Developing a new tool for scoliosis screening in a tertiary specialistic setting using artificial intelligence: a retrospective study on 10,813 patients: 2023 SOSORT award winner.

PURPOSE: The study aims to assess if the angle of trunk rotation (ATR) in combination with other readily measurable clinical parameters allows for effective non-invasive scoliosis screening. METHODS: We analysed 10,813 patients (4-18 years old) who underwent clinical and radiological evaluation for scoliosis in a tertiary clinic specialised in spinal deformities. We considered as predictors ATR, Prominence (mm), visible asymmetry of the waist, scapulae and shoulders, familiarity, sex, BMI, age, menarche, and localisation of the curve. We implemented a Logistic Regression model to classify the Cobb angle of the major curve according to thresholds of 15, 20, 25, 30, and 40 degrees, by randomly splitting the dataset into 80-20% for training and testing, respectively. RESULTS: The model showed accuracies of 74, 81, 79, 79, and 84% for 15-, 20-, 25-, 30- and 40-degrees thresholds, respectively. For all the thresholds ATR, Prominence, and visible asymmetry of the waist were the top five most important variables for the prediction. Samples that were wrongly classified as negatives had always statistically significant (p ≪ 0.01) lower values of ATR and Prominence. This confirmed that these two parameters were very important for the correct classification of the Cobb angle. The model showed better performances than using the 5 and 7 degrees ATR thresholds to prescribe a radiological examination. CONCLUSIONS: Machine-learning-based classification models have the potential to effectively improve the non-invasive screening for AIS. The results of the study constitute the basis for the development of easy-to-use tools enabling physicians to decide whether to prescribe radiographic imaging.

Measuring Quality of Life in Adults with Scoliosis: A Cross-Sectional Study Comparing SRS-22 and ISYQOL Questionnaires.

Idiopathic scoliosis is common in adulthood and can impact patients' physical and psychological health. The Scoliosis Research Society-22 Questionnaire (SRS-22) has been designed to assess health-related quality of life (HRQOL) in idiopathic scoliosis, and it is the most used disease-specific outcome tool from adolescence to adulthood. More recently, the Italian Spine Youth Quality of Life (ISYQOL) international questionnaire was developed, which performs better than SRS-22 in adolescent spinal deformities. However, the ISYQOL questionnaire has never been tested in adults. This study compares the construct validity of ISYQOL and SRS-22 with the Rasch analysis (partial credit model). We recruited 150 adults and 50 adolescents with scoliosis (≥30° Cobb). SRS-22, but not ISQYOL, showed disordered categories and one item not fitting the Rasch model. A 21-item SRS-22 version with revised categories was arranged and further compared to ISYQOL. Both questionnaires showed multidimensionality, and some items (SRS-22 in a greater number) functioned differently in persons of different ages. However, the artefacts caused by multidimensionality and differential functioning had a low impact on the questionnaires' measures. The construct validity of ISYQOL International and the revised SRS-22 are comparable. Both questionnaires (but not the original SRS-22) can return measures of disease burden in adults with scoliosis.

How good is the diagnostic test accuracy of telehealth assessment for dementia and mild cognitive impairment? A Cochrane Review summary with commentary.

BACKGROUND: It is estimated that 50% to 80% of people living with dementia worldwide remain undiagnosed and undocumented and have no access to care and treatment. Telehealth services can be utilized as one of the options to improve access to a diagnosis, especially for people living in rural areas or affected by COVID-19 containment measures. OBJECTIVE: To assess the diagnostic accuracy of telehealth assessment for dementia and mild cognitive impairment (MCI). METHODS: A summary of the Cochrane Review by McCleery et al. 2021, with comments from a rehabilitation perspective. RESULTS: Three cross-sectional diagnostic test accuracy studies (N = 136) were included. Participants were referred from primary care when presenting with cognitive symptoms or were identified as being at high risk of having dementia on a screening test in the care homes. The studies found that telehealth assessment correctly identified 80% to 100% of the people who were diagnosed with dementia during face-to-face assessment and also correctly identified 80% to 100% of people who did not have dementia. Only one study (N = 100) focused on MCI; 71% of participants who had MCI and 73% of participants who did not have MCI were correctly identified via telehealth assessment. Telehealth assessment in this study correctly identified 97% of the participants who had either MCI or dementia, but correctly identified only 22% of those who did not have either. CONCLUSION: Telehealth assessment for diagnosing dementia seems to have a good level of accuracy when compared to face-to-face assessment, although the small number of studies and small sample sizes and differences between the included studies indicate that the results are uncertain.

Can pharmacological, psychological and non-invasive brain stimulation interventions prevent depression after stroke? A cochrane review summary with commentary.

BACKGROUND: Depression is very common in patients after a stroke and it can impact recovery. OBJECTIVE: The Cochrane Review aimed to determine whether psychological therapy, pharmacological interventions, non-invasive brain stimulation, or their combination can prevent depression after stroke. METHODS: The population addressed were patients who suffered from a stroke and had no previous diagnosis of depressive disorders. Studies comparing pharmacological intervention to placebo, psychological therapy to usual care, and non-invasive brain stimulation to sham stimulation or usual care were included. RESULTS: Outcome information was available for nine pharmacological and two psychological trials, showing favorable treatment effects. CONCLUSIONS: The available evidence suggests that pharmacological interventions and psychological therapy may prevent depression and improve mood after stroke. Although, the current evidence is of very low quality resulting in serious uncertainties about the estimates of effect observed.

Neuropsychological Features of Severe Hospitalized Coronavirus Disease 2019 Patients at Clinical Stability and Clues for Postacute Rehabilitation.

OBJECTIVES: To report the cognitive features of patients with severe coronavirus disease 2019 (COVID-19) entering the postacute phase, to understand whether COVID-19 acute respiratory distress syndrome itself could result in long-term cognitive deficits, and to determine whether neuropsychological treatment after the acute stage might represent a specific rehabilitation need. DESIGN: Case series. SETTING: Rehabilitation hospital. PARTICIPANTS: We assessed the general cognitive functioning through tablet-supported video calls in 9 of 12 consecutive patients (N=9) admitted to the hospital at least 30 days earlier for acute respiratory distress syndrome due to COVID-19. Three patients were excluded based on the exclusion criteria. None of the patients presented cognitive symptoms before hospitalization. MAIN OUTCOME MEASURE: General cognitive functioning, measured using the Mini-Mental State Examination (MMSE) test. RESULTS: A general cognitive decay was observed in 3 patients (33.3%) who had a pathologic score on the MMSE, with a specific decline in attention, memory, language, and praxis abilities. The cognitive malfunctioning appears to be linearly associated with the length of stay (in d) in the intensive care unit (ICU). The longer the amount of time spent in the ICU, the lower the MMSE score, indicating a lower global cognitive functioning. CONCLUSIONS: Our results indicate that some patients with COVID-19 might also benefit from neuropsychological rehabilitation, given their possible global cognitive decay. The link between neuropsychological functioning and the length of stay in the ICU suggests that neurocognitive rehabilitative treatments should be directed explicitly toward patients who treated in the ICU, rather than toward every patient who experienced acute respiratory distress syndrome owing to COVID-19. However, given the limitation of a case series study, those hypotheses should be tested with future studies with larger samples and a longer follow-up period.

Altered visual feedback modulates cortical excitability in a mirror-box-like paradigm.

Watching self-generated unilateral hand movements reflected in a mirror-oriented along the midsagittal plane-enhances the excitability of the primary motor cortex (M1) ipsilateral to the moving hand of the observer. Mechanisms detecting sensory-motor conflicts generated by the mirror reflection of such movements might mediate this effect; if so, cortical excitability should be modulated by the magnitude of sensory-motor conflict. To this end, we explored the modulatory effects of an altered visual feedback on M1 excitability in a mirror-box-like paradigm, by increasing or decreasing the speed of the observed movement. Healthy subjects performed movements with their left index finger while watching a video of a hand superimposed to their right static hand, which was hidden from view. The hand observed in the video executed the same movement as the observer's left hand, but at slower, same, or faster paces. Motor evoked potentials (MEPs) induced by transcranial magnetic stimulation were measured from the first dorsal interosseous and the abductor digiti minimi of the participant's hidden resting hand. The excitability of the M1 ipsilateral to the moving hand was systematically modulated by the speed of the observed hand movement: the slower the observed movement, the greater the MEP amplitude from both muscles. This evidence shows that the magnitude of the visual-motor conflicts can be used to adjust the activity of the observer's motor system. Hence, an appropriate alteration of the visual feedback, here the reduction in the movement speed, may be useful to increase its modulatory effect on motor cortical excitability.