Effect of traditional rehabilitation programme versus telerehabilitation in adolescents with idiopathic scoliosis during the COVID-19 pandemic: a cohort study.

BACKGROUND: Telerehabilitation has become increasingly popular since the SARS-CoV-2 (COVID-19) outbreak. However, studies are needed to understand the effects of remote delivery of spine treatment approaches. OBJECTIVES: To verify and compare the effects of traditional rehabilitation programmes (in-person) and telerehabilitation (online) on the progression of scoliotic curvature in adolescents with idiopathic scoliosis during the COVID-19 pandemic, and to verify the acceptability, appropriateness, and feasibility among patients and physiotherapists regarding both treatments. METHODS: This is a cohort study (prospective analysis of 2 intervention groups: telerehabilitation (online) and traditional rehabilitation (in-person). A total of 66 adolescents with idiopathic scoliosis were included. Recruitment was conducted through the Clinical Center in Scoliosis Care (January-December 2020). Participants were divided into 2 intervention groups: telerehabilitation (online) (n = 33) and traditional rehabilitation programme (in-person) (n = 33). Both groups also were supplied with a spinal orthopaedic brace. Scoliosis was confirmed by a spine X-ray examination (Cobb angle). Radiographic parameters measured were: Cobb angles (thoracic and lumbar). The method of Nash and Moe (thoracic and lumbar) was also evaluated based on the relationship between the vertebral pedicles and the centre of the vertebral body in the X-rays. Assessments were performed at baseline (T0) and after 6 months of the intervention protocol (T6). Patient and physiotherapist reports were evaluated on the acceptability, appropriateness, and feasibility of the interventions. RESULTS: Adolescents with idiopathic scoliosis showed a significant decrease in the Cobb angle (main scoliotic curvature), with a 4.9° for the traditional rehabilitation programme and 2.4° for the telerehabilitation. Thoracic and lumbar Cobb angles did not show significant changes after the intervention in both groups or between groups. Thoracic and lumbar Nash and Moe scores scores also did not show significant differences after 6 months of in-person or telerehabilitation intervention, or between groups. The intervention by telerehabilitation was acceptable, appropriate, and feasible for patients and physiotherapists. CONCLUSION: Use of the rehabilitation programme for adolescents with idiopathic scoliosis, delivered via telerehabilitation during the COVID-19 pandemic, was encouraging for future applications due to the improved effect on reducing the Cobb angle, preventing progression of scoliosis. In addition, telerehabilitation showed good acceptability among patients and physiotherapists. Traditional rehabilitation programmes (in-person) in adolescents with idiopathic scoliosis also showed a reduction in the Cobb angle.

Reliability and validity between two instruments for measuring spine sagittal parameters in adolescents with idiopathic scoliosis during various stages of growth / Confiabilidad y validez entre dos instrumentos para medir parámetros sagitales de la columna vertebral en adolescentes con escoliosis idiopática durante varias etapas de crecimiento

Abstract Introduction: Adolescent idiopathic scoliosis (AIS) is the most common and severe spinal deformity, which affects children and adolescents in the stage of neuromotor development and skeletal maturity of the sagittal curvatures of the spine. The literature presents several radiation-free instruments to assess and monitor the progression of scoliotic curvature angles in the AIS. However, the reliability and validity of the inclinometer at different stages of growth in relation to X-ray parameters has not been understood to date. Objective: To evaluate the reliability of the inclinometer and its validity with the X-ray exam on the sagittal parameters of the spine in the early and late growth stages of adolescents with AIS. Methods: A cross-sectional study was conducted with 39 adolescents with AIS who were divided into two groups: the initial growth phase (10-13 years) and the late growth phase (14-18 years). The evaluated sagittal parameters of the spine were the angle of the thoracic kyphosis and the angle of the lumbar lordosis, both measured by the X-ray image examination and the inclinometer. Results: The inclinometer showed excellent inter- and intra-examiner reliability for the different growth phases, early and late, with a strong association with the X-ray (gold standard; r = 0.84; p = 0.308 and r = 0.75; p = 0.517). The angle of lumbar lordosis was different between the inclinometer and X-ray instruments in the early and late stages of growth (p < 0.001), with moderate reliability and a less significant correlation with the gold standard of radiography (r = 0.38; p = 0.001 and r = 0.49; p = 0.024). Conclusion: The inclinometer showed excellent reliability and validity for the sagittal parameter of thoracic kyphosis in the early and late stages of growth. The angle of lumbar lordosis measured by inclinometer proved to be of moderate reliability and weak validity when considering the phases of skeletal growth, showing it to be an inefficient instrument for monitoring the lumbar scoliotic curvature for AIS.

Resumen Introducción: La escoliosis idiopática del adolescente (EIA) es la deformidad espinal más común y severa, que afecta a niños y adolescentes en la etapa de desarrollo neuromotor y madurez esquelética de las curvaturas sagitales de la columna. La literatura presenta varios instrumentos libres de radiación para evaluar y monitorear la progresión de los ángulos de curvatura escolióticos en el AIS. Sin embargo, hasta la fecha no se ha entendido la fiabilidad y validez del inclinómetro en diferentes etapas de crecimiento en relación con los parámetros de rayos X. Objectivo: Evaluar la confiabilidad del inclinómetro y su validez con el examen de rayos X sobre los parámetros sagitales de la columna vertebral en las etapas de crecimiento temprano y tardío de adolescentes con EIA. Materiales y métodos: Se realizó un estudio transversal con 39 adolescentes con EIA que se dividieron en dos grupos: la fase de crecimiento inicial (10-13 años) y la fase de crecimiento tardío (14-18 años). Los parámetros sagitales de la columna evaluados fueron el ángulo de la cifosis torácica y el ángulo de la lordosis lumbar, ambos medidos por el examen de imagen de rayos X y el inclinómetro. Resultados: El inclinómetro mostró una excelente confiabilidad inter e intraexaminador para las diferentes fases de crecimiento, temprana y tardía, con una fuerte asociación con la radiografía (estándar de oro; r = 0.84; p = 0.308 y r = 0.75; p = 0,517). El ángulo de lordosis lumbar fue diferente entre el inclinómetro y los instrumentos de rayos X en las etapas tempranas y tardías del crecimiento (p < 0,001), con confiabilidad moderada y una correlación menos significativa con el estándar de oro de la radiografía (r = 0,38; p = 0,001 y r = 0,49; p = 0,024). Conclusión: El inclinómetro mostró excelente confiabilidad y validez para el parámetro sagital de cifosis torácica en etapas tempranas y tardías de crecimiento. El ángulo de lordosis lumbar medido por inclinómetro demostró ser de confiabilidad moderada y validez débil al considerar las fases de crecimiento esquelético, mostrándose como un instrumento ineficiente para monitorear la curvatura escoliótica lumbar para EIA.