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SOSORT 2024 : presented studies, news and comments

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“This 2024 edition of the annual SOSORT conference, held in Boston, was also an opportunity for discussion, involvement, and growth. Every year, the level of research presented at SOSORT continues to rise, and we at ISICO are always at the forefront, commented Professor Stefano Negrini, Scientific Director of our Institute. SOSORT is undoubtedly the congress that brings together the most important specialists and the most significant research at an international level on the rehabilitation treatment of scoliosis. There was lots of news and great satisfaction for our specialists, who enlivened the conference with nine research projects presented both with posters and oral presentations. Dr. Fabio Zaina presented a study on the ability of the ODI and the SRS 22 to distinguish adult patients with or without scoliosis. At the moment, neither of the two questionnaires is able to make the distinction; in the ODI, subjects with scoliosis have greater difficulty lifting weights and standing compared to those who don’t have it, but the difference is not significant. Our physiotherapy director, Michele Romano, led two ongoing studies on curves; instead, our physiotherapist, Alessandra Negrini, in addition to animating the pre-conference by talking about Telemedicine, presented a review study on sagittal measurements among healthy children and adults, up to 40 years of age, to collect and, if possible, arrive at an average overall data measurement of kyphosis, lordosis, and other sagittal parameters.

“I myself presented two studies on adherence to brace treatment measured with sensors: one is a review study that demonstrated that both the use of sensors and counselling, i.e., the support given to patients during the course of treatment, can increase adherence to therapy, while the second study identified sex and age as the main variables that influence patient compliance,” explains Prof. Negrini.

There are also three posters signed by ISICO. Dr. Greta Jurenaite has prepared a poster on a case report of patients with lumbar Scheuermann, which demonstrates that exercises and a corset can effectively treat the pain caused by this pathology and that the brace also improves spinal growth by reducing the deformity. Dr. Giulia Fregna instead presented a review in the field of trunk neurophysiology in a poster; finally, the European Prepare project was also discussed with a poster by Dr. Carlotte Kiekens, already present at other SOSORT conferences but at her first as an ISICO specialist with her own research. “The congress was really interesting and informative! We were pleased to note that the PREPARE poster attracted a lot of attention – comments Dr. Kiekens – I was surprised that many professionals still do not have a clear understanding of the fact that rehabilitation treatment requires a multi-professional approach, involving the patient in a collaborative process and including diverse components such as brace therapy, exercises, cognitive behavioural therapy (CBT), psychological support, education, and much more. ISICO stands out for its advanced approach in this field.”. As introduced by Dr. Kiekens, there has been much discussion about artificial intelligence and its applications in the assessment of scoliosis, the development of therapeutic strategies, and the prediction of treatment outcomes, added Professor Negrini. Our participation in the PREPARE project positions us at the forefront of these new applications, thanks to our constant commitment to research, which is fundamental for the improvement of therapies. To the specialists present in Boston, we must add those who worked on this research, from therapists Bruno Lionelli, Serena Quaggio, and Sara Rossi Raccagni to Dr. Giulia Fregna. Finally, a moment from the conference that we are pleased to share: the appointment of Dr. Sabrina Donzelli, part of the ISICO staff for many years, as SOSORT president for the next two years. The first woman in the history of this society: congratulations to Dr. Donzelli, a great professional.

 We look forward to seeing you again at SOSORT 2025 in Dubrovnik!

SOSORT Conference: Isico in the front row

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Once again, ISICO receives the acceptance, in the form of an oral presentation or a poster, of all nine abstracts submitted for the next annual international conference SOSORT that will be held from May 1 to May 4 in Boston, United States.

This is a reconfirmation with full marks for Isico, among the best researchers in the world in the rehabilitation treatment of spinal pathologies.
The following abstracts will be presented, where the first authors Dr. Fabio Zaina, Dr. Greta Jurenaite and Dr. Carlotte Kiekens, physiatrists, Michele Romano, director of physiotherapy, Giulia Fregna, physiotherapist, are from Isico further to Claudio Cordani, a physiotherapist.

– Normative data for radiographic sagittal parameters in asymptomatic population from childhood to adulthood: a systematic search and review (oral presentation)

– Lessons learned on trunk neurophysiology and motor control from adolescent idiopathic scoliosis. A scoping review (poster)

– Influence of specific interventions on bracing compliance in adolescents with idiopathic scoliosis. A systematic review of the literature including sensors’ monitoring (oral presentation)

– Can currently used questionnaires like ODI (and SRS-22) discriminate patients with scoliosis in a population with chronic back pain? (oral presentation)

– Personal and clinical determinants of brace wearing time in adolescents with idiopathic scoliosis (oral presentation)

– Convexity orientation of single scoliotic curves. Are they as we have always been taught? Verification of 4470 single curves (oral presentation)

– Suspected high prevalence and gender difference of scoliotic curves with the apex at T12 (poster)

– PREPARE: Personalized rehabilitation via novel AI patient stratification strategies – the case for idiopathic scoliosis during growth (poster)

– Case series report of atypical lumbar Scheuermann’s disease treated with braces and physiotherapeutic specific exercises (poster)

One of the 9 abstracts presented is linked to the European project PREPARE, in which ISICO takes part.

PREPARE Rehab aims to provide healthcare professionals with valuable insights and tools to predict better and stratify patients, ultimately leading to more personalized and effective rehabilitation interventions. Artificial Intelligence (AI) may help predict treatment outcomes and improve rehabilitation strategies for Idiopathic Scoliosis.

“By combining different factors that influence treatment success, AI-based models can provide a better understanding of the natural progression of the disease and the factors that determine the effectiveness of treatments. This allows us to personalize therapies better and avoid both over-treatment and under-treatment  – explains Dr. Carlotte Kiekens, one of the researchers of this project. With its ability to analyze large amounts of data and utilize deep learning techniques, AI offers a comprehensive approach to predicting functional prognosis and setting goals in Individual Rehabilitation Projects (IRPs)”.
In this study, data from over 21 thousand patients were taken into consideration. What do we expect to achieve?
“Three results: a clinical decision support system to be used by clinicians to make shared decisions with their patients and families, integrating big data and thus providing real-time insights; the development of innovative methods and models for categorizing patients into different groups based on specific criteria – ends Dr. Kiekens – and a roadmap that outlines the steps and requirements for ensuring compliance with medical device regulations.  These expected results indicate a comprehensive approach to improving healthcare through the integration of advanced technology, data analytics, and regulatory compliance measures”.

SOSORT Award: Isico is back on the podium!

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And once again, the winner is… Isico! For the fifth consecutive year, our institute has been awarded the prestigious SOSORT Award, recognising our innovative and cutting-edge research focused on Artificial Intelligence in the rehabilitation treatment of the spine. The winning research, titled “Developing a new tool for scoliosis screening in a tertiary specialist setting using artificial intelligence: a retrospective study on 10,813 patients,” was one of the eight Isico studies presented at the Sosort conference held in Melbourne, Australia, a few weeks ago.

This prize shows the quality of research conducted at Isico, combining scientific evidence with daily clinical practise to enhance rehabilitation treatment for patients worldwide. Dr. Francesco Negrini, a physiatrist and author of the study, explains the motivation behind the research: “We sought to explore ways to reduce the need for radiographs while ensuring accurate and timely scoliosis screening. Through collaboration with engineers in Zurich, we employed advanced analysis methods using artificial intelligence to develop a model that accurately identifies cases warranting X-rays.”

This international collaboration enabled Isico to harness innovative technologies and present research able to achieve this prestigious recognition. Dr. Negrini further emphasises the significance of the prize, stating, “I am immensely satisfied with this achievement. It reaffirms the validity and excellence of Isico’s scientific dedication, paving the way for a reduction in the number of X-rays prescribed to patients while maintaining optimal care.”

https://en.isico.it/isico/ricerca/pdf/ID00665.pdf

Dr. Sabrina Donzelli, the next president, tells us about the SOSORT conference

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Once again, the international SOSORT conference was one of the most important appointments for our institute (eight abstracts were presented), and with a cherry on top, the fifth SOSORT Award was won!
We asked Dr Sabrina Donzelli, physiatrist and president of SOSORT in 2024, the first woman to hold this position, to tell us something more about the event, given that she was one of the three Isico specialists present in Melbourne (the others were Dr Fabio Zaina and our director of physiotherapy, Michele Romano).

1) What did participating in this event mean to you?
For the first time, SOSORT participated in Spineweek. Spineweek is an event that occurs every four years and brings together many societies dedicated to various aspects of the spine. This event allows participants to follow different companies by participating in a single event. It provides the other companies involved greater visibility or the possibility of being known and attracting new members.
The event was a success for SOSORT thanks to the number of participants and presentations. SOSORT is growing, and this experience was another opportunity for growth for the company, which is preparing to organize its first annual congress with total autonomy.

2) What were the major scientific innovations?
Dr Angelo Aulisa presented a remarkable study on the efficacy of braces in patients with Scheuermann with a 10-year follow-up. It is the first study to explore this area with such an extended follow-up.
Comparison studies are starting to emerge, for example, between braces at different dosages or nighttime bracing compared with exercises only; unfortunately, the quality of these studies is limited, and the results still need to be evaluated with caution.
We are also witnessing an increasing collaboration between surgery and rehabilitation treatment in a great communication effort to learn how to manage better patients who have surgical indications and those who would like a surgical approach but could benefit from conservative treatment. The president of the SRS (Scoliosis Research Society), Dr Serena Hu, showed the innovations in the surgical field; indeed, there are still many challenges to reducing invasiveness with the same effectiveness.

3) The SRS also has a female president for the first time, and your successor in the SOSORT presidency is the Croatian doctor Suncica Bulat Wuerching. There are more and more women, so how are you experiencing this moment of transition to your presidency?
We women play a fundamental role in the scientific world, like our colleagues, and this can only fill me with satisfaction for the work we carry out with great determination and professionalism. In terms of my position, it will be a great responsibility to lead the company through this transition. Still, I am delighted to work with a fantastic team of professionals, starting with the current president, James Wynne.

SOSORT Melbourne: 8 Isico abstracts

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There are 8 abstracts, which will be presented by Isico at the annual Sosort international conference, held from May 1–5 in Melbourne, Australia.

Once again, Isico will be in the front row at the International SOSORT meeting, and one of the abstracts, entitled “Developing a new tool for scoliosis screening in a tertiary specialist setting using artificial intelligence: a retrospective study on 10,813 patients,” is also competing for this edition of the Sosort Award, which, as we recall, Isico won for several consecutive years. 
The other abstracts that will be presented by our expert physiatrists, Dr Sabrina Donzelli, and Dr Fabio Zaina, and by Michele Romano, Director of Physiotherapy at Isico, are:
– Adherence to physiotherapeutic scoliosis-specific exercises during adolescence: voices from patients and their families: a qualitative content analysis;
– Bracing interventions can help adolescents with idiopathic scoliosis with surgical indications:
– A systematic review; SOSORT Guidelines for scoliosis conservative treatment: an update
– It is worth treating an adolescent with idiopathic scoliosis when bone maturity has passed US Risser 2: Bracing can improve curves and aesthetics
– Outcome measures in scoliosis treatment: Is the Cobb angle enough?
– The apex vertebrae of the scoliotic curves; a study of their frequency in 11758 cases
– Evaluation of thoracic flexibility in the sagittal plane with the Thoracic Stiffness Test: intra- and inter-operator reliability

Therefore, a reconfirmation for Isico with full marks among the best researchers in the world in the rehabilitation treatment of spinal pathologies.

SOSORT 2022: a feedback by dr Sabrina Donzelli, the next president of SOSORT

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We asked physiatrist Dr Sabrina Donzelli, one of our doctors at ISICO, to tell us about the highlights and significance of SOSORT, the international conference held at the start of May in San Sabastian.
We knew that the event would be an important occasion for the specialists in attendance, as they had not been able to meet in person for two years. Little did we imagine, though, when we approached Dr Donzelli, that we were asking the very person who, in the course of the event, would be named as the next President of SOSORT. The presidency of this association is a highly prestigious role. This is the fourth time an ISICO member has been chosen for the position, and Dr Donzelli is the first woman to have the honour.

We therefore begin this interview by extending our congratulations to Dr Donzelli.

1) Wow! Well, this was great news on two levels: first, because the position will once again be held by an ISICO member, and second, because this is the first time a woman has been chosen. The International Society has grown considerably over the years and now has a large membership with a good balance of men and women, even though this is not so true of the single professions. There aren’t many doctors in SOSORT; most of its members are physiotherapists. If you aspire to be President of SOSORT, you have to serve the organisation, putting in years of voluntary work. For some years now, I have been committed to doing all I can for SOSORT because I share its vision and its mission: to ensure that patients with scoliosis always receive the best treatment based on the scientific evidence. It is therefore important to be committed to research and to spreading knowledge. In other words, the mission is also to educate. My commitment and willingness have helped me become widely appreciated within the society, allowing me to join the executive board in 2019, and to be made President Elect this year. 

2) What did it mean, after three years, to finally be meeting in person, with colleagues all in one place rather than scattered around the world?

SOSORT, which dates back to as long ago as 2004, was created to bring together the world’s leading experts in the field of rehabilitation treatment for spinal disorders, to allow them to “compare notes” and increase the level of scientific evidence in the field, as well as improve the treatments available to patients. Over time, its missions and aims have been and continue to be updated, because medicine is a constantly evolving science. The last proper congress was held in San Francisco in 2019, after which the event moved online for a couple of years. It was therefore fantastic finally being able to get together in person again. We were able to talk face to face and really share, all together, our passion for what we do and our everyday challenges. All this is reflected in the slogan that was used to announce and promote the event: SOSORT 2022 – More than a congress: an experience in San Sebastian. You will never forget it! 

3) What are the main scientific developments you were able to take away with you? 

Epigenetics appears to be the future when it comes to improving understanding of scoliosis and trying to identify individuals at risk of developing it. Obviously, there is still a huge amount of work to be done, but at present this seems to be the way to go. 

Second, ultrasound is the future of radiation-free diagnostics, albeit perhaps not so much when applied to the spine as when used to estimate residual growth. In this regard, I should mention an interesting study by  Sanders based on ultrasound of the hand, Bracing outcomes in end-of-growth patients. Evidence to support the use of braces even towards the end of growth: it’s not too late to wear a brace.
Indeed, other studies similar to ours have shown that good results can be obtained even at the end of growth. There is also promising scientific evidence in patients who have finished growing: we at ISICO were the first to present these findings, and now other groups, too, are showing that good results are possible even in individuals with advanced bone growth. 

It is worth considering that three of the six studies in the running for the SOSORT Award dealt with outcome prediction: they ranged from Dr Lori Dolan’s study with 10-year follow up after the end of bracing treatment to our research conducted in collaboration Dr Eric Parent of the University of Alberta, in Canada, in which we attempted, in patients observed over time, to predict future curves solely on the basis of X-rays performed before they started treatment with braces or exercises. 

4) SOSORT Award: were there any surprises?

Not at all. The winning study was the strongest methodologically. The paper, on which we collaborated with the University of Alberta, illustrated a prediction model developed on the whole sample: it has some limits related to the heterogeneity of the data, which reflects that of scoliosis itself. Each patient has their own clinical history and this makes it difficult to predict how the disease will evolve in relation to age, time since onset, and residual bone growth estimated using the Risser classification. 

The Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST), on the other hand, is a fundamentally important study: it has demonstrated the therapeutic effectiveness of braces and shown that follow up over time is essential in order to advance the study of scoliosis. The monitoring of the patients observed and treated by these researchers will continue to give us important information, while the methodological rigour of their study is a guarantee of very reliable scientific evidence.  

Pictured, Sabrina Donzelli, together with organiser (SOSORT 2022 local host) Garikoitz Aristegui, and Judith Sanchez Raya, co-Chair of the SOSORT 2022 Scientific Committee

Isico’s research wins the SOSORT Award

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For the fourth consecutive year, Isico has obtained the most prestigious award for those involved in rehabilitative treatment of the spine, winning the SOSORT Award with the study Prediction of Future Curve Angle using Prior Visit Information in Previously Untreated Idiopathic Scoliosis: Natural History in Patients under 26 Years Old with Prior Radiographs.

The research, which involved 2317 patients with idiopathic scoliosis between 6 and 25 years old, was developed by our researchers (the Isico authors are Prof. Stefano Negrini, together with Dr Giulia Rebagliati, Dr Fabio Zaina, Dr Sabrina Donzelli and Dr Alberto Negrini) in collaboration with Dr Erik Parent of the University of Alberta, Canada. This project was funded by a Standard Research Grant from the Scoliosis Research Society.

“Understanding natural history helps inform the treatment selection for modifying the course of the disease or to avoid overtreatment – explains prof. Stefano Negrini, Isico Scientific Director- Previous models predicting curve progression lacked validation, did not include the full growth spectrum or included treated patients. Our aim was to develop and validate models to predict future curve angles using clinical data collected only at, or both at and prior to, an initial specialist consultation in idiopathic scoliosis”. 

Scoliosis-specific exercises are recommended in small curves in skeletally immature patients, exercises and progressively more aggressive brace treatments are recommended for moderate and severe curves in 10% of growing children and adolescents and invasive corrective surgery is recommended in severe curves at risk of continued progression in adulthood for 0.1-0.3% of cases. 

“Patients were previously untreated and provided at least one prior radiograph prospectively collected at first consult – continues prof. Negrini – We excluded those previously treated”.

 Radiographs were remeasured blinded to the predicted outcome: the maximum Cobb angle on the last radiograph while untreated. Linear mixed-effects models with random effects and maximum likelihood estimate were used to examine the effect of data from the oldest visit (age, sex, maximum Cobb angle, Risser, and curve type) and from other visits while untreated (Max Cobb angle), and time (from oldest radiograph to prediction) on the Cobb angle outcome.

“Predictions models were proposed which can help clinicians predict future curve severity expected in patients not receiving treatment –ends prof. Negrini – Predictions can inform treatment prescription or show families why no treatment is recommended. Our models offer the flexibility to predict at a future timepoints over the full growth period. These validated models predicted future Cobb angle with 80% of predictions within 100 in non-treated idiopathic scoliosis over the full growth spectrum. Improved prediction ability may help clinicians inform treatment prescription or show families why no treatment is recommended”.

Ready for SOSORT

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There are just a few days and the SOSORT  International Conference finally, after two years from the start of the pandemic, is back in person in San Sebastian, Spain from the 4th to the 7th of May.
It will be the usual pre-course, scheduled for May 4, to kick off the event: three of our specialists will participate in the round table, Dr Fabio Zaina, with a session on Overview of Adult Spinal Deformity classification, and how it is differing from AIS, Dr Sabrina Donzelli with  ASD prevalence and Dr Michele Romano, director of Isico Physiotherapy, with Standardized presentations describing assessment, clinical decision making process and treatment.

In the following days, Isico will be present again with three presentations: Dr Fabio Zaina will present on May 6th “Night-time bracing improves back pain in patients with painful scoliosis: six months results of a retrospective controlled study“, Dr Michele Romano on May 7th “Exercises for adolescent idiopathic scoliosis: Updated Cochrane Review”  and finally, Prof. Stefano Negrini, scientific director of Isico, will compete for the SOSORT Award with his research “Splitting Growth into 3 Phases with Cut-offs at Pubertal Spurt and Risser 3 Facilitates Prediction of Progression. A Study of Natural History of Idiopathic Scoliosis Patients from age 6 to End of Growth”.

For more info: https://sansebastian2022.sosort.org