Telerehabilitation Support for Home Exercise in Mild AIS

Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity character-ized by a curvature of the spine greater than 10 degrees in the coronal plane, a deteri-oration in the physiological curvature in the sagittal plane and accompanying rotation in the axial plane. AIS is mostly seen at the thoracic level, less frequently at the lumbar and thoracolumbar levels, and is the most common form of structural scoliosis, accounting for approximately 80% of all scoliosis cases .

In AIS, the problem with spinal alignment affects the bones and soft tissue in the entire body; the resulting deformities such as postural disorders and loss of flexibility of the spine cause problems such as cosmetic concerns, functional losses, and pain in adolescents. In severe cases, respiratory functions and lung capacity decrease, and the patient's quality of life is affected by this condition. Different treatment approaches are recommended for the prevention and management of all these problems. When determining the appro-priate treatment option, the type, shape, degree of the curve, and the patient's charac-teristics should be taken into consideration. To stop or prevent the progression of the curve or to combat the complications experienced; different exercise approaches for scoliosis, the use of corsets, and, in more severe cases, surgical methods are the basic/ main treatment options. In addition, the incidence of curves of 10° and above varies between 1 and 3%, and most of them do not require surgical intervention. For moderate curves below 40°, special exercises and corsets are expressed as first-line treatments to control scoliosis without the need for surgery, therefore various exercise approaches are frequently used at all stages of AIS treatment.

When the literature is examined, it has been reported that exercises for AIS are often recommended to prevent the progression of the curve, correct postural behavior and provide awareness, increase neuromotor control of the spine, increase spinal and thoracic flexibility, increase muscle strength by optimizing muscle balance, and achieve body symmetry. In the treatment of scoliosis, specific exercises are usually given to the individual according to the shape, type, and degree of the curve. Therapeutic exercises include breathing exercises, self-correction exercises (mental imagery, exteroceptive, proprioceptive stimuli, and mirror control), and stabilization exercises (physical exercise, yoga, pilates, and core stabilization).

Telerehabilitation-based interventions are preferred to continue treatment when patients' access to rehabilitation needs is restricted for various reasons. Telerehabilitation has been applied to various diseases and has achieved significant success these days, but telerehabilitation studies in AIS patients are quite rare. Studies in this field have increased their popularity with the rise of telerehabilitation after the pandemic period and have begun to show promising results.

There are limited studies comparing telerehabilitation with home exercises; however, recent studies have shown that telerehabilitation may provide more positive results in terms of respiratory function, flexibility and participation . These findings reveal that telerehabilitation may positively affect exercise compliance and clinical out-comes in AIS; however, due to the small number of studies and the variety of exercises applied in the studies, the number of comparative data regarding the application of ex-ercises for scoliosis via telerehabilitation remains quite limited. In addition, the difference between the results obtained when the home programs are completely applied by oneself and the results obtained when a physiotherapist guides them remotely via telerehabil-itation has not been fully established. In this context, the aim of the study is to examine the effectiveness of the home-based exercise program, which is recommended as a standard after diagnosis in the hospital, in individuals diagnosed with adolescent idiopathic sco-liosis (AIS) and supported by a physiotherapist via telerehabilitation, compared to the same exercise program being applied individually at home. Our study is one of the few that directly examines the effect of supervision on clinical outcomes and has a unique place in terms of comparative evaluation of telerehabilitation with home programs.

Inclusion criteria

• The inclusion criteria for the study were "being between 10 and 18 years old, di-agnosed with adolescent idiopathic scoliosis (AIS) and not using a corset, having a Risser stage between 0 and 3 and a Cobb angle between 10° and 25°, individuals with a Type I curve pattern according to the Lenke classification."

Exclusion criteria

The exclusion criteria were determined as "those with any medical contraindication that may prevent them from doing exercise, patients who have undergone any treatment for scoliosis within the last year, patients who have undergone spinal surgery and patients using a corset, and patients with any mental, neurological and pulmonary disease."

-