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ISICO sets a record at the SOSORT Congress: here are the final two studies nominated for the AWARD

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Once again this year, ISICO stands out at the international SOSORT Congress, scheduled to take place in Dubrovnik from 23 to 26 April. Among the 12 studies accepted for the congress as oral or poster presentations, no fewer than four were selected among the 10 contenders for the SOSORT AWARD, the most prestigious recognition for research in the field of rehabilitative treatment of spinal disorders.

After presenting two of the finalist studies in the March newsletter, in this issue we introduce the other two studies in the running for the prize: 

“The Idiopathic Scoliosis Graphical Representation Of Worsening Trend of Natural History (IS-GROWTH) communication tool provides a reliable prediction useful to manage long-term treatment during growth” and “Wearing a brace for idiopathic scoliosis above 18 hours/day shows a dose-response effect on the outcomes improvement and end-of-treatment Cobb angle below 30 degrees”.

Two studies which, although very different from each other, focus on key themes for our daily practice: the effectiveness of bracing and communication with patients.

Over 18 hours a day: the “brace-effect” gets confirmed.

Our study “Wearing a brace for idiopathic scoliosis above 18 hours/day shows a dose-response effect on the outcomes improvement and end-of-treatment Cobb angle below 30 degrees” shows that wearing a brace for more than 18 hours a day leads to significantly better outcomes in the treatment of adolescent idiopathic scoliosis.
The findings of this research, conducted on 884 adolescent patients, reinforce what was already highlighted by the BrAIST (Bracing in Adolescent Idiopathic Scoliosis Trial) study, but also show that the benefit does not stop at 18 hours: the more the brace is worn, the greater the chance of ending treatment with a curve below 30°, thus reducing the risk of problems in adulthood.
Key findings include:

  • Wearing the brace for over 18 hours a day avoids surgery in 97-98% of cases.
  • With strong compliance, exceeding the 50° Cobb threshold is highly unlikely 
  • The more time the brace is worn, the higher the likelihood of ending with a curve below 30° Cobb.
  • In the most compliant patients, curve improvement exceeds 60%.

    “This study settles a debate that has gone on for years: wearing the brace for longer, if well tolerated, produces better results. The progression of scoliosis is avoided and the curve is improved, in a therapeutic path based on decisions shared with patients and families,” highlights Professor Stefano Negrini, one of the study’s authors. “Working with a personalised and collaborative approach with patients has enabled us to achieve very high compliance, even exceeding what is commonly reported in the literature. It demonstrates that it is possible to be effective even in everyday clinical practice,” concludes Negrini.

IS-GROWTH: a new ally to predict and communicate scoliosis progression 

How can we explain to an adolescent and their family that even a worsening outcome in the rehabilitative treatment of scoliosis can be a good result? 

The new IS-GROWTH model (analysed in the study “The Idiopathic Scoliosis Graphical Representation Of Worsening Trend of natural History”) was born to answer this challenge, improving communication and long-term treatment management.

When it comes to idiopathic scoliosis, communication is an integral part of treatment. For a rehabilitative pathway to succeed, it requires sharing, motivation, and awareness. 

It is precisely to support all this that ISICO has developed IS-GROWTH: a visual and predictive tool that graphically represents the natural progression of scoliosis during growth.

“In idiopathic scoliosis, often the best result is not improvement but simply not worsening. This concept is difficult to convey without a tool that clearly shows what the natural curve evolution would be without treatment,” explains Professor Stefano Negrini, author of the study.

The model was built using over 3,000 X-rays from more than 1,800 participants, from infancy through adolescence, and validated on 552 patients, with 95% accuracy after adjustment for radiographic measurement error.

Its objective? To provide a personalised graphical representation of the expected curve progression, divided by growth phases and updated over time. This allows clinicians to:

  • better understand the individual case trend;
  • strengthen dialogue with patients;
  • motivate them throughout the treatment pathway.

The model has proven particularly useful during follow-ups: 79% of doctors use it to motivate patients, and 84% consider it valuable for monitoring progression and interpreting results achieved.

“IS-GROWTH is not just a predictive model; it is above all, an ally for everyday communication. It helps us make patients participate and to build a more conscious therapeutic path,” – concludes Negrini.

The spine lengthens while walking: our new study confirms a unique physiological phenomenon

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A recent study conducted by the Polytechnic University of Milan in collaboration with our researchers and published in the Journal of Clinical Medicine under the title “The Spine Lengthens During Walking in Healthy Participants, with Age-Related Changes in Kinematic Parameters” has confirmed a previously observed phenomenon: the spine lengthens during walking compared to static standing posture. The study […]

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Isico: our research on the roof of the world

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ISICO specialists, starting with Prof. Stefano Negrini, scientific director, and Michele Romano, physiotherapy director, are at the top of the world’s research rankings with research on SEAS – Scientific Exercise Approach to Scoliosis, and the revolutionary Sforzesco brace, which has proven its efficacy in replacing plaster casts in the treatment of scoliosis.

The data from three studies (Global research hotspots and trends in non-surgical treatment of adolescent idiopathic scoliosis over the past three decades: a bibliometric and visualization study, Exercise therapy for adolescent idiopathic scoliosis rehabilitation: a bibliometric analysis, A bibliometric review and visual analysis orthotic treatment in adolescent idiopathic scoliosis from the Web of Science database and CiteSpace software) says so.

These studies have just been published and are the first to map the scientific knowledge of research on scoliosis conservative treatment using visual research techniques by examining its hotspots, frontiers, and evolutionary trajectories, aiming to give an in-depth overview of the research status and developments in this subject, serving as a reference for researchers. 

Alan Pritchard introduced the scientific approach known as bibliometrics in 1969, monitoring data relevance and projecting future limits are aided by it. Researchers may comprehend the breadth of pertinent studies and efficiently promote information integration with the help of bibliometric analysis and its visualisation.

“These are the first three bibliometric analyses and visual analyses of orthotic treatment in adolescent idiopathic scoliosis that were taken into account from 1990 to 2023. In total, over a thousand articles and a total of 1005 records were included,” explains Prof. Stefano Negrini. “In Isico, we have 283 publications indexed in the last twenty years; 71 have dealt with scoliosis and braces and 37 with our SEAS approach. Numbers that, together with these recent bibliometric analyses, photograph the commitment and quality of years of constant and constantly growing scientific research”.

Scoliosis and conservative treatment: what we know
Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity that develops in teenagers for unexplained causes. The guidelines of the International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT), are presently the treatment recommendations and the basis for available treatment choices.

For children with a Cobb angle between 26° to 45°AIS, bracing is the suggested nonoperative treatment option; for those with Cobb angles larger than 40° to 45°, surgery is advised. On the other hand, some parents and children with AIS insist on wearing a brace instead of having surgery performed. According to recently published meta-analyses, bracing can also reverse the progression of scoliosis curves from 40° to 60°. 
Nevertheless, no bibliometric investigation has yet been done in this area.

Top of the class
1) The countries
China and Turkey are the only two of the ten countries with the greatest publishing output, categorised as developing; the other eight are categorised as developed. With 1,261 citations, the USA’s study was the most referenced, followed by China (977) and Italy (576).
The United States of America has the greatest annual publication volume, the longest length of research in this field, and the earliest start. China has the second-largest yearly publication volume, with a late start but quick development. It has grown remarkably every year, particularly in the last few years, and currently holds the record for the nation’s highest proportion of yearly publications. 
Both are followed by Canada and immediately after by Italy, which comes in fourth place with 47 published articles.

2) The researchers/ High-impact authors
According to the study Global research hotspots and trends in non-surgical treatment of adolescent idiopathic scoliosis over the past three decades: a bibliometric and visualisation study, of the 3,472 authors included in the visualisation atlas, 15 have published more than 10 articles. And here, too, Italy with Isico is among the top five in the world: three positions are occupied by Canadian authors, one by a Chinese author, and the fifth by Prof. Stefano Negrini, scientific director of our institute, for the number of articles published. In the classification, in the tenth place in the world, we also find Dr. Fabio Zaina, a physiatry specialist at Isico.
Prof. Stefano Negrini is in first place regarding the frequency of citations.
The new SOSORT 2016 guidelines, published by Prof. Stefano Negrini et al. in 2018, had the highest burst intensity among the 25 burst citations with the most co-cited literature, according to an evaluation of the Web of Science database. It focused on the background of idiopathic scoliosis, described conservative treatments for various populations, provided flow charts for clinical practice, reviewed the literature, and made recommendations regarding bracing, PSSE, assessment, and other conservative treatments.
It should be noted that Prof. Negrini is also in seventh place with the 2011 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth.
Instead, the study Exercise therapy for adolescent idiopathic scoliosis rehabilitation takes into consideration the top 10 active authors who have published literature on exercise therapy for AIS rehabilitation, and here Isico is on the roof of the world: Prof. Stefano Negrini is in the first place, followed by our physiotherapy director Michele Romano, while in the fourth and fifth places, we find Dr. Fabio Zaina and physiotherapist Alessandra Negrini.
The authors of this latest research write: “With 287 citations overall and an average of 47 citations per manuscript, it shows that the Italian Scientific Spine Institute is placed top in terms of citations per paper. Furthermore, the H-index could fairly represent the author’s academic accomplishments. With the highest ranking on the H-Index, Negrini Stefano is the most influential person in this sector. 172 publications have been published thanks to the efforts of this group of authors, with Negrini Stefano taking the lead. The team focuses on rehabilitating idiopathic scoliosis during growth, particularly through treatment with specific exercises”.

Stanford University has identified the best researchers in the world; ISICO is part of it!

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Isico, with its specialists, is still in the “hall of fame” of the world of researchers: Prof. Stefano Negrini, our scientific director, has risen to 52nd place in the world among those involved in rehabilitation research, first among Italians.
This is to say that Prof. Negrini is among the best researchers and scientists in the world in the field of rehabilitation.
In the general ranking of all branches of scientific research, he is in 37,206th place overall.
How does it work? Every year, a group of analysts from the American University of Stanford, led by Prof. John Ioannidis, in collaboration with the medical publishing house Elsevier and the global research database “Scopus”, collects data relating to indicators of standardised citations, referring to as many as 8.6 million researchers from universities and research centres around the world. The ranking covers the entire career, and all researchers in the world since the 1960s are present. Thanks to the processing of this data on 22 scientific sectors and the related 176 sub-sectors, researchers cited in the top 2% of the ranking are inserted into a database. 

We started by saying “still” because already in the past, Isico, with some of its specialists, had entered the highest places in the “Expertscape” ranking, an American rating agency that identifies the leading experts in the world in various medical disciplines based on an analysis of a series of parameters and variables.
The site refers to the PubMed database to identify the world’s leading experts in more than 27,000 branches of medicine. Isico, as a clinical institute, was placed in 38th place, first among the structures that deal with non-surgical treatment, while in the ranking of global experts for the treatment of scoliosis (both rehabilitative and surgical), Prof. Negrini was among the top twenty (11th, to be precise).  Also present in the ranking at that time were Dr. Fabio Zaina, physiatrist, and our physiotherapy director, Michele Romano. 

A new confirmation of Isico’s high level of research and scientific experience in the rehabilitation treatment of spinal pathologies aimed at improving daily clinical practice with verified data. 

ISPRM 2023: keynote lecture by Stefano Negrini

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Isico will also be present at the ISPRM Congress in Cartagena, Colombia, from June 4th to 8th. The motto of the international conference will be “New perspectives in Physical Medicine and Rehabilitation for global health challenges” thus representing the intention of focusing on the current and future rehabilitation health needs of people around the world.

Prof. Stefano Negrini, scientific director of Isico, will give one of the 8 keynote lectures in the Plenary session on New Perspectives on Evidence in Rehabilitation: from history to future. “The lecture will report on all Cochrane Rehabilitation contributions during these years, how they changed our understanding of evidence in rehabilitation and offer a way to reduce the burden of evidence on our shoulders – explains prof. Stefano Negrini – We will also look at the future, starting from the evidence-production ecosystem we will develop during the 5th Cochrane Rehabilitation Methodology Meeting in the next few months.”

Please visit the site for more info or to register for the event: https://isprm2023.org

Prof. Stefano Negrini at the World Health Assembly as Cochrane representative

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From May 23 to 26, Stefano Negrini, scientific director of Isico, participated as a Cochrane representative in an event of the World Health Assembly, the main decision-making body of WHO. The event is co-organised by missions to WHO from five countries and several scientific, professional, and patient organisations in the field of rehabilitation.

The theme of this year’s Health Assembly was WHO at 75: Saving lives, driving health for all.

On May 25, the event “Strengthening Rehabilitation in Health Systems: What’s at Stake?” took place on the sidelines of the World Health Assembly to discuss advances and challenges in integrating rehabilitation into health systems.

After the approval of the resolution on rehabilitation by the General Assembly of all Ministers of Health in the world, Prof. Negrini was one of the speakers at the workshop organised by the World Rehabilitation Alliance, in which Negrini represents Cochrane, a global independent network of researchers, professionals, patients, carers, and people interested in health.

“It is the first time that there is a resolution on rehabilitation by the World Health Assembly – comments Prof. Negrini – Rehabilitation is an essential component of universal health coverage. The lack of access to rehabilitation may expose persons with rehabilitation needs to higher risks of marginalisation in society, poverty, vulnerability, complications and comorbidities, and impact on functioning, participation and inclusion in society. The negative impact on people’s lives also causes an important economic burden on societies””.

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

Isico science corner video column

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At Isico we give great importance to research, an integral part of our clinical work.  
Our newsletters always dedicate a space to the presentation and a comment when a new Isico study is published. 
From this issue on, we will go one step further, enriching each presentation with the video commentary of the first author of the research paper. We are pleased that it is just our scientific director Stefano Negrini, the first author of the article, launching the new Isico Science corner video column with a study of such great importance.