Efficacy of Postoperative Telerehabilitation in Adolescent Idiopathic Scoliosis

Scoliosis is a complex three-dimensional deformity characterized by a lateral deviation of the spine of at least 10 degrees in the coronal plane. "Idiopathic Scoliosis", which is the structural and etiological form of scoliosis that develops due to many causes, is called "Adolescent Idiopathic Scoliosis (AIS)" if it occurs in the period from the onset of puberty to the closure of the growth plates.

Current treatment options for scoliosis; It is known as observation, orthosis and surgical intervention, and the choice of the most appropriate treatment depends on the patient's age, menarche status, location and size of the curvature, and risk of progression.

Although children whose curves have reached 40-50 degrees and have not completed their skeletal maturation are generally considered to be indicated for surgical treatment, factors such as the pattern of the curve, the rate of progression, the presence of additional deformity, and failure to respond to conservative treatment also affect the surgical decision. Among the different procedures applied in the surgical treatment of scoliosis, the most frequently applied and effective results of which are shown in the literature is the "Posterior Fusion and Instrumentation" technique. In this technique, motion is eliminated in the relevant segment by fusion to the spine in order to correct the deformity, obtain a balanced spine and prevent the progression of the curvature.

Loss of flexibility and movement in the spine, balance disorder, trunk muscle endurance and a decrease in functional capacity; consequently, the quality of life may deteriorate. In the post-surgical period, it is recommended to rehabilitate the patient under the supervision of a physiotherapist, to provide pain control, to prevent and improve these problems that may occur in the spine.

In the literature, there are deficiencies and lack of evidence in rehabilitative studies after scoliosis surgery. Laurentowska et al. reported that a 4-week endurance training-based rehabilitation program applied 1 to 3 years after surgery provided a significant increase in exercise capacity and emphasized that rehabilitation of patients with scoliosis should be continued after spinal fusion. Weiss found that an in-hospital rehabilitation program based on pain management reduces chronic pain in patients with chronic pain who have had at least 10 years of surgery. In the literature, no sample randomized controlled clinical study was found in which a rehabilitation program was applied to support the adaptation and recovery of the fused spine after scoliosis surgery.

Telerehabilitation is a part of telehealth methods that refers to health care interactions that make use of telecommunications devices in the delivery of traditional face-to-face medical care and processes. It has a wide spectrum and can be defined as "providing rehabilitation services through information and communication technologies". Today, with the development of technological infrastructures, the understanding of telehealth is becoming widespread. Today, the use of telerebilitation is increasing rapidly due to the complexity and difficulty of reaching traditional rehabilitation infrastructures far from where they live, the reduction of hospitalizations and health expenditures, the need for some treatments to be continued for many years, and the ease of communication and organization.

With telerehabilitation, long-distance communication methods can be easily provided through videoconferencing, e-mail and messaging. The use and acceptance of technology by healthcare professionals can help create better quality, safe, successful telerehabilitation programs as a key factor influencing the success and sustainability of telerehabilitation programs.

In the literature, it is seen that telerehabilitation applications give successful results in different patient profiles in individuals with scoliosis who have or have not undergone surgical treatment.

The child with AIS discharged after surgery, both staying away from the medical team and not being able to reach the field-specific health professionals in the area where he lives, may cause him to be deprived of the treatment he needs after the surgery. It is known that today, especially with the effect of the COVID-19 pandemic process, even children, who may have available facilities, do not go to clinics related to contamination risk anxiety and do not receive treatment, as in other patient groups. For all these reasons, conducting treatment programs that will be supervised remotely in safe and effective ways in the post-surgical period can be an effective way to prevent and improve the occurrence of secondary problems after surgery.

In this thesis, it is planned to conduct a live video-conference program under the supervision of a physiotherapist, which is designed in accordance with the recovery processes, needs and literature of individuals with AIS after surgery. With the planned treatment program, it was aimed to investigate the effects of individuals with AIS on postoperative pain, flexibility, trunk muscle endurance, functional capacity, body appearance perception and quality of life.