Perspectives on Communication Technology Use for Alleviating the Impact of COVID-19 on Hospitalized Patients' Well-Being and Transitions in Care.

BACKGROUND: The COVID-19 pandemic created many challenges for in-patient care including patient isolation and limitations on hospital visitation. Although communication technology, such as video calling or texting, can reduce social isolation, there are challenges for implementation, particularly for older adults. OBJECTIVE/METHODS: This study used a mixed methodology to understand the challenges faced by in-patients and to explore the perspectives of patients, family members, and health care providers (HCPs) regarding the use of communication technology. Surveys and focus groups were used. FINDINGS: Patients who had access to communication technology perceived the COVID-19 pandemic to have more adverse impact on their well-beings but less on hospitalization outcomes, compared to those without. Most HCPs perceived that technology could improve programs offered, connectedness of patients to others, and access to transitions of care supports. Focus groups highlighted challenges with technology infrastructure in hospitals. DISCUSSION: Our study findings may assist efforts in appropriately adopting communication technology to improve the quality of in-patient and transition care.

tDCS over the left prefrontal Cortex improves mental flexibility and inhibition in geriatric inpatients with symptoms of depression or anxiety: A pilot randomized controlled trial.

Background: Patients with depression and/or anxiety are commonly seen in inpatient geriatric settings. Both disorders are associated with an increased risk of cognitive impairments, notably in executive functioning. Transcranial direct current stimulation (tDCS), a type of non-invasive brain stimulation, involves the administration of a low-dose electrical current to induce neuromodulation, which ultimately may act on downstream cognitive processing. Objective: The purpose of this study was to determine the effects of tDCS on executive functioning in geriatric inpatients with symptoms of depression and/or anxiety. Design: Pilot Randomized Controlled Trial. Setting: Specialized geriatric wards in a tertiary rehabilitation hospital. Methods: Thirty older-aged adults were recruited, of which twenty completed ten-to-fifteen sessions of 1.5 mA anodal or sham tDCS over the left dorsolateral prefrontal cortex. Cognitive assessments were administered at baseline and following the tDCS protocol; analyses examined the effects of tDCS on cognitive performance between groups (anodal or sham tDCS). Results: tDCS was found to increase inhibitory processing and cognitive flexibility in the anodal tDCS group, with significant changes on the Stroop test and Trail Making Test-Part B. No significant changes were observed on measures of attention or working memory. Discussion: These results provide preliminary evidence that tDCS-induced neuromodulation may selectively improve cognitive processing in older adults with symptoms of depression and/or anxiety. Clinical Trials Registration: www.clinicaltrials.gov, NCT04558177.

Assessment of Curve Flexibility on Scoliotic Surgical Candidates Using Ultrasound Imaging Method.

The ultrasound imaging method was implemented to assess the spinal curve flexibility of scoliotic surgical candidates, or how much correction it can achieve while patients are bending or lying down. Fifteen participants were recruited. Pre-operative radiographs and ultrasound images in both standing and bending positions were acquired. The post-operative standing radiographs were obtained 1 wk after surgery. Two raters (RZ, EL) measured the ultrasound images twice, 1 wk apart. A curve correction index (CI) was developed to estimate the curve flexibility. The CI from the pre-operative bending radiograph, ultrasound and post-operative radiograph were 0.51 ± 0.18; R1: 0.74 ± 0.08 vs R2: 0.72 ± 0.09 and 0.60 ± 0.10, respectively. The correlation of CI between ultrasound and post-operative radiography was slightly higher than the pre-operative bending and post-operative radiography. This pilot study demonstrated the bending ultrasound method is a promising supplemental tool to assess curve flexibility before surgical intervention for scoliotic surgical candidates.

How quantity and quality of brace wear affect the brace treatment outcomes for AIS.

PURPOSE: To determine the reliability of a prognostic curve progression model and the role of the quantity and quality of brace wear for adolescent idiopathic scoliosis (AIS) brace treatment. METHODS: To develop a curve progression model for full-time AIS brace treatment, 20 AIS subjects (Group 1) prescribed full-time thoracolumbar sacral orthosis (TLSO) were monitored and followed for 2 years beyond maturity. The developed curve progression model was: curve progression (in degrees) = 33 + 0.11 × Peterson risk (%) - 0.07 in-brace correction (%) - 0.45 × quality (%) - 0.48 × quantity (%) + 0.0062 × quantity × quality. To validate the model, 40 new (test) subjects (Group 2) who met the same inclusion criteria and used the same type of monitors, were monitored and followed for 2 years after bracing. RESULTS: For the 40 test subjects (Group 2), the average in-brace correction was 40 ± 22 %. The average quantity and quality of the brace wear were 56 ± 19 and 55 ± 17 %, respectively. Twelve subjects (30 %) progressed of which 10 subjects (25 %) required surgery and 28 subjects (70 %) showed no progression. The accuracy of the model to determine which patients would progress was 88 % (35/40) which was better than the Peterson's risk model (68 %; 26/40) alone. Patients who had the combined quantity times the quality over a threshold 43 % had a success treatment rate of 95 %. CONCLUSIONS: This study showed the prognostic model of brace treatment outcome on AIS patients treated with full-time TLSO was reliable. Both the quantity and quality of the brace wear were important factors in achieving successful brace treatment.

Smart brace versus standard rigid brace for the treatment of scoliosis: a pilot study.

The outcomes of brace treatment for scoliosis depend on how the brace is used. Simply prescribing a brace does not mean it will be worn properly. A smart brace has been developed to control the brace wear tightness with the expectation that appropriately worn braces will improve outcomes. Twelve brace candidates (10F; 2M) agreed to participate into this study and were randomly divided into 2 groups. The smart brace group used the smart brace for the first year, and then wore the standard brace for the following year. The standard rigid brace group wore their TLSO for 2 years. Both groups were followed for 3 years after they finished the brace treatment. The smart brace group showed better quality of brace wear, wearing their brace at the prescribed tightness level a higher proportion of time than the standard brace group. All subjects in the smart brace group had successful outcomes, Cobb angle changed less than 5°, whereas 2/6 subjects in the standard brace group had unsuccessful bracing. One had 7° increment and 1 underwent surgery. The smart brace group also reported that the smart brace was more comfortable to wear than the standard rigid brace.

Brace wear characteristics during the first 6 months for the treatment of scoliosis.

Bracing is the most commonly used non-surgical treatment for adolescent idiopathic scoliosis (AIS) and requires an extensive commitment on the part of the patient and family. However, demonstrating efficacy of brace treatment for AIS has been hampered by the lack of compressive information about wear characteristics. The first 6 months is considered a critical time to evaluate whether AIS patients will commit to the treatment and may predict the treatment outcome. The characteristics of brace wear can assist clinicians to provide better support and aid long term compliance with treatment. This study describes the first 6 month brace wear characteristics in 15 AIS patients (12F;3M) who were prescribed full-time brace wear. There was a statistically significant increase in wear time (p = 0.02) after brace fitting and the brace wear tightness stabilized after month 4. The force at the major pressure pad area continuously decreased after month 2. A moderate correlation was found between the (quantity * quality) of the brace wear at month 6 and the change of Cobb angle (first out of brace - pre brace) (r2 = 0.47). The more time that the brace was worn and the higher proportion of time worn at the prescribed tightness or above improves the likelihood of a better treatment result.

An objective measurement of brace usage for the treatment of adolescent idiopathic scoliosis.

Effectiveness of orthotic treatment for scoliosis depends on how much time and how well the orthosis is worn. Questionnaires and clinical judgment are subjective methods to wear compliance. Even though using a temperature sensor can objectively record how long the orthosis has been used, it may not be able to answer the orthosis effectiveness without knowing the wear tightness. Custom made thoracolumbosacral orthoses (TLSO) were instrumented with low power wireless data acquisition systems to measure the time and loads imposed by the pressure pad during daily activities. Force measurements were recorded at 1 sample/min and the system was able to record data up to 4 months without patient-involvement. Ten subjects (9F, 1M), age between 9 and 13.5 years, average 11.6±1.3 years, who prescribed a new TLSO and full-time brace wear were took part in this study over 4.4±1.0 months. Long-term logging of loads within a spinal orthosis is a reliable method to measure compliance objectively. The monthly quantity of brace wear ranged from 33% to 82%, average 60.0±4.3%. The monthly average loads imposed by the pressure pads varied from 39% to 78% relative to the reference level, average 64.3±4.6%. There was a statistically significant decrease in force, but increase in wear time over the period after the brace fitting session. This information may help to better understand the effectiveness of bracing and to predict the brace treatment outcomes.

Using ultrasound to guide the insertion of pedicle screws during scoliosis surgery.

Scoliosis surgery involves the insertion of screws and/or hooks into selected vertebrae to secure a pre-bent rod placed along the concave side of the spine. Usually conventional x-rays will be taken before the surgery to plan the alignment and positioning of the pedicle screws. However, reports state that perforation rate range from 6% to 54%. A misalignment of a pedicle screw can potentially cause permanent neurological spinal cord injury or even a life-threatening vascular injury. Because of the importance of positioning and aligning of pedicle screws, we are working on an ultrasound method to guide the insertion of pedicle screws in real time. A pulse-echo immersion experiment was set up to study how well the edges of cortical bone could be detected using a bovine spinous process in-vitro. Two ultrasound frequencies (3.5 MHz and 5.0 MHz) were considered in this study. This preliminary study shows that ultrasound is able to penetrate cortical bone and reflect back from the outer boundary. All interfaces are clearly identified for both frequencies. Strong reflection signals are obtained when the beam is normal to the interface. Derived thickness values from the reflections are comparable with those from micro-CT image. The 5.0 MHz ultrasound frequency provided better resolution than the 3.0 MHz frequency.

Score distribution of the scoliosis research society-22 questionnaire in subgroups of patients of all ages with idiopathic scoliosis.

STUDY DESIGN: Cross-sectional measurement study. OBJECTIVE: To analyze the score distribution of the Scoliosis Research Society (SRS)-22 questionnaire domains and items for patients with idiopathic scoliosis (IS) of all ages. SUMMARY OF BACKGROUND DATA: Scoliosis-related quality-of-life questionnaires have demonstrated high ceiling effects in younger patients. However, the score distribution has not been examined thoroughly in other clinically relevant IS subgroups. METHODS: The SRS-22 was completed by 173 females with IS. The proportions of ceiling effects, floor effects, of patients scoring greater than or equal to 4 out of 5 and the box plots of the score distribution for each domain and item were compared between subgroups. Subgroups were formed based on age (k = 4), management (k = 6), curve severity (k = 3), and curve type (k = 4). RESULTS: Domain ceiling effects varied between 0% and 23.1%. Domain floor effects were observed only for Self-image (<7%) and Satisfaction (<12%). Only Pain and Satisfaction showed moderate (>20%) ceiling effects. Ceiling effects for Pain and Mental Health decreased with increasing age (P < 0.05). Pain ceiling effects decreased and Satisfaction ceiling effects increased from least to most invasive management (P < 0.05), but no differences were found among Cobb severity or curve types subgroups. Of the 22 items, 9 had major (>or=50%) ceiling effects and 11 had moderate ceiling effects. Most subgroups (14/16) had 4 to 6 items with major ceiling effects. The following items had major ceiling effects in the majority of subgroups: Function, 9 and 15; Pain, 11 and 17; and Self-image, 14. CONCLUSION: Most SRS-22 domains had acceptable levels of ceiling effects (<20%) in the majority of the subgroups examined. However, more sensitive measurements may be needed to supplement the SRS-22 in assessing Pain in patients below 18 years or Satisfaction after surgery.

The International Research Society of Spinal Deformities (IRSSD) and its contribution to science.

From the time of its initial, informal meetings starting in 1980 to its formal creation in 1990, the IRSSD has met on a bi-annual basis to discuss all aspects of the spine and associated deformities. It has encouraged open discussion on all topics and, in particular, has tried to be the seed-bed for new ideas. The members are spread around the world and include people from all areas of academia as well as the most important people, the patients themselves. Most notably, application of the ideas and results of the research has always been at the forefront of the discussions. This paper was conceived with the idea of evaluating the impact made by the IRSSD over the last 30 years in the various areas and is intended to create discussion for the upcoming meeting in Montreal regarding future focus: "We are lost over the Atlantic Ocean but we are making good time."

Discriminative and predictive validity of the scoliosis research society-22 questionnaire in management and curve-severity subgroups of adolescents with idiopathic scoliosis.

STUDY DESIGN: Prospective cross-sectional measurement study. OBJECTIVE: To determine the ability of the Scoliosis Research Society (SRS)-22 questionnaire to discriminate among management and scoliosis severity subgroups and to correlate with internal and external measures of curve severity. SUMMARY OF BACKGROUND DATA: In earlier studies of the SRS-22 discriminative ability, age was not a controlled factor. The ability of the SRS-22 to predict curve severity has not been thoroughly examined. METHODS: The SRS-22 was completed by 227 females with adolescent idiopathic scoliosis. Using Analysis of covariance analyses controlling for age, the SRS-22 scores were compared among management subgroups (observation, brace, presurgery, and postsurgery) and curve-severity subgroups (in nonoperated subjects: Cobb angles of <30 degrees, 30 degrees -50 degrees, and >50 degrees). A stepwise discriminant analysis was used to identify the SRS-22 domains most discriminative for curve-severity categories. Correlation between SRS-22 scores and radiographic or surface topography measurements was used to determine the predictive ability of the questionnaire. RESULTS: Pain was better for subjects treated with braces than for those planning surgery. Self-image was better for subjects under observation or postsurgery than for those planning surgery. Satisfaction was better for the brace and postsurgery subgroups than for the observation or presurgery subgroups. Statistically significant mean differences between subgroups were all larger than 0.5, which is within the range of minimal clinically important differences recommended for each of the 5-point SRS-22 domain scoring scales. Pain and mental health were worse for those with Cobb angles of >50 degrees than with Cobb angles of 30 degrees to 50 degrees. Self-image and total scores were worse for those with Cobb angles of >50 degrees than both other subgroups. Using discriminant analysis, self-image was the only SRS-22 domain score selected to classify subjects within curve severity subgroups. The percentage of patients accurately classified was 54% when trying to classify within 3 curve severity subgroups. The percentage of patients accurately classified was 73% when classifying simply as those with curves larger or smaller than 50 degrees . CONCLUSION: Pain, self-image, and satisfaction scores could discriminate among management subgroups, but function, mental health and total scores could not. The total score and all domain scores except satisfaction discriminated among curve-severity subgroups. Using discriminant analysis, self-image was the only domain retained in a model predicting curve-severity categories.

Virtual reality interventions for rehabilitation: considerations for developing protocols.

This paper is a preliminary report on a work in progress that explores the existence of practice effects in early use of virtual reality environments for rehabilitation purposes and the effects of increases in level of difficulty as defined by rate of on-screen objects.

Vertebral rotation measurement: a summary and comparison of common radiographic and CT methods.

Current research has provided a more comprehensive understanding of Adolescent Idiopathic Scoliosis (AIS) as a three-dimensional spinal deformity, encompassing both lateral and rotational components. Apart from quantifying curve severity using the Cobb angle, vertebral rotation has become increasingly prominent in the study of scoliosis. It demonstrates significance in both preoperative and postoperative assessment, providing better appreciation of the impact of bracing or surgical interventions. In the past, the need for computer resources, digitizers and custom software limited studies of rotation to research performed after a patient left the scoliosis clinic. With advanced technology, however, rotation measurements are now more feasible. While numerous vertebral rotation measurement methods have been developed and tested, thorough comparisons of these are still relatively unexplored. This review discusses the advantages and disadvantages of six common measurement techniques based on technology most pertinent in clinical settings: radiography (Cobb, Nash-Moe, Perdriolle and Stokes' method) and computer tomography (CT) imaging (Aaro-Dahlborn and Ho's method). Better insight into the clinical suitability of rotation measurement methods currently available is presented, along with a discussion of critical concerns that should be addressed in future studies and development of new methods.

Brace treatment for adolescent idiopathic scoliosis.

Adolescent idiopathic scoliosis (AIS) presents as an abnormal curvature of spine with vertebral rotation. It may impact the patient for their entire life. Approximately 0.25% of adolescents will require treatment. Brace treatment is the most commonly used non-surgical treatment for AIS. Its goal is stop the progression and maintain the curve at an acceptable level through the high risk growth phase of adolescence. However, its effectiveness is controversial and the actual biomechanical action of the brace is not fully understood. Recently, the Scoliosis Research society (SRS) created a standard criterion for AIS brace studies. However, to evaluate the effectiveness of the brace treatment, the spine flexibility, in brace correction and patient's compliance should also be included in a study. Although bracing has been used for more than 50 years, there are still many unknowns. How much wear time per day is needed for an optimum treatment outcome? How much brace tightness is optimal? What is the best weaning protocol? What is the best method to determine the curve flexibility? How much in-brace correction is needed to obtain good results? Without accurate and precise methods to objectively measure or answer the above questions, it is misleading to state whether or not brace treatment is effective. Therefore, a lot of research is still required before one can answer the effectiveness of the brace treatment.

Score distribution of the Scoliosis Quality of Life Index questionnaire in different subgroups of patients with adolescent idiopathic scoliosis.

STUDY DESIGN: Prospective cross-sectional measurement study. OBJECTIVE: To analyze the score distribution on the Scoliosis Quality of Life Index (SQLI) questionnaire domains and items for subjects with adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA: The SQLI was derived from the SRS-22 questionnaire so that it would be more applicable to persons with AIS between 10 and 18 years old. However, the score distribution of the SRS-22 is characterized by high ceiling effects within subgroups of persons with AIS. METHODS: The SQLI questionnaire was completed by 95 females with AIS. Floor, ceiling effects, and score distribution were examined for subgroups based on age (n = 4), management (4), curve severity (3), and curve type (6). RESULTS: Ceiling effect proportions (0%-40%) were higher than floor effects (n = 1). Back pain and satisfaction were the only domains with ceiling effects exceeding 20%. For some domains, ceiling effects were significantly most prevalent for younger subgroups, those with low or moderate curve severity and those treated less aggressively. High ceiling effects were also observed for the observation, postsurgical, main thoracic, and double major curves subgroups. More than half the participants scored over 4/5 for all SQLI domains in the overall sample and in the observation, surgery, <13.5 years, 13.5 to <15 years, <30 degrees, 30 degrees to 50 degrees, main thoracic curves, double major curves, and thoracolumbar/lumbar curves subgroups, respectively. At least one item from each domain (except satisfaction) showed ceiling effects >50% in most subgroups (14 or more subgroups out of 15). CONCLUSION: Even though ceiling effects (>20%) were not common, scores clustered near the top of the SQLI scale. The SQLI score distribution may impair the questionnaire's sensitivity to change and discriminative ability, particularly in younger subjects with lesser low or moderate curve severity, under observation or after surgery. The clinical utility of some SQLI items within each domain may be limited by high ceiling effects.