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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.

Back and neck pain and smartphone: is there a correlation?

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Can being bent over the smartphone too often cause back- and neck pain in younger people? Data coming out of the study Posture and time spent using a smartphone are not correlated with neck pain and disability in young adults: A cross-sectional study, published some time ago by the Journal of Bodywork and Movement Therapies are not confirming this.

The cross-sectional correlational study was conducted in a sample of students selected through convenience sampling between September 2016 and March 2017: the inclusion criteria were university students at the School of Medicine and Surgery, routine/daily use of mobile devices with advanced computing and connectivity capability built on an operating system, and aged 18–30 years. A total of 238 volunteers were recruited.

“The objective of the study – explains Prof. Stefano Negrini, scientific director of Isico and one of the authors of the research – was to determine the impact of smartphone use on neck impairment and functional limitation in university students. Neck pain was assessed using a visual analogue pain score (VAS) and a pain drawing (PD); disability status was measured using the Neck Disability Index (NDI-I); cervical postures while using the phone were captured using the Deluxe Cervical Range of Motion (CROM) device”.

While half of the young medical students reported neck pain, the use of smartphones was not correlated with neck pain and disability. “While we wait for future prospective studies – ends Prof. Negrini – there is no reason to recommend a change in smartphone use habits among young adults in the meantime”.

Isico among the attendees of the November SRS webinar

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A new webinar for professionals is scheduled for November 7, part of the cycle of those organized in recent months by the SRS (available on the pages of the society’s website).

Two specialists from Isico, our scientific director, Prof. Stefano Negrini and Dr. Fabio Zaina, Isico physiatrist will be taking part in this online event titled Current Status of Bracing in Adults and Adolescents:An SRS-SOSORT Collaboration.

Join the SRS Non-Operative Committee and the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) for a webinar analyzing the current evidence and practice guidelines for bracing for adolescent and adult patients with spinal deformity.

This webinar will provide a systematic analysis of the current evidence and best practice guidelines for bracing management of patients with spinal deformity in both adolescents and adults. With variations in brace design and documentation of long-term benefits, use the consensus discussed to clarify your current practice and brace selections.
There will be an update on the current training of Orthotists, including specialization, fabrication, fitting and deformity correction.

To register please visit the page of the SRS website

eSosort2021: ISICO awarded for the third time in a row

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And the winner is: Isico! For the third consecutive year, our Institute has been awarded the highest international recognition for those involved in the rehabilitation treatment of vertebral pathologies. On Saturday, May 1st, on the occasion of the annual SOSORT conference, this year in online mode due to the pandemic, our studio “Efficacy of bracing in infantile scoliosis. A 5.5 years prospective cohort shows that idiopathic respond better than secondary” was awarded the SOSORT Award. 

It is not the first time, because only in the last two years Isico has won the coveted international recognition for the best research by SOSORT, to which is added, in 2019, the award won as co-authors of a research study in collaboration with the University of Hong Kong. A truly unique continuity.
“An award that once again certifies the high quality achieved by the scientific research carried out in our Institute at an international level – explains Prof. Stefano Negrini, scientific director of Isico and first author of the awarded research (the other authors are Dr Sabrina Donzelli, Dr Greta Jurenaite, Dr Francesco Negrini and Dr Fabio Zaina) – through this research the main goal was we have set ourselves the goal to check the results in the medium term of bracing of infantile scoliosis, comparing the two groups: idiopathic and secondary scoliosis.”
According to Mehta results, casting is considered the gold standard conservative treatment for infantile scoliosis, still casting requires repeated general anaesthesia, and recently doubts have been raised that this could cause potential brain damages in the long term. 

“In our Institute, we have been using bracing for a long time to reduce invasivity for the patient – says Prof. Negrini – Moreover, the results of the Sforzesco brace have shown to be similar to casting in adolescents. Thanks to the clinical and research experience gained over the years, we have developed a retrospective study in a prospective cohort. We have been using braces since 2004 and have been able to present the largest case history on braces to date (34 patients), with an average follow-up of 5 years, documenting excellent results in idiopathic scoliosis (success in 50% of cases – only one failure), while in those secondary to other pathologies it is possible to delay surgery over time even in the face of more frequent failures (surgery inevitable in 20% of cases)”.
We remind you that infantile scoliosis is very rare, about 1 case in 10,000 children, and for this reason, it must be treated by very expert and dedicated specialized clinics with specialists who  have been managing spine deformity for long and have a rich clinical experience
“In this context, we are also the only Italian structure that is participating in an international multicentre study, which involves clinical centres in 40 countries around the world, to verify the effectiveness of braces compared to casts – concludes prof. Negrini – During the two-year duration of the project, we will bring about 5 cases treated at our Institute for research purposes. Isico has several years of experience in the use of braces, our participation will not include the application of casts, but our results in bracing will be compared with those of other centres that apply casts”.

eSosort2021: Isico competes for the AWARD

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Isico, too will be present with several presentations at the annual international conference Sosort, online from April 29th to May 1st.
A presence, albeit virtual, characterized by the possibility of competing again for the SOSORT Award. We recall that Isico has been awarded already in the last two years the prestigious international recognition given by SOSORT for the best research, to which is added, in 2019, the Award won as co-authors of a research study in collaboration with the University of Hong Kong.

“In this online edition, our study Efficacy of bracing in infantile scoliosis. A 4-years prospective cohort shows that idiopathic respond better than secondary scoliosis will compete for the Award along with six other studies – explains Prof Stefano Negrini, scientific director of Isico and first author of the research – an important result that recognizes the high quality of the research we are performing in Isico. Also, the study Adults with idiopathic scoliosis: progression over 5 Cobb degrees is predicted by menopause and metabolic bone disease, which sees as first author Dr Sabrina Donzelli (who won the Award in 2020) was nominated among the 7 best research studies: Dr. Donzelli will hold the presentation but will not compete for the Award this year.”
In addition, another study, Increasing Brace Comfort, Durability and Sagittal Balance through Semi-rigid Pelvis Material does not change Short-Term Very-Rigid Sforzesco Brace Results, is among those selected for the Podium presentation and will be presented during the event by Dr Francesco Negrini, an Isico physiatrist.

Isico also distinguished itself for the works accepted as Posters, available to subscribers to the event in an on-demand session, and they are three: Can the tilt-differences of limiting vertebrae be a prognostic factor for the worsening of the scoliosis curves treated with specific exercises? A pilot study using a series of matched patients, edited by our director of physiotherapy, Michele Romano, Reducing the pelvis constriction changes the sagittal plane in the brace. A retrospective case-control study of 37 free-pelvis vs 336 classical consecutive very-rigid Sforzesco braces and The modular MI-brace is as effective as the classical custom-made Sforzesco brace. A matched case-control study of 120 consecutive high-degree female AIS, both from Prof Stefano Negrini.

This year’s virtual meeting will begin with synchronous (live) presentations on Thursday, April 29th and Friday, April 30th, from 9 am to 11 am Eastern Time, and on Saturday, May 1st, from 9 am to 1 pm Eastern Time.

All the presentations will be recorded and be made available on-demand for a duration of 1 year on the SOSORT conference website for registered participants. For more information and registration, visit the event website https://esosort21.sosort.org

Natural History of Scoliosis: the development of a predictive model

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There are two abstracts on the natural history of scoliosis that Isico is going to present at the 56th SRS conference scheduled for next September in the United States: “Predicting Future Curve Severity for Juvenile Idiopathic Scoliosis: A Natural History Study” and “Predicting Future Curve Severity Requires Different Models for Adolescent and Juvenile Idiopathic Scoliosis “.
Abstracts which constitute research carried out by Isico in collaboration with the Canadian University of Alberta and Dr Erik Parent. The preliminary results of this research study will be presented by Prof Stefano Negrini at the Research Grant Outcome Symposium organized by SRS and scheduled for March 6 from 9 to 11 ET US.
Most models to predict future Scoliosis severity have not been validated; many previous samples included treated patients limiting our understanding of the natural history. 

“Our aim was to predict future curve severity at a time point of the clinician’s choice during adolescence using data from x-rays obtained before starting treatment in patients with a diagnosis of Juvenile Idiopathic Scoliosis (JIS) – explains dr Sabrina Donzelli, one of the authors of this research study – we included 2331 patients with a diagnosis of JIS, under age 26, previously untreated.
The data obtained through the radiographs confirm the factors involved in the severity of scoliosis: for juvenile scoliosis the age at onset and the extent of the curve, and for adolescent scoliosis the Risser stage and female gender. The idea is to optimize the use of this data for clinical purposes “.

That is, to be able to validate the model to verify  whether it works for another population with similar characteristics. “During the webinar to which I have been invited – says Prof. Negrini – I will present the preliminary data not only of the two abstracts but also of the other analyses developed by the Canadian university. As a team, we are continuing to validate one model with which we can create an algorithm to predict the cases with the highest development risk.”