Tele-scoliosis-screening and treat protocol: A hybrid in-person and online approach for scoliosis treatment in remote patients.

Abstract

Background: Adherence to treatment protocol is important prognostic factor for successful result in adolescent idiopathic scoliosis treatment with bracing and/or physiotherapeutic scoliosis specific exercises. However, patients living away from specialized centers, have travelling and financial obstacles to receive proper care. Our clinic developed a specific protocol for online evaluation and treatment sessions.

Aim: To evaluate the effectiveness of a hybrid in-person and online treatment protocol for scoliosis treatment.

Methods: Retrospective matched case-control study. Our online evaluation required patient digital radiographs and eight standardized clinical photos, in standing and forward bending positions. An intensive in-person program was prescribed, to allow adequate teaching of physiotherapeutic scoliosis specific exercises or brace manufacturing when needed. Then, the patients followed a home-program of exercises, having regular online supervised sessions. They were asked to re-visit our clinic every 3-6 months. Our online intervention group (OIG) (combined in-person and online treatment) was consisted of 118 patients (103 females-15 males, mean Cobb angle 29.4°, Risser 0.8, age 12.6 years). Our inclusion criteria were Cobb angle 10°-40°, Risser 0-2, less 1-year post-menarche for girls, and permanent residence outside of our region. We used a retrospective matched-control group (MCG) with similar characteristics that received only in-person treatment (106 patients, 92 females-14 males, mean Cobb angle 27.1°, Risser 1.1, age 12.9 years). In the last 3 years totally 3092 online sessions were done for the OIG. Compliance was self-reported in both groups. Independent sample t-test were used for statistical analysis. Mean follow-up was 29.7 months.

Results: Compliance with exercises was significantly better (P = 0.006) in OIG (78.3% > 3 days/week) compared to MCG (52.8% > 3 days/week). In OIG 35% improved, 54% remained stable, and 11% progressed, while in MCG 23.6% improved, 56.6% stable, and 19.8% progressed (P = 0.04). The loss to follow-up was also significantly lower (P = 0.03) in the OIG (6 subjects, 5.1%) compared to MCG (10 subjects, 10.9%).

Conclusion: Our tele-scoliosis-screening and treat protocol significantly improved compliance, monitoring, and final treatment result in adolescent idiopathic scoliosis patients at high risk of progression. Online supervision can keep patient's motivation, allowing proper follow-up and can be used for patients with transportation barriers.