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Telephysiotherapy in Isico: the published research

In this pandemic year a lot has changed in our daily habits, much in the way we work. Something also in the way we treat patients. We had to adapt to take opportunities from difficulties. In Isico, we have done this from the beginning, overcoming the first phase of closures thanks to the online mode of medical visits and physiotherapy treatments.

It was a way not to leave our patients alone and not to waste the efforts made, a way that after some time has become an integral part of our therapeutic proposal.

We learnt a lot and this also translated into the research, published recently by the Spine Journal,Lessons learnt in two months of the exclusive application of telephysiotherapy instead of classical physiotherapy during the lockdown in Italy“. 

“Current evidence on telemedicine mostly refers to interventions not requiring hands-on approaches, based on either technology or oral/visual interactions – explains Michele Romano, director of Isico physiotherapy and author of the research –  In a way, the pandemic offered a sudden push to telemedicine. The question is which lessons can we learn on telephysiotherapy after a few months of extensive and mandatory experience?” 

For this reason, we want to share the experiences of exclusively telephysiotherapy treatments acquired by 38 physiotherapists working for Isico during the 2 months of lockdown from March 16th to May 11th.

It was crucial in the first phase that patients accept telephysiotherapy. Usually, the appointments are managed by the booking call-center, but after the first phone calls it was clear that this unusual and unexpected change proposed by a secretary was not well received by the patients.

Consequently, the new standard is that the appointment is made by phone call by the treating physiotherapist him/herself. That facilitates the interaction with the patient, and allows to professionally answer all eventual doubts.

How to organise to be able to carry out physiotherapy treatments online?  “An involvement of caregivers and families is necessary for the session. A free video-communication App is used (Skype or Meet) – explains Michele Romano  – Evaluation results autonomously collected by patients with the help of a caregiver, are sent before the session to fill the assessment form in advance. One caregiver is present during the session, with one camera to film the patient, to help correct mistakes and observe the right execution of specific exercises; a second device is used for the Institute App to record the exercises”.

During 2 months of lockdown, telephysiotherapy sessions have been 2,239 (100%). After the lockdown, when back to “normal” were face-to-face hands-on physiotherapy, 10% (532 out of a total of 5,091) remained telephysiotherapy sessions.

The common feeling of patients and their caregivers was of not having been abandoned – explains Michele  Romano –  during these months we verified that the systems work properly, now this wide and sudden experience is available for the worldwide physiotherapy community. Telephysiotherapy is a not so difficult, readily available instrument.

Obviously, limits and drawbacks referred by physiotherapists and patients included the impossibility to use hands-on, the need to simplify the approach, the limited attention of younger patients, the connection difficulties.  

Most physiotherapists and patients agreed that this type of approach is perfect in emergency, but it cannot substitute normal physiotherapy sessions in normal times.

“Yet we have found – concludes Michele Romano – that there is a group of patients who have discovered telemedicine and continue to use it even now, an additional opportunity that therefore in Isico we have decided to offer patients in the future, alongside the classical medical visits and physiotherapy treatments performed in-person.”

Message in a bottle: an Isico research

Isico’s study, “Torsion bottle, a very simple, reliable, and cheap tool for a basic scoliosis screening, published by Scoliosis and Spinal Disorders, demonstrates how and why scoliosis can be identified using a bottle of water. 

“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 – explains Michele Romano, director of physiotherapists in Isico – A scoliometer is a professional medical instrument used by specialists such as doctors and physiotherapists to detect the pathology. In the absence of this instrument, is there a simple test for scoliosis that we can do in our own homes? Yes, the Torsion Bottle. Our paper aimed to check the possible usefulness of a simple tool (the Torsion Bottle) developed to offer an instrument for home-use by parents but also for screening purposes in low-income countries”.

The study was divided into two parts. The main purpose was to compare the measurements collected with the torsion bottle and the same measurements collected with the scoliometer in a population of patients accessing our clinic for the rehabilitation treatment following Isico standard evaluation protocols.

The secondary aim was to verify the reliability of blinded inter-operator assessments, performed with the torsion bottle on the same patients by two physiotherapists. These double-blinded measurements were taken periodically for a short-time-interval in our clinic to verify measurement accuracy in the everyday clinical activities.

The conclusion? The torsion bottle is useful to perform a pre-investigation of the presence of a prominence, permitting a simplified assessment of its value, thus referring to a specialist for a medical assessment.

We remind you that you can perform a quick and simple assessment/check for scoliosis or curved back on the website screening.isico.it,where you are simply asked to take some measurements with easily procurable tools like a ruler and others again to be detected with the help of a simple bottle of water, the Torsion Bottle

Seas: how it evolves to move forward

Due to the Coronavirus emergency and the consequent restrictive measures, our SEAS courses, foreseen in different countries of the world in the next period, cannot be done: we are ready to reschedule them as soon as possible.
In some cases, however, SEAS has been able to evolve in online mode in order not to stop completely.
After the four-handed course in Moscow when Michele Romano, director of physical therapy in Isico, was connected online from Milan, we were invited to hold a theoretical Webinar in Turkey, a few days ago, on April 22nd.
In both cases it was a success beyond expectations, considering that the Webinar had 600 participants. During the Webinar, Dr Michele Romano explained what SEAS is, the scientific evidence of this type of approach to the treatment of idiopathic scoliosis and how it will evolve after the epidemic.

About Seas Course in Moscow, the lessons were given by our director of physiotherapy, Michele Romano, who linked up with 21 participants in Moscow, together with the course organiser Dr Dimitri Gorkovsky, who is a sports physician and specialist in physical and rehabilitation medicine.

“As the current situation prevented me from going to Moscow in person, as originally planned, we took a last-minute decision to switch from a residential to an online course” Romano explained. “A fundamentally important role in the success of this event was played by Dr Gorkovsky, who, since 2016, has worked with us on the staging of eight previous courses in various Russian cities: Moscow, St. Petersburg and Novosibirsk.”

On all these previous occasions, Dr Gorkovsky flanked Romano, translating from English into Russian.
“Those past experiences certainly helped me this time, as I am now familiar with the topic” he said. “Michele gave practical demonstrations using a dummy, which we watched via Skype, and I then replicated these exercises with volunteers from among the participants. Instead, Michele was able to answer the participants’ questions and clarify their doubts directly, as though he were here with us. The course was excellent, as usual, and the participants were very satisfied with what they learned. This remote modality could certainly represent an important opportunity for the future.”

Teleprevention: a video

If we analyse it, movement, in general, is part of different aspects of our lives: knowledge, therapies, human relationships… And, of course, we are also talking about physical activity: our body in motion! 

More than anything, movement promotes wellbeing, mental as well as physical, and above all, it helps to prevent conditions of the kind our specialists deal with, such as low back pain and neck pain. The more we move, the less susceptible we are to such ailments.

Our director of physiotherapy, Michele Romano, has prepared a video in which he explains how to prevent back pain and presents a series of simple exercises to be done at home.
They take up very little time and you don’t need any equipment to do them: preventive exercises in telehealth mode
Share our exercise programme using the hashtag #isicotelemedicine. 

Take a look at the video!

Isis Navarro at Isico headquarter

Could you tell us about your studies?

I am a PhD Student at Universidade Federal do Rio Grande do Sul. Since 2017, after I completed the SEAS course, I started to have only patients with scoliosis and work just with these patients. In my master’s degree I studied the surface topography as a possibility of easy and three-dimensional tool to evaluate scoliotic patients. I had some publications based on this primary subject.

https://www.sciencedirect.com/science/article/abs/pii/S0966636218303126

http://www.fortunejournals.com/articles/thoracic-idiopathic-scoliosis-establishing-the-diagnostic-accuracy-and-reference-values-of-surface-topography.html

And I have also some articles accepted for publication:

NAVARRO, ISIS J.R.L.; CANDOTTI, CLÁUDIA T. ; FURLANETTO, TÁSSIA S. ; DUTRA, V. H. ; AMARAL, M. A. ; LOSS, JEFFERSON F. . Validation of a mathematical procedure for the cobb angle assessment based on photogrammetry. Journal of Chiropractic Medicine (Print), 2019.

NAVARRO, I. J. R. L.; CANDOTTI, CLÁUDIA T. ; AMARAL, M. A. ; DUTRA, V. H. ; Gelain, G. ; LOSS, JEFFERSON F. . Validation of the measurement of the angle of trunk rotation in photogrammetry. JOURNAL OF MANIPULATIVE AND PHYSIOLOGICAL THERAPEUTICS, 2019.

What is your profession?

I am a physiotherapist.

Why did you register for the SEAS  course?

I was looking for the SEAS course, and my plan was to travel to Italy to attend the course, but fortunately Michele and Alessandra came to Brazil to teach for the first group in Brazil. I discovered the SEAS approach doing lots of researches on internet, searching for consistent methods of treatment to scoliotic patients to offer to them the best possibility of treatment and results.

What makes the SEAS learning course different from other educational courses and programs?

The more significant advantage of the SEAS course is the clarity of the reasoning behind the technic and the facility to apply what you learned. The SEAS approach allows doing physiotherapy with all type of scoliotic patients, independent of the type or classification of the curve. The teachers were always ready to answer all the questions and help with difficult cases I asked separately.

Are you satisfied with what you have learned? 

Yes. But when you start to practice more and more always news doubts arise. 

If you were asked to recommend the course, what would you say?

The SEAS course is an excellent way to understand the world of scoliosis, its characteristics and the reasoning to treat adequately and accurately. After the course, you will be able to evaluate and treat scoliotic patients based on a method easy to understand and to apply with a high level of scientific evidence.

Michele Romano, professor for a day at the University of Québec

A few weeks ago, Michele Romano, Director of physical therapy at Isico, gave a workshop at the prestigious University of Quebec in Trois-Rivières, Canada.
The lesson was devoted to SEAS (the Scientific Exercises-based Approach to Scoliosis) and took place during a conference organised by the University as part of its annual scoliosis month (this year being held for the ninth time).

“It was a wonderful opportunity” remarked Dr Romano. “The invitation coincided with my recent stay in Quebec, where I was leading a course devoted to our scientific exercises-based approach. The workshop was attended by 60 or more students in the last year of a chiropractic degree course. They gave me a really warm welcome and participated very actively, especially in the practical part of the lesson, asking me numerous questions. They were extremely enthusiastic, to the point of inviting me back next year, perhaps to lead an entire course tailored to their particular training needs”.