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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”.

SOSORT 2022: the AWARD winners and a fourth ISICO President

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This year’s SOSORT meeting, held in San Sebastian, Spain in the wake of two editions forced online by the pandemic, was a double success for ISICO, which had two studies shortlisted for the SOSORT Award.
One of them, Prediction of Future Curve Angle using Prior Visit Information in Previously Untreated Idiopathic Scoliosis: Natural History in Patients under 26 Years Old with Prior Radiograph, conducted in collaboration with the University of Alberta in Canada, came first, making this the fourth consecutive year that ISICO has taken home the prestigious award. But this was not the only high point. Our Dr Sabrina Donzelli, physiatrist, was named as the next President of the International Society. This is the fourth time that ISICO has had this has honour since SOSORT was founded in 2004,  and it is the first time a woman has been appointed to the role.

“This prestigious appointment is an acknowledgement of Dr Donzelli’s scientific standing, hard work and commitment, as well as a recognition of our institute, which now provides a benchmark for clinical and research activity worldwide” remarked Prof. Stefano Negrini, Scientific Director of ISICO as well as one of the ISICO authors — the others being De Giulia Rebagliati, Dr Fabio Zaina and Dr Alberto Negrini — who collaborated with Dr Eric  Parent, first author of the study that won the SOSORT AWARD. The congress was hugely stimulating and we can’t wait for 2023 and next year’s meeting in Melbourne, Australia”.

And the Sosort Award winner is… Isico!

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At the International Sosort Meeting in June, this year held for the first time ever entirely online, Isico recorded another great success.

Dr Sabrina Donzelli, Isico physiatrist, won the Sosort Award, the event’s top prize, for her research entitled: “Predicting final results of Brace Treatment of Adolescents with Idiopathic Scoliosis: First Out-of-Brace are Better than In-Brace-radiographs”. Her study was chosen over the work of 7 other researchers in the running for the award.

Among eight studies selected as oral presentations, the Scientific Committee picked out, as the two finalists, Dr Donzelli’s research study and a study on the genetics of scoliosis by the Montreal-based research group led by Prof A Moreau. “After the initial selection we were asked to submit a complete article to be entered for the Sosort Award” explains Dr Donzelli. “The prize, for the winning study, is a sum of money allowing it to be published in any magazine, as an open-access article, in other words in a format accessible, free of charge, to anyone who might be interested in reading it”.

The other studies running for the award included a long-term follow up of patients with scoliosis, presented by Dr AG Aulisa, a cost analysis of conservative versus surgical treatment, and two studies on Scolioscan©, the ultrasound equipment present as well at Isico’s Milan clinic. 

“Our winning research underlines how important patients’ first out-of-brace radiographs are for predicting the results at the end of their course of treatment,” Dr Donzelli goes on. “The accuracy of the model we developed and tested, is the key factor that won us this prestigious award, which will allow us to publish our work in the coming months.” 

In the course of the online meeting, several of our specialists gave presentations: Alessandra Negrini, Isico physiotherapist, asked “Is swimming helpful or harmful in adolescents with idiopathic scoliosis?”, Dr Fabio Zaina, Isico physiatrist, gave a presentation entitled “ISYQOL, a Rasch consistent tool for quality of life evaluation in scoliosis patients during adulthood: comparison with the gold standard”, while our director of physiotherapy, Michele Romano, spoke about “The effect of dance performance on idiopathic scoliosis progression in adolescents”.

This is the second year running that Isico has not only been among the finalists but also gone on to win the award. 

In 2019, Isico also won an award with a study concerning scoliosis and sport. “The quality of our research has increased not only as a result of our acquisition of increasingly high-level methodological skills, but also thanks to the growing availability of systematically collected data,” explains Dr Donzelli. “In recent years, the data we routinely collect from patients visiting our facilities have allowed us to develop so-called predictive models. In other words, we consider the characteristics of large groups of patients to try and understand whether they allow us to predict their final results, or whether certain risk factors are more important to consider than others when deciding what type of therapy to prescribe. Our growing clinical and research expertise has led to international collaborations. Many others now look to us to provide expert support. We are also seeing an increase in our collaborations with international partners that want to analyse and compare their clinical and radiographic data with our database”.

SOSORT 2020: all Isico’s abstracts “pass the test”

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Isico will once again be in the front line at the International SOSORT meeting, this year being held from 27th to 29th April in Melbourne, Australia, during Spine Week (27th April to 1st May, 2020).

“All the abstracts we presented have been accepted” reports Dr Sabrina Donzelli, Isico physiatrist and author of the research paper that is in the running for the SOSORT Award. “This is an extremely gratifying result, considering the number of abstracts submitted, and it underlines the fact that we remain firmly committed to research. We are also delighted and honoured to feature, once again in the list of the “top ten” studies presented”. 

In short, Isico has, once again, received full marks from the global spine rehabilitation community. Let us not forget that last year the Isico study entitled Effect of sport activity added to full-time bracing in 785 Risser 0-2 adolescents with high degree idiopathic scoliosis, which also featured among the top ten “nominations”, went on to win the SOSORT Award.

Here, then, are the studies that our specialists will be presenting this year in Melbourne: Is swimming helpful or harmful in adolescents with idiopathic scoliosis (Dr Alessandra Negrini, physiotherapist); The effect of dance performance on idiopathic scoliosis progression in adolescents (Dr Michele Romano, physiotherapist), ISYQOL, a Rasch-consistent tool for quality of life evaluation in scoliosis patients during adulthood: comparison with the gold standard (Dr Fabio Zaina, physiatrist).

Finally, Dr Sabrina Donzelli will be giving two lectures. The first one, which is entitled Is clinical measurement of the hump helpful for X-ray prescription and a good predictor of the curve? Results from ageometrical study from a large prospective cohort, was also given at the last SRS meeting, while the second is the one that has been shortlisted for the SOSORT Award: Final results of brace treatment of adolescents with idiopathic scoliosis prediction: 30 days out-of-brace is better than in-brace X-ray.