Isico Approach: cap. 1
The goal of this booklet, which is mainly written for the healthcare personnel but also for the patient, is to provide a thorough overview of the therapeutic approaches to spinal deformities that are used by ISICO (Italian Spine Scientific Institute), an organisation fully devoted to rehabilitation and conservative treatment of scoliosis and back pain, and that constitutes an example of a highly specialised institute in the field. This “super-specialty”--a strong belief in the Evidence-Based Clinical Practice approach implemented by its founders--a peculiar history of treatment for these diseases in Italy and southern Europe, as well as the geographical characteristics of our country, had led us to develop an approach that is in some ways unique. In fact, as you will learn in this text, the ISICO approach and concepts (SEAS for exercises, SPoRT for bracing, and the overall ISICO rehabilitation approach) combine the most current scientific knowledge with solutions that are high-tech, low-cost and readily accessible in order to provide advanced, correct rehabilitation to people encompassing a wide geographical region.
In this booklet you will find many practical proposals but also quite a number of pages dedicated to theory, on the basis of scientific knowledge. Please consider that, once the principles are recognised, the action to be taken is only a consequence: doing something without understanding why we do it will certainly lead to mistakes. Moreover, it’s important to have an idea of what to do, even if learning requires a long period of specific training. Therefore, the two main concepts developed by ISICO over the years (SEAS, or Scientific Exercises Approach to Scoliosis; and SPoRT, or Symmetric Patient-oriented, Rigid, Three-dimensional, active bracing) will be presented as follows:
- Why and when to apply this treatment: The efficacy of every concept is based on its correct medical indications.
- Theoretical basis: This is the scientific knowledge that has led to the development of the concept and its continuous quality improvement.
- Practical applications: Some examples of what to do, even if these concepts are learned and correctly applied, require formal education and years of use. It appears easy because these concepts have the strength of simplicity, but actually they are not simplistic at all.
- Results: These constitute the statistics and scientific publications regarding the concepts.
Subsequently, after discussing the Evidence-Based methods used in case of kyphosis, spondylolisthesis and adult scoliosis (whether painful or not), the ISICO approach will be discussed with focus on key points such as the role of a systematic and thorough evaluation, the fact of exclusively proposing outpatient rehabilitation (with obvious advantages for patients and society in terms of comfort and money), the methods developed to offer high competence at the patient’s home, the cognitive-behavioural team approach proposed and the key role of counselling, and finally the high-tech solutions employed to help clinicians and enhance research. Today ISICO offers a new type of healthcare that is centred on the patient and evidence instead of focusing on the rehabilitator. Readers will appreciate that this approach and its concepts stem from our ten principles (Table 1), which define the mission of ISICO: “to promote and develop an innovative model of approach to spinal pathologies”.
1. Efficacy: Scientifically proven validity of used techniques, excluding alternative / traditional methods without any evidence;
2. Efficiency: With the same efficacy, efficient protocols, i.e., the least demanding ones in terms of time and costs;
3. Research: Implemented on a daily basis during the clinical activity, as a guarantee of continuous improvement;
4. Innovation: New effective and efficacious techniques should as soon as possible be acquired and transferred to clinical practice;
5. Acceptability: Techniques that can be adapted to needs and preferences of the patient, who is not the object, but the subject of treatments;
6. Humanisation: The single person is at the core of treatment, thanks to dialogue and psychological attention;
7. Teamwork: All operators take part to the patient’s treatment, in a close collaboration;
8. Transparency: Complete and accurate documentation of what we do, that is made available to the patient and the family practitioner;
9. Organisation: The application of the right organisational principles allows us to favour processes of continuous improvement;
10. Services appropriateness and reliability: They are a natural consequence of the application of principles described here.
Table 1. The ISICO Principles
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