TRACE (Trunk Aesthetic Clinical Evaluation), a routine clinical tool to evaluate aesthetics in scoliosis patients: development from the Aesthetic Index (AI) and repeatability

<p>Abstract</p> <p>Background</p> <p>Aesthetic appearance is of primary importance in the treatment of adolescent idiopathic scoliosis (AIS), but to date tools for routine clinical practice have not become available. The aim of the present study is to develop such a tool and to verify its repeatability.</p> <p>Methods</p> <p>Instrumentation: At first we developed the Aesthetic Index (AI), based on a three-point scale for asymmetry of the shoulders, scapulae and waist that we tested for 5 years. From this experience we developed another tool we called TRACE, the acronym of Trunk Aesthetic Clinical Evaluation; TRACE is a 12-point scale based on four sub-scales, shoulders (0–3), scapulae (0–2), hemi-thorax (0–2) and waist (0–4).</p> <p>Population: Posterior-anterior (PA) photographs of one hundred-sixty AIS patients</p> <p>Procedures: Each photograph was scored in two independent tests by four observers using AI, and subsequently TRACE.</p> <p>Data analysis: Kappa statistical analysis and 95% level of agreement were used; we also identified the minimum significant change (95% confidence level).</p> <p>Results</p> <p>We found the intra- and inter-raters repeatability of AI to be fair. Three points out of seven was the minimum significant change between two different evaluations. For TRACE, intra-rater repeatability was fair and inter-raters poor; but the minimum significant change was three (intra-rater), or four (inter-raters) out of twelve points.</p> <p>Conclusion</p> <p>Widening the scale from 7 (AI) to 12 points (TRACE) increased the clinical sensitivity to changes of the aesthetic scale, even if TRACE has only a fair repeatability. TRACE is a no-cost tool for routine clinical practice in AIS patients. Due to the absence of other comparable validated tools, once the inherent measurement error is known and understood, its routine clinical use by physicians is advised.</p

How to improve aesthetics in patients with Adolescent Idiopathic Scoliosis (AIS): a SPoRT brace treatment according to SOSORT management criteria

<p>Abstract</p> <p>Background</p> <p>Aesthetics is a main goal of both conservative and surgical treatments in adolescent idiopathic scoliosis (AIS). Previously, we developed and validated a clinical scale - the Aesthetic Index (AI)--in order to measure aesthetic impairment and changes during treatment.</p> <p>Aim</p> <p>To verify the efficacy of bracing on aesthetics in AIS.</p> <p>Study Design</p> <p>Prospective Cohort Study.</p> <p>Population</p> <p>Thirty-four consecutive patients, age 13.2 ± 3.7, initial Cobb Angle 32 ± 12°, ATR 10 ± 4° Bunnel, 11 males.</p> <p>Methods</p> <p>Patients with AI scores of at least 5/6 were included. Each of them had a brace prescription (18 to 23 hours per day), according to the SPoRT concept. AI was measured again after six months and at the end of treatment, and then the pre- and post-treatment scores compared. The Wilcoxon test was performed.</p> <p>Results</p> <p>Twenty-nine patients out of the 34 included completed the treatment and had six-month and final results; four patients were lost during the treatment, and one was fused. At baseline, median AI was 6 (95% IC 5-6) but the score decreased to 3 (95% IC 0-5; p < 0.05) after six months with brace, and this value was maintained in the 29 who completed the treatment (95% IC 1-6; p < 0.05 with respect to the baseline).</p> <p>Conclusion</p> <p>Aesthetics can be improved in a clinically significant way when the brace treatment is performed according to the SPoRT concept and by following the SOSORT management criteria. This is a relevant result for patients and a major goal of scoliosis treatment, be it conservative or surgical. The use of a more sensitive tool like TRACE could more easily detect the clinical changes; nevertheless, AI proved sensible enough that its use in everyday clinical practice can be suggested.</p

Effect of obesity and low back pain on spinal mobility: a cross sectional study in women

<p>Abstract</p> <p>Background</p> <p>obesity is nowadays a pandemic condition. Obese subjects are commonly characterized by musculoskeletal disorders and particularly by non-specific chronic low back pain (cLBP). However, the relationship between obesity and cLBP remains to date unsupported by an objective measurement of the mechanical behaviour of the spine and its morphology in obese subjects. Such analysis may provide a deeper understanding of the relationships between function and the onset of clinical symptoms.</p> <p>Purpose</p> <p>to objectively assess the posture and function of the spine during standing, flexion and lateral bending in obese subjects with and without cLBP and to investigate the role of obesity in cLBP.</p> <p>Study design</p> <p>Cross-sectional study</p> <p>Patient sample</p> <p>thirteen obese subjects, thirteen obese subjects with cLBP, and eleven healthy subjects were enrolled in this study.</p> <p>Outcome measures</p> <p>we evaluated the outcome in terms of angles at the initial standing position (START) and at maximum forward flexion (MAX). The range of motion (ROM) between START and MAX was also computed.</p> <p>Methods</p> <p>we studied forward flexion and lateral bending of the spine using an optoelectronic system and passive retroreflective markers applied on the trunk. A biomechanical model was developed in order to analyse kinematics and define angles of clinical interest.</p> <p>Results</p> <p>obesity was characterized by a generally reduced ROM of the spine, due to a reduced mobility at both pelvic and thoracic level; a static postural adaptation with an increased anterior pelvic tilt. Obesity with cLBP is associated with an increased lumbar lordosis.</p> <p>In lateral bending, obesity with cLBP is associated with a reduced ROM of the lumbar and thoracic spine, whereas obesity on its own appears to affect only the thoracic curve.</p> <p>Conclusions</p> <p>obese individuals with cLBP showed higher degree of spinal impairment when compared to those without cLBP. The observed obesity-related thoracic stiffness may characterize this sub-group of patients, even if prospective studies should be carried out to verify this hypothesis.</p

Cross-cultural validation of the Italian Spine Youth Quality of Life questionnaire: the ISYQOL international

Questionnaire; Quality of life; SpineQüestionari; Qualitat de vida; Columna vertebralCuestionario; Calidad de vida; Columna vertebralBACKGROUND: Adolescent idiopathic scoliosis and its treatments can severely impact health-related quality of life. The Italian Spine Youth Quality of Life (ISYQOL) questionnaire, initially developed in Italian and tested on Italian people, was created to measure quality of life in young persons with spine changes. ISYQOL was created using the Rasch analysis, a modern psychometric technique for questionnaires’ assessment and development, which showed that the ordinal scores of the ISYQOL Italian version provide sound quality of life measures. AIM: The current work aims to evaluate the cross-cultural equivalence of the ISYQOL questionnaire in seven different countries. DESIGN: Cross-sectional, international, multi-centre study. SETTING: Outpatient clinic. POPULATION: Five hundred fifty persons with adolescent idiopathic scoliosis from English Canada, French Canada, Greece, Italy, Spain, Poland, and Türkiye. METHODS: The ISYQOL Italian version was translated into six languages with the forward-backwards procedure. The conceptual equivalence of the items’ content was verified, and any inconsistency was resolved by consensus. The Rasch analysis was used here to evaluate that ISYQOL translations retained the good measurement properties of the Italian version of the questionnaire. In addition, the Differential Item Functioning (DIF) was checked to assess the psychometric equivalence of the ISYQOL items in patients from different countries. RESULTS: Four items of the translated ISYQOL were dropped from the questionnaire since they did not contribute to measuring due to their poor fit to the model of Rasch. Seven items were affected by DIF for nationality, a finding pointing out that these items do not work the same (i.e. are not equivalent) in the different countries. Thanks to the Rasch analysis, the DIF for nationality was amended, and ISYQOL International was eventually obtained. CONCLUSIONS: ISYQOL International returns interval quality of life measures in people with adolescent idiopathic scoliosis with high cross-cultural equivalence in the tested countries. CLINICAL REHABILITATION IMPACT: Rigorous testing showed that ISYQOL International ordinal scores return quality of life measures cross-culturally equivalent in English and French Canada, Greece, Italy, Spain, Poland, and Türkiye. A new, psychometrically sound patient-reported outcome measure is thus available in rehabilitation medicine to measure health-related quality of life in idiopathic scoliosis.For the ISYQOL French version, Claudie Forest received a grant awarded by the Programme d’Excellence en Médecine pour l’Initiation En Recherche (PREMIER) from the School of Rehabilitation at University of Montreal and Carole Fortin was supported by a Junior 1 salary award from Fonds de Recherche du Québec - Santé (FRQS). Antonio Caronni was supported by the IRCCS Istituto Auxologico Italiano – Milano, Italia, within the RESET research project (Ricerca Corrente 2020, Italian Ministry of Health)

Exercises for adolescent idiopathic scoliosis

Background: Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine . While AIS can progress during growth and cause a surface deformity, it is usually not symptomatic. However, in adulthood, if the final spinal curvature surpasses a certain critical threshold, the risk of health problems and curve progression is increased. The use of scoliosis-specific exercises (SSE) to reduce progression of AIS and postpone or avoid other more invasive treatments is controversial.Objectives: To evaluate the efficacy of SSE in adolescent patients with AIS.Search methods: The following databases (up to 30 March 2011) were searched with no language limitations: CENTRAL (The Cochrane Library 2011, issue 2), MEDLINE (from January 1966), EMBASE (from January 1980), CINHAL (from January 1982), SportDiscus (from January 1975), PsycInfo (from January 1887), PEDro (from January 1929). We screened reference lists of articles and also conducted an extensive handsearch of grey literature.Selection criteria: Randomised controlled trials and prospective cohort studies with a control group comparing exercises with no treatment, other treatment, surgery, and different types of exercises.Data collection and analysis: Two review authors independently selected studies, assessed risk of bias and extracted data.Main results: Two studies (154 participants) were included. There is low quality evidence from one randomised controlled study that exercises as an adjunctive to other conservative treatments increase the efficacy of these treatments (thoracic curve reduced: mean difference (MD) 9.00, (95% confidence interval (CI) 5.47 to 12.53); lumbar curve reduced:MD 8.00, (95% CI 5.08 to 10.92)). There is very low quality evidence from a prospective controlled cohort study that scoliosis-specific exercises structured within an exercise programme can reduce brace prescription (risk ratio (RR) 0.24, (95% CI 0.06 to1.04) as compared to usual physiotherapy (many different kinds of general exercises according to the preferences of the single therapists within different facilities).Authors' conclusions: There is a lack of high quality evidence to recommend the use of SSE for AIS. One very low quality study suggested that these exercises may be more effective than electrostimulation, traction and postural training to avoid scoliosis progression, but better quality research needs to be conducted before the use of SSE can be recommended in clinical practice