence level I; 2 were level II; 7 level III; and 20 level IV; through the Consensus procedure 26 reached level V and 10 level VI. The Strength of Recommendations was Grade A for 13, B for 49 and C for 3; none had grade D. Conclusion: These Guidelines have been a big effort of SOSORT to paint the actual situation of CTIS, starting from the evidence, and filling all the gray areas using a scientific method. According to results, it is possible to understand the lack of research in general on CTIS. SOSORT invites researchers to join, and clinicians to develop good research strategies to allow in the future to support or refute these recommendations according to new and stronger evidence.
One of the reasons that make scoliosis a disease that scares so much the parents is its specific ... more One of the reasons that make scoliosis a disease that scares so much the parents is its specific characteristic of being difficult to detect on its onset.The aim of this paper is to check the possible usefulness of a simple tool (the torsion bottle) that has been developed with the aim to offer an instrument for home use by parents but also for screening purposes in the low-income countries. Study design: retrospective analysis to evaluate intra-operator reliability of the tools and inter-operator repeatability using the torsion bottle.For the first and the second part of the study, 35 subjects were measured.The goal of the first experiment was to evaluate the reliability of the torsion bottle to identify all individuals who experienced a thoracic or lumbar prominence equal or greater than 7°.The secondary aim was to verify the reliability of blinded inter-operator assessments, performed with the torsion bottle by two physiotherapists on the same patients. The reliability of the ass...
Introduction: The ATR measure is one of the most important clinical measurement of scoliosis pati... more Introduction: The ATR measure is one of the most important clinical measurement of scoliosis patients. It is the most Important Information for screening and fundamental also for therapy management The ATR is a clinical sign considered closely related to rotation of the vertebrae interested by the scoliotic curves. The ATR assessment is performed with the patient in forward bending of the trunk, to make appear the hump. Objectives: The purpose of the study is to understand better the real value of the hump assessed In the classical position (forward bending of the trunk), compared with the measurement performed with the patient in standing position. Another aim is to assess the real association of the vertebral rotation measured on the X-ray and its hypothetical clinical correspondent represented by the hump. Methods: 40 female adolescents at their first evaluation before any treatment were recruited for the study. A series of measures has been carried out: ATR with patient in forwa...
Background: Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine. ... more Background: Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine. While AIS can progress during growth and cause a surface deformity, it is usually not symptomatic. However, in adulthood, if the final spinal curvature surpasses a certain critical threshold, the risk of health problems and curve progression is increased. The use of scoliosis-specific exercises (SSE) to reduce progression of AIS and postpone or avoid other more invasive treatments is controversial. Objectives:
There is low evidence on the possible efficacy of exercises to treat idiopathic scoliosis, graded... more There is low evidence on the possible efficacy of exercises to treat idiopathic scoliosis, graded as C by the existing Italian Guidelines. Our aim was to verify if exercises quality has an effect on results. DESIGN: Prospective controlled study on idiopathic scoliosis patients that performed only exercises to avoid progression. TREATMENT: SEAS Group make exercises according to the protocol SEAS.02 (Scientific Exercises Approach to Scoliosis, version 2002). The CONT Group performed exercises at a local structure according to different protocols preferred by the treating therapists. Population. SEAS: 48 patients (37 females), 12.5+/-2.2 years, 15.1 degrees +/-5.7 degrees Cobb (degrees C), 9.0 degrees +/-3.3 degrees Bunnell (degrees B). The difference in the number of braced patients within the first year has been almost statistically significant (P=0.07): 1 in SEAS vs. 5 in CONT. Cobb degrees improved with treatment (P<0.05) only in the SEAS group. Clinical results (variation of at...
In the literature the rate of surgery for AIS (Adolescent Idiopathic Scoliosis) of 30 degrees ran... more In the literature the rate of surgery for AIS (Adolescent Idiopathic Scoliosis) of 30 degrees ranges from 22.4% to 31% when braces are used, versus the natural history rate of 28.1%. When a complete conservative approach is used (braces and exercises), this rate decreases to the range of 3.8% to 7.3%. All these studies are retrospective. The aim was to evaluate the final results of a prospective set of patients treated in a center fully dedicated to a complete conservative treatment (exercises and braces) of AIS. This is an everyday clinical, retrospective study on a prospective data base. The population included 112 AIS patients, 13.2+/-1.8 years old, with 23.4+/-11.5 degrees Cobb degrees at the start of treatment. All the patients had been treated with a full set of conservative treatments, including exercises, according to their individual needs. We used the SEAS (Scientific Exercises Approach to Scoliosis) protocol and the ISICO approach, while the orthosis used included: Risser...
SEAS is an acronym for "Scientific Exercises Approach to Scoliosis". Main characteristi... more SEAS is an acronym for "Scientific Exercises Approach to Scoliosis". Main characteristics of SEAS are team approach and cognitive-behavioural approach because in our view these are two indispensable elements in chronic disease rehabilitation. In this article we describe the main differences between SEAS approach and other exercise techniques as well as theoretical bases and therapeutic goals. We illustrate practical application of SEAS concept and scientific results in order to reduce the patient's progress of scoliosis so that a brace would be needed. When compared to usual care, improvement of scoliosis parameters and balance normalization in scoliosis patients.
The Lyon school has proposed a preparation to brace wearing through an intensive mobilization in ... more The Lyon school has proposed a preparation to brace wearing through an intensive mobilization in order to obtain a better reduction of the braced scoliotic curve. Our aim was to verify this hypothesis. A prospective controlled study on consecutive patients having idiopathic scoliosis with brace management. Results after 5 months of brace wearing were reviewed by radiographic examination without the brace. SEAS Group exercises according to the protocol SEAS.02 (Scientific Exercises Approach to Scoliosis, version 2002); CONT Group various type of exercises. Population. 110 patients (34 females), 13.5+/-2.4 years, 31.1 degrees +/-11.1 degrees Cobb (degrees C), 14.4 degrees +/-6.0 degrees Bunnell (degrees B). All parameters improved at follow-up in both groups. SEAS had better results than CONT for degrees C. Clinical results (variations of at least 5 degrees C and 2 degrees B) were better in SEAS than CONT. This study proves the efficacy of SEAS.02 exercises preparatory for bracing. Br...
A previously published systematic review (2003) documented evidence on the efficacy of specific p... more A previously published systematic review (2003) documented evidence on the efficacy of specific physical exercises to reduce progression of adolescent idiopathic scoliosis. A bibliographic search with strict inclusion criteria has been performed on the main electronic databases and through extensive hand search. We retrieved 19 studies: 1 randomised (RCT) and 8 controlled studies. A methodological and clinical evaluation has been performed. The 19 papers considered included 1654 treated patients and 688 controls. The highest quality study (RCT) compared 2 groups of 40 patients, showing an improvement of the curve in all treated patients after 6 months. We found 3 papers on Scoliosis Intensive Rehabilitation (Schroth), 5 on passive autocorrection-based methods (Schroth, side-shift), 4 on active autocorrection-based approaches (Lyon and SEAS) and 5 with no autocorrection. Apart from one, all studies confirmed the efficacy of exercises in reducing the progression rate and/or improving ...
The publication of research in the field of conservative treatment of scoliosis is increasing aft... more The publication of research in the field of conservative treatment of scoliosis is increasing after a long period of progressive decline. In 2014, three high quality and scientifically sound papers gave new strength to the conservative scoliosis approach. The efficacy of treatment over observation was demonstrated by two RCTs for bracing, and one for scoliosis-specific exercises provided by a physical therapist. It is difficult to design strong studies in this field due to the long time needed for follow up and the challenge of recruiting patients and families willing to be involved in the decision process. Nevertheless, the main methodological errors are not related to the study design but rather on the way it is performed, which very frequently affects the reliability of results. The most common errors are: selection bias, with many studies including functional rather than a true structural scoliosis; inappropriate outcome measures, utilizing parameters not related to scoliosis progression or quality of life; inappropriate follow up, reporting only immediate results and not addressing end of growth results; an incorrect interpretation of findings, with an overestimation of results; and missing the evaluation of skeletal maturity, without which results cannot be considered stable. Being aware of these errors is extremely important both for authors and for readers in order to avoid questionable practices based on inconclusive studies that could harm patients.
Scoliosis fusion surgery is generally considered the only means to stop the progression of adult ... more Scoliosis fusion surgery is generally considered the only means to stop the progression of adult idiopathic scoliosis (ADIS), but for patients refusing surgery there is lack of evidence in favour of conservative treatment. The aim of the present study was to verify the possible effectiveness of scoliosis-specific exercises when facing ADIS progression. We designed a retrospective cohort study. We included 34 ADIS patients in treatment at our Institute (5 males and 29 females, mean age was 38.0 ± 11.0), exclusively treated with specific Scoliosis Specific SEAS exercises. SEAS exercises are scoliosis-specific exercises. In adult patients they are aimed to recover postural collapse, postural control and vertebral stability through an active self-correction. Postural integration is a key element, including the neuromotor integration of correct postures and an ergonomic education program. Therapy includes at least two weekly exercise sessions each lasting 45 min. Radiographic progression was the main outcome and it was analysed as a continuous variable. One way ANOVA and paired t-test were applied for continuous data, while chi-square test was applied for categorical data. Alpha was set at 0.05. The mean Cobb angle of the patients included into the present study, was 55.8 ± 13.2 °. Fifteen patients had previous x-rays testifying scoliosis progression: the average curve progression (worsening) was 9.8 ± 6.6 ° at a median of 25 (range 17-48) years. The remaining were characterized by more severe curves, exceeding 40 ° Cobb (mean curvature 50.9 ± 13.6) but it was not possible to prove that the curves had progressed in these cases. After an average period of 2 years of treatment (range 1-18y), 68 % of the patients experienced an improvement in their scoliosis. However in one patient (3 %) the scoliosis worsened by 5 ° in 18 years (progression rate reduced from 0.5 ° to 0.27 ° per year). Patients improved 4.6 ± 5.0 ° Cobb (P &amp;amp;lt; 0.05), with no differences based on the localization of the curve, gender, age, length of treatment, Cobb degrees at the start of observation or treatment. Scoliosis Specific SEAS Exercises proved to be superior to natural history in ADIS, at least in individual cases and should be considered as a first line treatment especially in patients refusing scoliosis surgery.
Archives of Physical Medicine and Rehabilitation, Jun 1, 2015
We compliment Longworth et al 1 for their article that we read with interest and would like to co... more We compliment Longworth et al 1 for their article that we read with interest and would like to comment on. Recently, we published an article that applied a similar methodology and showed an association between swimming, spinal deformities, and low back pain. 2 Even though we used a cutoff of 7 Bunnell Q2 that is usually applied in the most selective school screening, 3 we did not report any association between scoliosis and swimming, because we did not perform radiography to confirm the diagnosis. We called these findings "trunk asymmetries." 4 We think that this should also be the case in this study of dance. By applying a cutoff of 5 Bunnell in our study, we found 43
Introduction: SpineCor is a dynamic brace that showed good results in scoliosis treatment. But da... more Introduction: SpineCor is a dynamic brace that showed good results in scoliosis treatment. But data suggest that its efficacy is reduced as curves magnitude increase, and no comparisons exist versus exercise alone. The objective of this double study is to compare the short term results of the SpineCor versus SEAS exercises and versus rigid SpoRT brace for AIS. Study design: 2 retrospective controlled studies. Population 1: 56 consecutive AIS patients (39 female; age 13±1, Cobb 21±4°; ATR 11±4°): 28 patients (19 females; age 13±1; TRACE 6; Cobb angle 22±4°; ATR 12±4°, Risser 0-3) treated by SpineCor 20/24 hours; 28 patients (20 females; age 13±1; TRACE 5; Cobb angle 20±4°; ATR 9±3°, Risser 0-3) treated by SEAS exercises. Population 2: 103 consecutive AIS patients from our prospective database (85 females; age 13±1, Cobb 24±5°; ATR 8±4°): 29 patients (19 females; age 13±1; TRACE 6; Cobb angle 22±5°; ATR 9±3°, Risser 0-3) treated by SpineCor 20/24 hours per day; 74 patients (66 females; age 13±1; TRACE 5; Cobb angle 25±4°; ATR 8±4°, Risser 0-3) treated by SPoRT Brace 18 to 23 hours per day. The short term results of treatment, both clinical and radiographic, were evaluated after 18 months. Outcome measures: N° of rigid brace prescribed, TRACE, Cobb angle (changes > ±5), ATR (changes > ±2). Results: Study 1: the N° of patients prescribed with a rigid brace was not significantly different in the 2 groups. TRACE was stable for SEAS while decreased for SpineCor (p<0.05). Considering the number of patients changed > ±5° Cobb in the SEAS Group we found 39.3% improved and 14.3% worsened vs 25% and 21.4% in SpineCor (NS); no differences for ATR. Study 2: Both the treatment showed to be effective in improving the TRACE. Considering the other parameters, the SPoRT brace seems to be slightly more effective than the SpineCor both for the Cobb angle and the ATR. Conclusion: Short term results showed the SpineCor's efficacy to be between rigid brace and exercise for treatment efficacy for AIS.
Aim: Rehabilitation of adolescent idiopathic scoliosis (AIS) requires a careful choice from among... more Aim: Rehabilitation of adolescent idiopathic scoliosis (AIS) requires a careful choice from among the possible treatments, such as bracing and exercises, according to the patient's needs. According to the literature, there is little evidence regarding the efficacy of these rehabilitation instruments. During the past few years, a full series of studies has been carried out to investigate their efficacy. The aim of this paper was to summarize all these results. Methods: Three systematic reviews (two on exercises and one on manual therapy), and four cohort prospective studies were performed. The prospective studies included two trials with a prospective control group on exercises (one to avoid bracing and one in preparation to bracing) and two trials with retrospective control group on a new brace developed by the Authors (Sforzesco brace and SPoRT concept of correction versus Lyon brace and Risser cast). Results: Results show that in literature there is proof of level 1b on exercises but no studies on manual therapy. High quality exercises like Scientific Exercises Approach to Scoliosis (SEAS) have more efficacy than usual physiotherapy, significantly reducing brace prescription in one year from 25% of cases to 6%. Moreover, such exercises help to obtain the best results in bracing first correction. The Sforzesco brace has proved to have more efficacy than the Lyon brace, whereas it has the same efficacy--but reduced side effects and impact on quality of life--than the Risser brace. Conclusion: With an efficient management of data collection, it is possible to develop a set of studies aimed at verifying the efficacy of clinical daily rehabilitation approaches.
Diagnosis of low back pain (LBP) is made by exclusion of secondary spinal diseases, identifiable ... more Diagnosis of low back pain (LBP) is made by exclusion of secondary spinal diseases, identifiable in the first month of pain (acute LBP-ALBP) through the so-called "reds flags", and only if pain persists over 4 weeks (sub-acute LBP-SALBP) using diagnostic exams. LBP classification is actually based on the localization (LBP and sciatica) and duration of pain: ALBP, SALBP, and chronic (CLBP) when it lasts over 6 months. ALBP prognosis is very good because it is auto-resolving in most of the cases; on the contrary, CLBP has a bad prognosis (very low rate of resolution even with treatment). The stage of most interest is SALBP, in which it is possible to identify risk factors ("yellow flags") of chronicity and to avoid the development of a series of vicious cycles that, according to a bio-psycho-social model of illness, can lead the patient to CLBP. In CLBP it's mandatory to make the patient able to manage his problem, so to increase his quality of life and decrease disability and pain. Treatment approach to ALBP consist of reassuring the patient and providing accurate preventive information, recommendations to remain as active as possible, to avoid bed rest. In SALBP and CLBP, a multidisciplinary team rehabilitation approach is the most important one, combining educational, cognitive-behavioural and physical exercise treatments according to the individual needs. Pain killer therapies can be proposed, but bearing in mind their short-term effects.
The aim of this prospective controlled study is to present end-growth results of different exerci... more The aim of this prospective controlled study is to present end-growth results of different exercise for Hyperkyphosis.
Background: The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Trea... more Background: The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT), that produced its first Guidelines in 2005, felt the need to revise them and increase their scientific quality. The aim is to offer to all professionals and their patients an evidence-based updated review of the actual evidence on conservative treatment of idiopathic scoliosis (CTIS). Methods: All types of professionals (specialty physicians, and allied health professionals) engaged in CTIS have been involved together with a methodologist and a patient representative. A review of all the relevant literature and of the existing Guidelines have been performed. Documents, recommendations, and practical approach flow charts have been developed according to a Delphi procedure. A methodological and practical review has been made, and a final Consensus Session was held during the 2011 Barcelona SOSORT Meeting. Results: The contents of the document are: methodology; generalities on idiopathic scoliosis; approach to CTIS in different patients, with practical flow-charts; literature review and recommendations on assessment, bracing, physiotherapy, Physiotherapeutic Specific Exercises (PSE) and other CTIS. Sixty-five recommendations have been given, divided in the following topics: Bracing (20 recommendations), PSE to prevent scoliosis progression during growth (8), PSE during brace treatment and surgical therapy (5), Other conservative treatments (3), Respiratory function and exercises (3), Sports activities (6), Assessment (20). No recommendations reached a Strength of Evidence level I; 2 were level II; 7 level III; and 20 level IV; through the Consensus procedure 26 reached level V and 10 level VI. The Strength of Recommendations was Grade A for 13, B for 49 and C for 3; none had grade D. Conclusion: These Guidelines have been a big effort of SOSORT to paint the actual situation of CTIS, starting from the evidence, and filling all the gray areas using a scientific method. According to results, it is possible to understand the lack of research in general on CTIS. SOSORT invites researchers to join, and clinicians to develop good research strategies to allow in the future to support or refute these recommendations according to new and stronger evidence.
One of the reasons that make scoliosis a disease that scares so much the parents is its specific ... more One of the reasons that make scoliosis a disease that scares so much the parents is its specific characteristic of being difficult to detect on its onset.The aim of this paper is to check the possible usefulness of a simple tool (the torsion bottle) that has been developed with the aim to offer an instrument for home use by parents but also for screening purposes in the low-income countries. Study design: retrospective analysis to evaluate intra-operator reliability of the tools and inter-operator repeatability using the torsion bottle.For the first and the second part of the study, 35 subjects were measured.The goal of the first experiment was to evaluate the reliability of the torsion bottle to identify all individuals who experienced a thoracic or lumbar prominence equal or greater than 7°.The secondary aim was to verify the reliability of blinded inter-operator assessments, performed with the torsion bottle by two physiotherapists on the same patients. The reliability of the ass...
Introduction: The ATR measure is one of the most important clinical measurement of scoliosis pati... more Introduction: The ATR measure is one of the most important clinical measurement of scoliosis patients. It is the most Important Information for screening and fundamental also for therapy management The ATR is a clinical sign considered closely related to rotation of the vertebrae interested by the scoliotic curves. The ATR assessment is performed with the patient in forward bending of the trunk, to make appear the hump. Objectives: The purpose of the study is to understand better the real value of the hump assessed In the classical position (forward bending of the trunk), compared with the measurement performed with the patient in standing position. Another aim is to assess the real association of the vertebral rotation measured on the X-ray and its hypothetical clinical correspondent represented by the hump. Methods: 40 female adolescents at their first evaluation before any treatment were recruited for the study. A series of measures has been carried out: ATR with patient in forwa...
Background: Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine. ... more Background: Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine. While AIS can progress during growth and cause a surface deformity, it is usually not symptomatic. However, in adulthood, if the final spinal curvature surpasses a certain critical threshold, the risk of health problems and curve progression is increased. The use of scoliosis-specific exercises (SSE) to reduce progression of AIS and postpone or avoid other more invasive treatments is controversial. Objectives:
There is low evidence on the possible efficacy of exercises to treat idiopathic scoliosis, graded... more There is low evidence on the possible efficacy of exercises to treat idiopathic scoliosis, graded as C by the existing Italian Guidelines. Our aim was to verify if exercises quality has an effect on results. DESIGN: Prospective controlled study on idiopathic scoliosis patients that performed only exercises to avoid progression. TREATMENT: SEAS Group make exercises according to the protocol SEAS.02 (Scientific Exercises Approach to Scoliosis, version 2002). The CONT Group performed exercises at a local structure according to different protocols preferred by the treating therapists. Population. SEAS: 48 patients (37 females), 12.5+/-2.2 years, 15.1 degrees +/-5.7 degrees Cobb (degrees C), 9.0 degrees +/-3.3 degrees Bunnell (degrees B). The difference in the number of braced patients within the first year has been almost statistically significant (P=0.07): 1 in SEAS vs. 5 in CONT. Cobb degrees improved with treatment (P<0.05) only in the SEAS group. Clinical results (variation of at...
In the literature the rate of surgery for AIS (Adolescent Idiopathic Scoliosis) of 30 degrees ran... more In the literature the rate of surgery for AIS (Adolescent Idiopathic Scoliosis) of 30 degrees ranges from 22.4% to 31% when braces are used, versus the natural history rate of 28.1%. When a complete conservative approach is used (braces and exercises), this rate decreases to the range of 3.8% to 7.3%. All these studies are retrospective. The aim was to evaluate the final results of a prospective set of patients treated in a center fully dedicated to a complete conservative treatment (exercises and braces) of AIS. This is an everyday clinical, retrospective study on a prospective data base. The population included 112 AIS patients, 13.2+/-1.8 years old, with 23.4+/-11.5 degrees Cobb degrees at the start of treatment. All the patients had been treated with a full set of conservative treatments, including exercises, according to their individual needs. We used the SEAS (Scientific Exercises Approach to Scoliosis) protocol and the ISICO approach, while the orthosis used included: Risser...
SEAS is an acronym for "Scientific Exercises Approach to Scoliosis". Main characteristi... more SEAS is an acronym for "Scientific Exercises Approach to Scoliosis". Main characteristics of SEAS are team approach and cognitive-behavioural approach because in our view these are two indispensable elements in chronic disease rehabilitation. In this article we describe the main differences between SEAS approach and other exercise techniques as well as theoretical bases and therapeutic goals. We illustrate practical application of SEAS concept and scientific results in order to reduce the patient's progress of scoliosis so that a brace would be needed. When compared to usual care, improvement of scoliosis parameters and balance normalization in scoliosis patients.
The Lyon school has proposed a preparation to brace wearing through an intensive mobilization in ... more The Lyon school has proposed a preparation to brace wearing through an intensive mobilization in order to obtain a better reduction of the braced scoliotic curve. Our aim was to verify this hypothesis. A prospective controlled study on consecutive patients having idiopathic scoliosis with brace management. Results after 5 months of brace wearing were reviewed by radiographic examination without the brace. SEAS Group exercises according to the protocol SEAS.02 (Scientific Exercises Approach to Scoliosis, version 2002); CONT Group various type of exercises. Population. 110 patients (34 females), 13.5+/-2.4 years, 31.1 degrees +/-11.1 degrees Cobb (degrees C), 14.4 degrees +/-6.0 degrees Bunnell (degrees B). All parameters improved at follow-up in both groups. SEAS had better results than CONT for degrees C. Clinical results (variations of at least 5 degrees C and 2 degrees B) were better in SEAS than CONT. This study proves the efficacy of SEAS.02 exercises preparatory for bracing. Br...
A previously published systematic review (2003) documented evidence on the efficacy of specific p... more A previously published systematic review (2003) documented evidence on the efficacy of specific physical exercises to reduce progression of adolescent idiopathic scoliosis. A bibliographic search with strict inclusion criteria has been performed on the main electronic databases and through extensive hand search. We retrieved 19 studies: 1 randomised (RCT) and 8 controlled studies. A methodological and clinical evaluation has been performed. The 19 papers considered included 1654 treated patients and 688 controls. The highest quality study (RCT) compared 2 groups of 40 patients, showing an improvement of the curve in all treated patients after 6 months. We found 3 papers on Scoliosis Intensive Rehabilitation (Schroth), 5 on passive autocorrection-based methods (Schroth, side-shift), 4 on active autocorrection-based approaches (Lyon and SEAS) and 5 with no autocorrection. Apart from one, all studies confirmed the efficacy of exercises in reducing the progression rate and/or improving ...
The publication of research in the field of conservative treatment of scoliosis is increasing aft... more The publication of research in the field of conservative treatment of scoliosis is increasing after a long period of progressive decline. In 2014, three high quality and scientifically sound papers gave new strength to the conservative scoliosis approach. The efficacy of treatment over observation was demonstrated by two RCTs for bracing, and one for scoliosis-specific exercises provided by a physical therapist. It is difficult to design strong studies in this field due to the long time needed for follow up and the challenge of recruiting patients and families willing to be involved in the decision process. Nevertheless, the main methodological errors are not related to the study design but rather on the way it is performed, which very frequently affects the reliability of results. The most common errors are: selection bias, with many studies including functional rather than a true structural scoliosis; inappropriate outcome measures, utilizing parameters not related to scoliosis progression or quality of life; inappropriate follow up, reporting only immediate results and not addressing end of growth results; an incorrect interpretation of findings, with an overestimation of results; and missing the evaluation of skeletal maturity, without which results cannot be considered stable. Being aware of these errors is extremely important both for authors and for readers in order to avoid questionable practices based on inconclusive studies that could harm patients.
Scoliosis fusion surgery is generally considered the only means to stop the progression of adult ... more Scoliosis fusion surgery is generally considered the only means to stop the progression of adult idiopathic scoliosis (ADIS), but for patients refusing surgery there is lack of evidence in favour of conservative treatment. The aim of the present study was to verify the possible effectiveness of scoliosis-specific exercises when facing ADIS progression. We designed a retrospective cohort study. We included 34 ADIS patients in treatment at our Institute (5 males and 29 females, mean age was 38.0 ± 11.0), exclusively treated with specific Scoliosis Specific SEAS exercises. SEAS exercises are scoliosis-specific exercises. In adult patients they are aimed to recover postural collapse, postural control and vertebral stability through an active self-correction. Postural integration is a key element, including the neuromotor integration of correct postures and an ergonomic education program. Therapy includes at least two weekly exercise sessions each lasting 45 min. Radiographic progression was the main outcome and it was analysed as a continuous variable. One way ANOVA and paired t-test were applied for continuous data, while chi-square test was applied for categorical data. Alpha was set at 0.05. The mean Cobb angle of the patients included into the present study, was 55.8 ± 13.2 °. Fifteen patients had previous x-rays testifying scoliosis progression: the average curve progression (worsening) was 9.8 ± 6.6 ° at a median of 25 (range 17-48) years. The remaining were characterized by more severe curves, exceeding 40 ° Cobb (mean curvature 50.9 ± 13.6) but it was not possible to prove that the curves had progressed in these cases. After an average period of 2 years of treatment (range 1-18y), 68 % of the patients experienced an improvement in their scoliosis. However in one patient (3 %) the scoliosis worsened by 5 ° in 18 years (progression rate reduced from 0.5 ° to 0.27 ° per year). Patients improved 4.6 ± 5.0 ° Cobb (P &amp;amp;lt; 0.05), with no differences based on the localization of the curve, gender, age, length of treatment, Cobb degrees at the start of observation or treatment. Scoliosis Specific SEAS Exercises proved to be superior to natural history in ADIS, at least in individual cases and should be considered as a first line treatment especially in patients refusing scoliosis surgery.
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Papers by Michele Romano