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Ouchida J, Nakashima H, Ito S, Segi N, Yamauchi I, Oishi R, Miyairi Y, Morita Y, Ode Y, Nagatani Y, Okada Y, Tsushima M, Kanemura T, Machino M, Ohara T, Ota K, Tachi H, Tsuji T, Kagami Y, Shinjo R, Imagama S. Longitudinal impact of multi-segment spinal fixation surgery on mobility status and clinical outcomes in adult spinal deformity: a multicenter retrospective study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-024-08397-1. [PMID: 38976001 DOI: 10.1007/s00586-024-08397-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 06/25/2024] [Accepted: 07/02/2024] [Indexed: 07/09/2024]
Abstract
PURPOSE To investigate changes in postoperative mobility status in patients with ASD, and the determining factors that influence these changes and their impact on clinical outcomes, including the rate of home discharge and long-term mobility. METHODS A total of 299 patients with ASD who underwent multi-segment posterior spinal fusion were registered in a multi-center database were investigated. Patient mobility status was assessed using walking aids and classified into five levels (1: independent, 2: cane, 3: walker, 4: assisted, and 5: wheelchair) preoperatively, at discharge, and after 2 years. We determined improvements or declines in the patient's mobility based on changes in the classification levels. The analysis focused on the factors contributing to the deterioration of postoperative mobility. RESULTS Two years postoperatively, 87% of patients maintained or improved mobility. However, 27% showed decreased mobility status at discharge, associated with a lower rate of home discharge (49% vs. 80% in the maintained mobility group) and limited improvement in mobility status (35% vs. 5%) after 2 years. Notably, postoperative increases in thoracic kyphosis (7.0 ± 12.1 vs. 2.0 ± 12.4°, p = 0.002) and lower lumbar lordosis (4.2 ± 13.1 vs. 1.8 ± 12.6°, p = 0.050) were substantial factors in mobility decline. CONCLUSION Postoperative mobility often temporarily decreases but generally improves after 2 years. However, an overcorrection in sagittal alignment, evidenced by increased TK, could detrimentally affect patients' mobility status. Transient mobility decline associated with overcorrection may require further rehabilitation or hospitalization. Further studies are required to determine the biomechanical effects of surgical correction on mobility.
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Affiliation(s)
- Jun Ouchida
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Hiroaki Nakashima
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
| | - Sadayuki Ito
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Naoki Segi
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Ippei Yamauchi
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Ryotaro Oishi
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Yuichi Miyairi
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Yoshinori Morita
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Yukihito Ode
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Yasuhiro Nagatani
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Yuya Okada
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Mikito Tsushima
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Tokumi Kanemura
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Masaaki Machino
- Department of Orthopedics and Spine Surgery, Meijo Hospital, Nagoya, Japan
| | - Tetsuya Ohara
- Department of Orthopedics and Spine Surgery, Meijo Hospital, Nagoya, Japan
| | - Kyotaro Ota
- Department of Orthopedic Surgery, Toyota Kosei Hospital, Toyota, Japan
| | - Hiroto Tachi
- Department of Orthopedic Surgery, Toyota Kosei Hospital, Toyota, Japan
| | - Taichi Tsuji
- Department of Orthopedic Surgery, Toyota Kosei Hospital, Toyota, Japan
| | - Yujiro Kagami
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Ryuichi Shinjo
- Department of Orthopedic Surgery, Anjo Kosei Hospital, Anjo, Japan
| | - Shiro Imagama
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
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Roghani T, Allen DD, Gladin A, Rahimi A, Mehrabi M, Rezaeian ZS, Farajzadegan Z, Katzman WB. The Association Between Physical Function and Hyperkyphosis in Older Females: A Systematic Review and Meta-analysis. J Geriatr Phys Ther 2024; 47:85-96. [PMID: 36827693 DOI: 10.1519/jpt.0000000000000371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND AND PURPOSE Thoracic hyperkyphosis may adversely influence physical function in older adults, but the literature is mixed and confounded by possible sex differences. This systematic review and meta-analysis aimed to examine the association between hyperkyphosis and physical function in older females. METHODS Scopus, ISI Web of Science, Cochrane Library, PubMed, CINAHL, and PEDro databases were searched through 2021 for studies that included measures of thoracic hyperkyphosis and physical function with extractable data for women older than 60 years. Studies were excluded if they were qualitative, case reports, case series, ecological studies, reviews, or were not published in English. The study quality and risk of bias were assessed using checklists from the National Heart, Lung, and Blood Institute. Data were synthesized using Cohen's d effect size and 95% confidence interval (CI), and random-effects models were used for the meta-analyses. RESULTS AND DISCUSSION Three cohort and 22 cross-sectional studies of fair to good quality met the inclusion criteria. Eight studies reporting single-group data showed a moderate association between greater kyphosis angles and lower physical function ( d = -0.57; 95% CI -0.73, -0.40). Fourteen studies reporting 2-group data showed a large negative effect on physical function for groups with greater kyphosis angles ( d = -1.16; 95% CI -1.53, -0.78). Three studies that reported multivariate data also tended to show negative associations between physical function and hyperkyphosis. Limitations include a relative lack of causal evidence; confirming causation requires additional longitudinal studies. Studies have assessed various physical function categories, including strength, gait, and balance. Future studies could determine the categories of function most affected so that preventive interventions could target hyperkyphosis appropriately. CONCLUSIONS Hyperkyphosis was associated with lower physical function in older women. Three cohort studies suggest that greater kyphosis angles may predict greater loss of physical function over time. These results imply that therapies that help to minimize hyperkyphosis may help preserve function in older women.
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Affiliation(s)
- Tayebeh Roghani
- Musculoskeletal Research Center, Department of Physical Therapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Diane D Allen
- Graduate Program in Physical Therapy, University of California San Francisco/San Francisco State University, San Francisco, California
| | - Amy Gladin
- Pain Medicine, San Francisco Kaiser Permanente Medical Center, San Francisco, California
| | - Alireza Rahimi
- Clinical Informationist Research Group, Health Information Technology Research Center, Isfahan University Medical Sciences, Isfahan, Iran
| | - Marziyeh Mehrabi
- Musculoskeletal Research Center, Department of Physical Therapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Sadat Rezaeian
- Musculoskeletal Research Center, Department of Physical Therapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ziba Farajzadegan
- Department of Community and Family Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Wendy B Katzman
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco
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Lee JH, Jeon HS, Park JH, Kim JH, Kwon OY, Choi WJ, Kim YH, Kim JM. Effects of 4-week downhill treadmill walking on the vertebral angle and postural muscle activity in participants with thoracic kyphosis and forward head posture: A comparative longitudinal study. J Back Musculoskelet Rehabil 2024; 37:707-713. [PMID: 38160339 DOI: 10.3233/bmr-230187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Maintaining correct posture and optimal spine function has become an important issue due to the increased use of computers and smartphones. OBJECTIVE To investigate the effect of a 4-week downhill treadmill exercise (DTWE) program on participants with thoracic kyphosis and forward head posture (FHP). METHODS Twenty-eight male participants were randomly assigned to the DTWE (n= 14) or standard treadmill walking exercise (STWE) (n= 14) group. They performed 30-minute exercise three times a week for 4 weeks. The vertebral angle was measured using a three-dimensional (3D) motion analysis system. Surface electromyography (EMG) was performed to record muscle activity in the thoracic erector spinae (TES), sternocleidomastoid muscle (SCM), and cervical erector spinae (CES). RESULTS The DTWE group showed significant increases in the craniovertebral angle (CVA) and TES EMG activity and significant decreases in the thoracic kyphosis angle and SCM and CES EMG activity compared with those shown by the STWE group following the intervention (p< 0.05). However, lumbar lordosis or pelvic tilt angles did not differ significantly between the groups after the intervention (p> 0.05). CONCLUSIONS DTWE can be effective in reducing thoracic kyphosis and FHP without causing compensatory movements of the lumbar spine and pelvis.
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Affiliation(s)
- Jun-Hyeok Lee
- Department of Physical Therapy, The Graduate School, Yonsei University, Wonju, Kangwon-do, Korea
| | - Hye-Seon Jeon
- Department of Physical Therapy, College of Health Science, Yonsei University, Wonju, Kangwon-do, Korea
| | - Joo-Hee Park
- Department of Physical Therapy, The Graduate School, Yonsei University, Wonju, Kangwon-do, Korea
| | - Ji-Hyun Kim
- Department of Physical Therapy, The Graduate School, Yonsei University, Wonju, Kangwon-do, Korea
| | - Oh-Yun Kwon
- Department of Physical Therapy, College of Health Science, Yonsei University, Wonju, Kangwon-do, Korea
| | - Woochol Joseph Choi
- Department of Physical Therapy, College of Health Science, Yonsei University, Wonju, Kangwon-do, Korea
| | - Young-Ho Kim
- Department of Biomedical Engineering, Yonsei University, Wonju, Kangwon-do, Korea
| | - Jong-Man Kim
- Department of Biomedical Engineering, Yonsei University, Wonju, Kangwon-do, Korea
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Ito A, Iijima S. Changes in spinal alignment one month post abdominal surgery: A prospective cohort study. Medicine (Baltimore) 2023; 102:e33674. [PMID: 37115047 PMCID: PMC10146048 DOI: 10.1097/md.0000000000033674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
Following abdominal surgery, many patients assume a bending or stooping posture to protect the surgical wound. Such postural changes are known to induce side effects, but the improvement and persistence of these effects are unknown. Therefore, the purpose of this study was to clarify the nature of postural changes in patients undergoing abdominal surgery. In this prospective cohort study, we enrolled 25 patients who underwent abdominal surgery from February 2019 to January 2020. Measurements were obtained during the preoperative, pre-discharge, and first outpatient stages. The sacral tilt, lumbar lordotic, thoracic kyphosis, and overall tilt angles were measured in the static standing position in a private room. Wound pain was measured using a Visual Analogue Scale. Repeated measures analysis of variance was applied to compare spine measurements for each measurement period, followed by the Bonferroni method for each level. Pearson's product-moment correlation coefficient was performed to examine the relationship between wound pain and spinal column angle. The lumbar kyphosis angle was lower before discharge (-7.2 ± 7.4°) compared to preoperatively (-11.1 ± 7.5°) (95% CI 0.76, 7.08; P < .01, η2 = 0.21). Regarding the overall tilt angle, the anterior tilt angle increased before discharge (3.4 ± 3.9°) compared to preoperatively (1.1 ± 4.1°) (95% CI 0.86, 3.78; P < .01, η2 = 0.33). No statistically significant correlation with pain was observed. Compared to the preoperative period, the patients had an anterior tilt, mainly due to lumbar spine changes, prior to discharge from the hospital. Changes in spinal alignment were not associated with wound pain.
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Affiliation(s)
- Akihiro Ito
- Department of Physical Therapy, School of Health Science, International University of Health and Welfare, Otawara, Japan
- Department of Physical Therapy and Rehabilitation, International University of Health and Welfare Hospital, Nasushiobara, Japan
| | - Shinno Iijima
- Department of Physical Therapy and Rehabilitation, International University of Health and Welfare Hospital, Nasushiobara, Japan
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Chankavee N, Amatachaya S, Hunsawong T, Thaweewannakij T, Mato L. Effects of modified long stick exercise on hyperkyphosis, muscle imbalance and balance control in elderly community-dwelling women with hyperkyphosis. J Back Musculoskelet Rehabil 2023; 36:1151-1162. [PMID: 37458016 DOI: 10.3233/bmr-220350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND Hyperkyphosis is a condition often seen in older women. This condition causes muscle imbalance in the upper back of the body and impacts balance control. Long stick exercise (LSE) is an exercise programme for the elderly that improves muscle strength and balance control. OBJECTIVE This research was designed to investigate the effects of a modified LSE on hyperkyphosis, muscle imbalance and balance control in elderly community-dwelling women with hyperkyphosis. METHODS Twenty-eight elderly women with hyperkyphosis were divided into experimental and control groups. The experimental group was assigned to practice the modified LSE programme 30-40 minutes/day, 3 days/week, for 12 weeks. Hyperkyphosis, pectoralis minor length, muscle strength, functional reach test (FRT) and timed up and go test (TUG) were obtained at baseline, after 6 weeks and after 12 weeks of exercise. RESULTS The experimental group demonstrated improved hyperkyphosis, pectoralis minor length, muscle strength, FRT, and TUG after 12 weeks of training. Moreover, the experimental group exhibited significantly greater improvements in all outcomes than the control group (p< 0.05). CONCLUSION The modified LSE programme is an alternative exercise that is easy and low-impact for improving hyperkyphosis, muscle imbalance, and balance control in elderly community-dwelling women with hyperkyphosis.
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Affiliation(s)
- Nanniphada Chankavee
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
- Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Sugalya Amatachaya
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
- Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Torkamol Hunsawong
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
- Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Thiwabhorn Thaweewannakij
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
- Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Lugkana Mato
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
- Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand
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Raybin JL, Zhou W, Pan Z, Jankowski C. Quality of Life Outcomes With Creative Arts Therapy in Children With Cancer. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2022; 39:155-167. [PMID: 35467438 DOI: 10.1177/27527530211055988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Introduction: Children with cancer experience distress and decreased quality of life (QOL). Creative arts therapy (CAT) is a therapeutic modality which may improve QOL. This study examined the relationship between CAT and QOL in children and adolescents with cancer. Secondary aims explored relationships between CAT and emotional reactions, resilience, and posture (to investigate future potential as an objective biomarker of QOL). Methods: Children aged 3-18 years undergoing cancer treatments and a parent proxy completed the PedsQL3.0 Cancer Module, Faces Scale for emotional reactions, Resilience Scale in adolescents (>12 years), and an inclinometer to measure thoracic kyphosis before and after CAT. CAT exposure (number of sessions) was recorded. Results: Ninety-eight children with cancer (mean age 7.8 years, range 3-17) and parent proxy were enrolled. Of the 83 participants included in the final analysis, 18 received no CAT, 32 received low dose, and 33 received high dose CAT. A significant improvement in QOL was seen with high dose CAT in (slope change, p = .015), but the overall time by group interaction was not significant. Slope change response patterns suggested that CAT led to improved posture as compared to no CAT (time by group interaction, p = .044). Discussion: CAT may be an effective intervention to improve QOL in this population. Because initial evidence suggests that posture also improves with CAT, further investigation of posture as a potential objective biomarker of QOL is supported. Further study with a randomized controlled trial is warranted.
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Affiliation(s)
- Jennifer L Raybin
- Pediatric Palliative Care, Center for Cancer and Blood Disorders, Pediatrics, Children's Hospital Colorado, University of Colorado, Aurora, CO, USA
| | - Wenru Zhou
- Colorado School of Public Health-Biostatistics and Informatics, CO, USA
| | - Zhaoxing Pan
- Department of Pediatrics, Anschutz School of Medicine, 129263University of Colorado, CO, USA
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Iwahashi S, Hashida R, Matsuse H, Higashi E, Bekki M, Iwanaga S, Hara K, Higuchi T, Hirakawa Y, Kubota A, Imagawa H, Muta Y, Minamitani K, Yoshida T, Yokosuka K, Yamada K, Sato K, Shiba N. The impact of sarcopenia on low back pain and quality of life in patients with osteoporosis. BMC Musculoskelet Disord 2022; 23:142. [PMID: 35148724 PMCID: PMC8832799 DOI: 10.1186/s12891-022-05086-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 02/03/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Osteoporosis combined with sarcopenia contributes to a high risk of falling, fracture, and even mortality. However, sarcopenia's impact on low back pain and quality of life (QOL) in patients with osteoporosis is still unknown. The purpose of this study is to investigate low back pain and QOL in osteoporosis patients with sarcopenia. METHODS We assessed 100 ambulatory patients who came to our hospital for osteoporosis treatment. Low back pain was evaluated using the Visual Analogue Scale (VAS) with 100 being an extreme amount of pain and 0 no pain. The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) score was used to assess QOL after adjustment for age, history of vertebral fracture, and adult spinal deformity. Differences in low back pain intensity assessed by VAS between groups were evaluated by the Willcoxon rank-sum test. Covariance analysis was used to assess QOL. All data are expressed as either median, interquartile range, or average, standard error. RESULTS Patients were classified into the sarcopenia group (n = 32) and the non-sarcopenia group (n = 68). Low back pain intensity assessed by VAS was significantly higher in the sarcopenia group than in the non-sarcopenia group (33.0 [0-46.6] vs. 8.5 [0-40.0]; p < 0.05). The subscales of the JOABPEQ for low back pain were significantly lower in the sarcopenia group than in the non-sarcopenia group (65.0 ± 4.63 vs. 84.0 ± 3.1; p < 0.05). CONCLUSION In this cross-sectional study, sarcopenia affected low back pain and QOL in ambulatory patients with osteoporosis. Sarcopenia may exacerbate low back pain and QOL.
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Affiliation(s)
- Shoji Iwahashi
- Department of Orthopedics, Kurume University School of Medicine, 830-0011, Kurume, Japan
| | - Ryuki Hashida
- Department of Orthopedics, Kurume University School of Medicine, 830-0011, Kurume, Japan. .,Division of Rehabilitation, Kurume University Hospital, 67 Asahi-machi, 830-0011, Kurume, Fukuoka, Japan.
| | - Hiroo Matsuse
- Department of Orthopedics, Kurume University School of Medicine, 830-0011, Kurume, Japan.,Division of Rehabilitation, Kurume University Hospital, 67 Asahi-machi, 830-0011, Kurume, Fukuoka, Japan
| | - Eriko Higashi
- Division of Rehabilitation, Kurume University Hospital, 67 Asahi-machi, 830-0011, Kurume, Fukuoka, Japan
| | - Masafumi Bekki
- Department of Orthopedics, Kurume University School of Medicine, 830-0011, Kurume, Japan.,Division of Rehabilitation, Kurume University Hospital, 67 Asahi-machi, 830-0011, Kurume, Fukuoka, Japan
| | - Sohei Iwanaga
- Department of Orthopedics, Kurume University School of Medicine, 830-0011, Kurume, Japan.,Division of Rehabilitation, Kurume University Hospital, 67 Asahi-machi, 830-0011, Kurume, Fukuoka, Japan
| | - Koji Hara
- Department of Orthopedics, Kurume University School of Medicine, 830-0011, Kurume, Japan.,Division of Rehabilitation, Kurume University Hospital, 67 Asahi-machi, 830-0011, Kurume, Fukuoka, Japan
| | - Takahiko Higuchi
- Munakata Suikokai General Hospital, 5-7-1 Himakino, 811-3298, Fukutsu, Japan
| | - Yohei Hirakawa
- Department of Orthopaedics, Munakata Suikokai General Hospital, 5-7-1 Himakino, 811-3298, Fukutsu, Japan
| | - Asami Kubota
- Munakata Suikokai General Hospital, 5-7-1 Himakino, 811-3298, Fukutsu, Japan
| | - Hiromi Imagawa
- Munakata Suikokai General Hospital, 5-7-1 Himakino, 811-3298, Fukutsu, Japan
| | - Yoko Muta
- Munakata Suikokai General Hospital, 5-7-1 Himakino, 811-3298, Fukutsu, Japan
| | - Kazuhito Minamitani
- Department of Orthopaedics, Munakata Suikokai General Hospital, 5-7-1 Himakino, 811-3298, Fukutsu, Japan
| | - Tatsuhiro Yoshida
- Department of Orthopedics, Kurume University School of Medicine, 830-0011, Kurume, Japan
| | - Kimiaki Yokosuka
- Department of Orthopedics, Kurume University School of Medicine, 830-0011, Kurume, Japan
| | - Kei Yamada
- Department of Orthopedics, Kurume University School of Medicine, 830-0011, Kurume, Japan
| | - Kimiaki Sato
- Department of Orthopedics, Kurume University School of Medicine, 830-0011, Kurume, Japan
| | - Naoto Shiba
- Department of Orthopedics, Kurume University School of Medicine, 830-0011, Kurume, Japan.,Division of Rehabilitation, Kurume University Hospital, 67 Asahi-machi, 830-0011, Kurume, Fukuoka, Japan
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Does thoracic kyphosis severity predict response to physiotherapy rehabilitation in patients with osteoporotic vertebral fracture? A secondary analysis of the PROVE RCT. Physiotherapy 2022; 115:85-92. [DOI: 10.1016/j.physio.2022.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 01/18/2022] [Accepted: 02/13/2022] [Indexed: 01/06/2023]
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9
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Raybin JL, Hendricks-Ferguson V, Cook P, Jankowski C. Associations between demographics and quality of life in children in the first year of cancer treatment. Pediatr Blood Cancer 2021; 68:e29388. [PMID: 34626456 DOI: 10.1002/pbc.29388] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 11/05/2022]
Abstract
Symptom distress and decreased quality of life (QOL) among children with cancer are well documented. Research is emerging on the child's voice in QOL-symptom reports, but existing QOL questionnaires are burdensome and objective biologic markers are lacking. We examined children's symptoms and QOL from parent and child perspectives and compared the results to one biologic marker (body posture). A cross-sectional secondary analysis of prospective data from children receiving creative arts therapy explored potential associations among demographics with and between QOL measures (PedsQL, Faces Scale, posture). Children (n = 98) ranged in age from 3 to 17 years (M = 7.8) and were in the first year of cancer treatment. No significant associations were found among the child's sex, race/ethnicity, socioeconomic status (SES), or distance from hospital, and total PedsQL. Older age was associated with worse total PedsQL, pain, nausea, worry, and posture (all P < 0.05). Greater worry (β = 0.51) and worse posture (β = 0.41) were the QOL variables most strongly correlated with older age. Poorer posture was associated with worse child PedsQL (total score, nausea, treatment anxiety, cognitive) and parent PedsQL (pain, nausea). Worse scores on the Faces Scale, PedsQL, and posture were all correlated (r = 0.21-0.39, all P < 0.05). Interventions to improve QOL could target nausea, worry, and older patients. Accuracy and interpretation of symptom distress in children are problematic. The Faces Scale and posture may be suitable, readily obtained measures of QOL in pediatric oncology that hold promise.
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Affiliation(s)
- Jennifer L Raybin
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, Colorado.,University of Colorado Anschutz Medical Campus, College of Nursing and School of Medicine, Aurora, Colorado
| | | | - Paul Cook
- University of Colorado Anschutz Medical Campus, College of Nursing and School of Medicine, Aurora, Colorado
| | - Catherine Jankowski
- University of Colorado Anschutz Medical Campus, College of Nursing and School of Medicine, Aurora, Colorado
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Ponzano M, Tibert N, Bansal S, Katzman W, Giangregorio L. Exercise for improving age-related hyperkyphosis: a systematic review and meta-analysis with GRADE assessment. Arch Osteoporos 2021; 16:140. [PMID: 34546447 DOI: 10.1007/s11657-021-00998-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/22/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED We reviewed exercise trials in men and women ≥ 45 years with hyperkyphosis at the baseline and performed meta-analyses for kyphosis and health-related outcomes. PURPOSE To determine the effects of exercise interventions on kyphosis angle, back extensor muscle strength or endurance, physical functioning, quality of life, pain, falls, and adverse events in adults 45 years or older with hyperkyphosis. METHODS Multiple databases were searched to May 2020. Randomized controlled trials (RCTs), non-RCT, and pre-post intervention studies that had at least one group with a mean kyphosis angle of at least 40° at the baseline were included. RESULTS Twenty-four studies were included. Exercise or physical therapy improved kyphosis outcomes (SMD - 0.31; 95% confidence intervals [CI] - 0.46, - 0.16; moderate certainty evidence), back extensor muscle strength (MD 10.51 N; 95% CI 6.65, 14.38; very low certainty evidence), and endurance (MD 9.76 s; 95% CI 6.40, 13.13; low certainty evidence). Meta-analyses showed improvements in health-related quality of life (HRQoL) (SMD 0.21; 95% CI 0.06, 0.37; moderate certainty of evidence), general pain (MD - 0.26; 95% CI - 0.39, - 0.13; low certainty of evidence), and performance on the timed up and go (TUG) test (MD - 0.28 s; 95% CI - 0.48, - 0.08; very low certainty of evidence). The effects on the rate of falls (incidence rate ratio [IRR] 1.15; 95% CI 0.64, 2.05; low certainty evidence) or minor adverse events (IRR 1.29; 95% CI 0.95, 1.74; low certainty evidence) are uncertain. No serious adverse events were reported in the included studies. CONCLUSIONS Interventions targeting hyperkyphosis may improve kyphosis outcomes in adults with hyperkyphosis.
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Affiliation(s)
- Matteo Ponzano
- Department of Kinesiology, University of Waterloo, Waterloo, Canada
| | - Nicholas Tibert
- Department of Kinesiology, University of Waterloo, Waterloo, Canada
| | - Symron Bansal
- Department of Kinesiology, University of Waterloo, Waterloo, Canada
| | - Wendy Katzman
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, USA
| | - Lora Giangregorio
- Department of Kinesiology, University of Waterloo, Waterloo, Canada. .,Schlegel-UW Research Institute for Aging, Waterloo, Canada.
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11
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Sabzwari S, Fatmi Z, Khan AA. Elderly musculoskeletal disease burden in Karachi, Pakistan: Associations and implications for developing countries. Aging Med (Milton) 2021; 4:19-25. [PMID: 33738376 PMCID: PMC7954836 DOI: 10.1002/agm2.12141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/02/2020] [Accepted: 12/02/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The global rise in the older population has increased the rates of osteoporosis and osteoarthritis, conditions that impact mobility and functionality. There is limited data on musculoskeletal disease in older populations residing in developing countries. METHODS A community-based study using multistage cluster random sampling of older individuals was conducted in Karachi. Predefined criteria were used for osteoporosis and osteoarthritis. Gait assessment was performed. RESULTS More than half of the participants were females and 53% reported illiteracy. Around 30% had osteoporosis and two-thirds had osteoarthritis. Multivariate analysis showed associations of female sex, Pashtun ethnicity, illiteracy, and hypertension with the combined variable of osteoporosis and osteoarthritis. CONCLUSIONS The prevalence of osteoarthritis was higher than in other regional studies. Presence of both osteoporosis and osteoarthritis increased the risk of certain geriatric syndromes. High rates of musculoskeletal morbidity are seen in the elderly in Pakistan. Measures at a health-system level are required for better outcomes in older adults.
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12
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Li WY, Chau PH, Dai Y, Tiwari AF. The Prevalence and Negative Effects of Thoracic Hyperkyphosis on Chinese Community-Dwelling Older Adults in Wuhan, Hubei Province, China. J Nutr Health Aging 2021; 25:57-63. [PMID: 33367463 DOI: 10.1007/s12603-020-1441-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Globally, 20% to 50% older adults have been found to have thoracic hyperkyphosis. Negative effects on physical performance have been reported. However, there has been a lack of research on the prevalence and negative effects of thoracic hyperkyphosis among Chinese community-dwelling elderly. DESIGN A cross-sectional study. SETTING The communities in Wuhan, China. PARTICIPANTS Three hundred and ninety-five Chinese community-dwelling older adults with thoracic hyperkyphosis. MEASURES Chinese community-dwelling older adults aged 60 or above lived in Wuhan, China from August to December 2018 were recruited for spine and physical performance assessments. The primary outcome was the prevalence of thoracic hyperkyphosis estimated according to the angle of kyphosis which was measured by manual inclinometers. The secondary outcomes were the effects of thoracic hyperkyphosis on physical performance measured by One-leg Standing Test (OLS), Timed Up AND Go Test (TUG), Chest Expansion Test (CE), Six Minutes Walking Test (6MWT), and Farsi Version of Functional Gait Assessment (FGA). The socio-demographic and health-related information were collected by a questionnaire. RESULTS Among 395 participants, the mean angle of kyphosis was 49.0° ± 10.5°, 75.2% of participants had the angle of kyphosis >40° (i.e., having thoracic kyperkyphosis). Compared with older adults having no thoracic hyperkyphosis, older adults with thoracic hyperkyphosis had increased risks performing impaired in OLS (OR=4.55, 95% CI 2.18-9.53, p<0.001), TUG (OR=6.08, 95% CI 2.57-14.40, p<0.001), CE (OR=3.23, 95% CI 1.63-6.38, p=0.001), 6MWT (OR=4.64, 95% CI 1.98-10.86, p<0.001), and FGA (OR=5.18, 95% CI 2.25-11.89, p<0.001) after controlling socio-demographic and health-related factors. CONCLUSION The thoracic hyperkyphosis had high prevalence and associated with impaired performance in balance, gait, and cardiopulmonary function tests among Chinese community-dwelling older adults, which calls for the future intervention.
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Affiliation(s)
- W-Y Li
- Pui Hing Chau, School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Hong Kong,
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13
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Tudini FT, Myers BJ, Bohannon RW. Forward flexed posture: reliability and determinants of tragus-to-wall measurement. Physiother Theory Pract 2020; 38:579-586. [PMID: 32466740 DOI: 10.1080/09593985.2020.1771801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Forward flexed posture is an impairment in body structure commonly seen among older adults and those with pathologies such as ankylosing spondylitis and osteoporosis. Accurate measurement of forward flexed posture is important as it is related to pain, mobility limitations, and falls. Our purpose was to examine the reliability and determinants of forward flexed posture as indicated by tragus-to-wall (TTW) distance. METHODS Twenty healthy younger and 20 healthy older adults were included in this secondary analysis of data from a neck strength study. Measurements included the linear distance of TTW standing naturally and with neck retraction, age, gender, body mass index (BMI), and neck retraction strength. Measurements were performed initially by 2 investigators and by the primary investigator 1 week later. Intraclass correlation coefficients (ICCs) (model 3,1) described relative reliability and Bland-Altman plots characterized absolute reliability. A mixed general linear model examined the determinants for TTW distance. RESULTS Good inter-rater (ICC = 0.811-0.878) and test-retest reliability (ICC = 0.853-0.862) were found in both positions. Bland-Altman plots showed that absolute limits of agreement ranged from - 1.9 to +3.8 cm for inter-rater reliability and -2.4 to +2.6 cm for test-retest reliability. Analysis of TTW determinants demonstrated significant differences between neck positions, dichotomous age groups, and BMI groups (p ≤ 0.001). There was no significant difference based on neck strength. CONCLUSIONS Our results indicate that TTW distance, measured using a standardized procedure, is a reliable method of quantifying forward flexed posture. TTW distance is greater in relaxed standing, older individuals, and those with greater BMI.
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Affiliation(s)
- Frank T Tudini
- Physical Therapy, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC, USA
| | - Bradley J Myers
- Physical Therapy, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC, USA
| | - Richard W Bohannon
- Physical Therapy, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC, USA
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14
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Koelé MC, Lems WF, Willems HC. The Clinical Relevance of Hyperkyphosis: A Narrative Review. Front Endocrinol (Lausanne) 2020; 11:5. [PMID: 32038498 PMCID: PMC6993454 DOI: 10.3389/fendo.2020.00005] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 01/07/2020] [Indexed: 12/12/2022] Open
Abstract
The kyphosis angle of the thoracic spine tends to increase with aging. Hyperkyphosis is a kyphosis angle, exceeding the normal range. This narrative literature review aims to provide an overview of the current literature concerning kyphosis measurement methods, the etiology and adverse health effects of hyperkyphosis. As of yet, a well-defined threshold for hyperkyphosis is lacking. To attain more generalizability and to be able to compare study results in older adults, we propose to define age-related hyperkyphosis as a Cobb angle of 50° or more in standing position. Hyperkyphosis may be a potentially modifiable risk factor for adverse health outcomes, like fall risk and fractures. Additionally, hyperkyphosis may indicate the presence of osteoporosis, which is treatable. Prospective and intervention studies, using a Cobb angle of 50° as a clear and uniform definition of hyperkyphosis, are warranted to investigate the clinical relevance of hyperkyphosis.
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Affiliation(s)
- M C Koelé
- Division of Geriatrics, Department of Internal Medicine, Academic Medical Centre Amsterdam, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, Netherlands
| | - W F Lems
- Department of Rheumatology, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - H C Willems
- Division of Geriatrics, Department of Internal Medicine, Academic Medical Centre Amsterdam, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, Netherlands
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15
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PAIVA VAGNERCLAYTONDE, RISSO NETO MARCELOITALO, ZUIANI GUILHERMEREBECHI, VEIGA IVANGUIDOLIN, PASQUALINI WAGNER, TEBET MARCOSANTONIO, AMARAL RODRIGO, JENSEN RUBENSGIRALD, MARCHI LUIS, PIMENTA LUIZHENRIQUEDEMATTOS, CAVALI PAULOTADEUMAIA, CLIQUET JÚNIOR ALBERTO. NATURAL HISTORY OF LUMBAR CANAL STENOSIS: CLINICAL ASPECTS AND SAGITTAL BALANCE. COLUNA/COLUMNA 2019. [DOI: 10.1590/s1808-185120191803179255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective To compare the sagittal alignment (SA) parameters in individuals with LCS and surgical indication with a control group and to study the correlations between SA parameters and ODI, VAS and EQ-5D in individuals with LCS and surgical indication. Methods In this multicenter cross-sectional case-control study, the individuals were allocated as follows. A stenosis group (SG) composed by patients with LCS confirmed by magnetic resonance imaging with surgical indication, treated between July 2010 and August 2016 and a control group (CG), without LCS. All subjects underwent anamnesis, completed the Health-related Quality of Life (HRQoL) and total spine radiographs were taken. Clinical data, HRQoL and radiographic parameters were correlated. Results Sixty-four individuals formed the SG and 14 the CG. The SG had higher values of mean age, coronal imbalance, sagittal vertical axis (SVA), pelvic tilt (PT), sacrofemoral distance (SFD), overhang (OH), PI-LL mismatch, Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for pain and smaller thoracic kyphosis (TK), total (TLPL) and regional lumbopelvic lordosis (RLPL) in all vertebrae, sagittal offset (SO) in all evaluated vertebrae and EuroQol-5D (EQ-5D) with p <0.05. In the SG, the only significant correlations (p <0.05) were between TK and ODI and EQ-5D; all the other sagittal parameters did not correlated with VAS, ODI or EQ-5D. Conclusion SG had SA parameters altered in relation to CG. There was a direct correlation between decrease in TK and worsening of ODI and EQ-5D in SG. Level of evidence: III; Case Control Study.
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16
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Zvekic-Svorcan J, Aleksic J, Jankovic T, Filipovic K, Cvetkovic M, Vuksanovic M, Filipov P. Capture the vertebral fracture: Risk factors as a prediction. J Back Musculoskelet Rehabil 2019; 32:269-276. [PMID: 30347589 DOI: 10.3233/bmr-170898] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Vertebral fractures are the most common osteoporotic fractures occurring due to low bone mineral density, as well as other risk factors. The aim of the paper is to investigate risk factors for vertebral osteoporotic fracture occurrence in postmenopausal women. METHODS Retrospective analysis of data pertaining to 651 postmenopausal women obtained from the National Osteoporosis Registry of Serbia was conducted. Further analyses were performed on 217 osteoporotic women identified from those records, whereby those in the experimental group (n= 110) had a vertebral fracture, while those assigned to the control group (n= 107) did not. The two groups were comparable in terms of age (t= 0.450; p> 0.01). Risk factors that could serve as the best predictors of vertebral fracture occurrence were investigated. Multivariate logistic regression analysis was used for testing effect of several factors on vertebral fracture occurrence as the dependent variable. RESULTS Patients that have never suffered a vertebral fracture had a significantly higher bone mineral density (t= 8.161; p< 0.01) in comparison to those with a verified vertebral fracture. Factors that significantly contributed to the risk of vertebral fracture were presence of kyphosis (OR 708.338; 95% CI 19.238-26.081.950), use of glucocorticoids (OR 87.618; 95% CI 9.175-836.707), and presence of comorbidities (OR 7.327; 95% CI 1.500-35.793). Moreover, a unit increase in body mass index (BMI) was found to lower the probability of vertebral fracture by a factor of 0.846. Women that entered menopause later have lower chance of suffering a vertebral fracture (OR = 0.539; 95% CI 0.400-0.726). CONCLUSION Lower body mass index, presence of kyphosis, use of glucocorticoids, early menopause onset, and presence of comorbidities are the factors that contribute the most to vertebral osteoporotic fracture occurrence.
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Affiliation(s)
- Jelena Zvekic-Svorcan
- University of Novi Sad, Faculty of Medicine Novi Sad, Serbia.,Special Hospital for Rheumatic Diseases Novi Sad, Serbia
| | | | - Tanja Jankovic
- University of Novi Sad, Faculty of Medicine Novi Sad, Serbia.,Special Hospital for Rheumatic Diseases Novi Sad, Serbia
| | - Karmela Filipovic
- University of Novi Sad, Faculty of Medicine Novi Sad, Serbia.,Special Hospital for Rheumatic Diseases Novi Sad, Serbia
| | - Milan Cvetkovic
- University of Novi Sad, Faculty of Sport and Physical Education Novi Sad, Serbia
| | - Miljanka Vuksanovic
- University of Belgrade, Medical Faculty, University Clinical Center Zvezdara, Belgrade, Serbia
| | - Predrag Filipov
- University of Novi Sad, Faculty of Medicine Novi Sad, Serbia.,Health Center "Novi Sad", Novi Sad, Serbia
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17
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van Dort MJ, Driessen JH, Romme EA, Geusens P, Willems PC, Smeenk FW, Wouters EF, van den Bergh JP. Thoracic Kyphosis on Chest CT Scans Is Associated With Incident Vertebral Fractures in Smokers. J Bone Miner Res 2019; 34:859-866. [PMID: 30690782 PMCID: PMC6946934 DOI: 10.1002/jbmr.3672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/20/2018] [Accepted: 01/11/2019] [Indexed: 12/13/2022]
Abstract
Greater kyphosis angles lead to increased loading on vertebral bodies in computational models. However, results about the relationship between severity of kyphosis and incident vertebral fracture (VF) risk have been conflicting. Therefore, the aim of this study was to evaluate associations between 1) prevalent VFs and severity of kyphosis, and 2) severity of kyphosis and incident VF risk in smokers with or without chronic obstructive pulmonary disease (COPD). Former and current smokers with or without COPD were included. CT scans were made at baseline, 1-year, and 3-year follow-up. VFs were evaluated on superposed sagittal CT reconstructions. Kyphosis was measured as the angle between the lines above T4 and below T9 or T12 . We included 1239 subjects (mean age 61.3 ± 8.0 years, 61.1% male, 80.6% with COPD), of whom 253 (20.4%) had a prevalent VF and 294 (23.7%) an incident VF within 3 years. Presence, number, and severity of prevalent VFs were associated with a greater kyphosis angle. The mean increase in kyphosis angle within 3 years was small but significantly greater in subjects with incident VFs compared with those without (2.2 ± 4.1 versus 1.2 ± 3.9 degrees, respectively, for T4 to T12 angle, p < 0.001). After adjustment for bone attenuation (BA) and prevalent VFs, baseline kyphosis angle was associated with incident VFs within 1 and 3 years (angle T4 to T12 per +1 SD, hazard ratio [HR] = 1.34 [1.12-1.61] and HR 1.29 [1.15-1.45], respectively). Our data showed that a greater kyphosis angle at baseline was independently associated with increased risk of incident VFs within 1 and 3 years, supporting the theory that greater kyphosis angle contributes to higher biomechanical loads in the spine. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Mayke J van Dort
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands
| | - Johanna Hm Driessen
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands.,CAPHRI Care and Public Health Research Institute, Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands.,Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands
| | - Elisabeth Apm Romme
- Department of Respiratory Medicine, Catharina Hospital, Eindhoven, the Netherlands
| | - Piet Geusens
- Department of Internal Medicine, Rheumatology, Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands
| | - Paul C Willems
- CAPHRI Care and Public Health Research Institute, Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands.,Department of Orthopedic Surgery, Maastricht University Medical Center + (MUMC+), Maastricht, the Netherlands
| | - Frank Wjm Smeenk
- Department of Respiratory Medicine, Catharina Hospital, Eindhoven, the Netherlands.,School of Health Professions Education, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands
| | - Emiel Fm Wouters
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands.,Department of Respiratory Diseases, Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands
| | - Joop Pw van den Bergh
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands.,Department of Internal Medicine, VieCuri Medical Centre, Venlo, the Netherlands
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18
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Bohannon RW, Tudini F, Constantine D. Tragus-to-wall: A systematic review of procedures, measurements obtained, and clinimetric properties. J Back Musculoskelet Rehabil 2019; 32:179-189. [PMID: 30248033 DOI: 10.3233/bmr-171090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Our purpose was to summarize the literature on the applicability, procedures for performing, and clinimetric findings related to the measurement of tragus-to-wall (TTW) distance. METHOD Pubmed, Scopus, and CINAHL databases were systematically searched using the key words "tragus" AND "wall". Articles were examined for information on the participants whose TTW distance was measured, the procedures used for measuring TTW, and findings regarding TTW distances measured and the clinimetric properties of the measurements. RESULTS Thirty-nine articles were identified that described use of the TTW test. Most used the test with patients with ankylosing spondylitis. We found evidence for the convergent and known groups validity and reliability of the TTW measurements. Limited support for the responsiveness of TTW measurements was found. Two studies provided normative reference values. CONCLUSIONS The TTW test is a simple objective indicator of forward flexed posture supported by research on its validity and reliability. More specific information on responsiveness and age-specific norms would increase the value of this nonspecific postural indicator.
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Jo G, Park J, Yoon JY, Kim H, Kim SC, Park SH. Effect of spinal kypho-orthosis to gait and forward flexion in Parkinson disease. J Phys Ther Sci 2018; 30:988-992. [PMID: 30154587 PMCID: PMC6110201 DOI: 10.1589/jpts.30.988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 05/07/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The gait characteristics, such as short step, decreased arm swing and stooped
posture, in Parkinson disease (PD) are well established. Pharmacological and
non-pharmacological treatments have been attempted to improve the gait in patients with
PD. Among the non-pharmacological approaches to improve gait, spinal orthosis can be
applied for patients with spinal deformity. The purpose of our study was to investigate
the effect of spinal kypho-orthosis to gait in PD by using a three-dimensional analysis.
[Participants and Methods] Twenty-six patients with PD with gait disturbance with forward
bend posture >15°. All participants were instructed to walk along a 6-m track and turn
180° and come back to the starting point under three-dimensional motion capture. The
participants performed the test again with spinal kypho-orthosis. Gait parameters during
examination is compared with and without spinal kypho-orthosis. The degree of forward
flexion after kypho-orthosis in patients with PD was compared. [Results] Wearing the
spinal kypho-orthosis significantly improved turning performance but did not affect
locomotion. The severity of forward bend posture is mildly improved after the application
of spinal kypho-orthosis. [Conclusion] Spinal kypho-orthosis has a short-term effect for
gait performance, particularly during turning and erect posture. Spinal kypho-orthosis can
be potentially used for management of turning deficits in PD.
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Affiliation(s)
- Geunyeol Jo
- Department of Physical Medicine and Rehabilitation, Haeundae Paik Hospital, Inje University, Republic of Korea
| | - Jinse Park
- Department of Neurology, Haeundae Paik Hospital, Inje University: 875 Haeundaero, Haeundaegu, Busan 612-030, Republic of Korea
| | - Ji-Yeon Yoon
- Department of Physical Therapy, Haeundae Paik Hospital, Inje University, Republic of Korea
| | - Haeyu Kim
- Department of Neurological Surgery, Haeundae Paik Hospital, Inje University, Republic of Korea
| | - Seong Cheol Kim
- Department of Urology, Haeundae Paik Hospital, Inje University, Republic of Korea
| | - Sang-Hyun Park
- Department of Urology, Haeundae Paik Hospital, Inje University, Republic of Korea
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20
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Turk AC, Sahın F, Kucukler FK, Devecı H. Analysis of kyphosis, vertebral fracture and bone mineral density measurement in women living in nursing homes. Saudi Med J 2018; 39:711-718. [PMID: 29968895 PMCID: PMC6146251 DOI: 10.15537/smj.2018.7.22580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To analyze the relationship between vertebral fracture, degree of kyphosis, and BMD in women living in nursing homes. METHODS This cross-sectional study was carried out in the Department of Physical Medicine and Rehabilitation, Hitit University Hospital, Corum, Turkey, betweenJanuary 2014 and January 2015. Of the 126 female patients who participated in the study, 48 lived in nursing homes (nursing-home-group [NHG]), 78 lived in non-nursing home settings (control-group [CG]). Vertebral fractures were evaluated via the semi-quantitative Genant method. Cases in which a Cobb angle measured 40 degrees or more resulted in a diagnosis of kyphosis. RESULTS The mean age of participants in the NHG was 77.2±7.6 years and 76.8±6.2 years in the CG (p greater than 0.05). The kyphosis rate in the NHG was found to be higher at 52.1% compared to 27.7% for the CG (p less than 0.001). In the NHG, 68.7% had osteoporosis, 31.3% had osteopenia; in the CG, 55.2% had osteoporosis, 32% had osteopenia, 12.8% had normal values (p less than 0.05).The vertebral fracture rate was 37.5% in the NHG and 24.3% in the CG (p greater than 0.05). The Cobb angle had correlation with the number of fractures in both groups (p less than 0.05). CONCLUSIONS The osteoporosis and kyphosis rates of women living in NHG were higher than those of women living in CG. As kyphosis and the number of fractures are correlated, it is important to analyze kyphosis in women residing in NHG.
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Affiliation(s)
- Ayla C Turk
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Hitit University, Corum, Turkey. E-mail.
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Scheidt S, Endreß S, Gesicki M, Hofmann UK. Using video rasterstereography and treadmill gait analysis as a tool for evaluating postoperative outcome after lumbar spinal fusion. Gait Posture 2018; 64:18-24. [PMID: 29803082 DOI: 10.1016/j.gaitpost.2018.05.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 05/14/2018] [Accepted: 05/16/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The rise in the number of patients with lumbar back pain has led to an increase in the number of spinal surgeries. To avoid unfavorable outcomes, high accuracy and reliability of indication for surgery are essential. This requires critical evaluation of postoperative outcomes with its two key dimensions pain and function. While imaging findings give details about the technical dimension of the intervention, they are prone to high inter-/intra-observer variability, with limited relation to functional outcomes. Pain improvement can be directly asked from patients or documented by questionnaires. There is abundant literature on postoperative function based on questionnaires, but quantifiable data such as gait or posture analysis are scarce. Highprecision measurement tools are available and easy to implement in a clinician's work routine. OBJECTIVE This study evaluates whether lumbar fusion surgery changes gait and postural variables and how these changes are related to patients' descriptions of alterations in their levels of pain. METHODS Back profiles and gait analyses were measured by video rasterstereography and treadmill gait analysis. Measurements were recorded before surgery, at discharge, after 3 months in a longitudinal (n = 30), and after 12 months in a cross-sectional group (n = 29). A reference group was formed (n = 28). The improvement on the Numeric Pain Rating Scale was documented and compared with changes in gait and posture. RESULTS A significant reduction in kyphotic (52-43°, p = 0.014) and lordotic (28-11°, p < 0.001) angles was observed. The values again increased after 3 months, with a significant reduction in cadence (98-91 steps/min, p = 0.006). While improvements in pain were also obtained by surgery (p < 0.001), no clear correlation could be detected between 3-month alleviation in pain and changes in kyphotic/lordotic angle or cadence. CONCLUSIONS Although both methods offer high-precision measurement, changes in gait and posture were not related with the patients' reported pain relief after lumbar fusion surgery.
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Affiliation(s)
- Sebastian Scheidt
- Department of Orthopaedic Surgery, University Hospital of Tuebingen, Hoppe-Seyler-Strasse 3, D-72076, Tuebingen, Germany; Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany.
| | - Sandra Endreß
- Medical Faculty of the University of Tuebingen, D-72076, Tuebingen, Germany.
| | - Marco Gesicki
- Department of Orthopaedic Surgery, University Hospital of Tuebingen, Hoppe-Seyler-Strasse 3, D-72076, Tuebingen, Germany; Praxis Dres. Falck and Gesicki, Horemer 4, D-72076, Tübingen, Germany.
| | - Ulf Krister Hofmann
- Department of Orthopaedic Surgery, University Hospital of Tuebingen, Hoppe-Seyler-Strasse 3, D-72076, Tuebingen, Germany.
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22
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Walicka-Cupryś K, Wyszyńska J, Podgórska-Bednarz J, Drzał-Grabiec J. Concurrent validity of photogrammetric and inclinometric techniques based on assessment of anteroposterior spinal curvatures. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:497-507. [PMID: 29185110 DOI: 10.1007/s00586-017-5409-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 11/22/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of the study was to investigate correlations between parameters of anteroposterior spinal curvatures in the sagittal plane, measured with the use of photogrammetric technique and inclinometer in healthy elderly women. METHODS Randomized study involved 50 females, ranging from 50 to 70 years of age (mean 62.26 ± 6.94); mean body mass index (BMI) 27.69 ± 4.79. The examined parameters included angle of inclination in lumbosacral spine (ALFA), thoracolumbar transition (BETA), upper thoracic segment (GAMMA), angle of lumbar lordosis (LLA) and thoracic kyphosis (TKA). Results obtained with gravitational inclinometer were compared with those identified with photogrammetry method. Statistical analyses were performed with Mann-Whitney U test, regression analysis and Bland-Altman analysis. RESULTS In Mann-Whitney U test, with correction due to continuity, no statistically significant differences for any variable were found. Regression analysis was significant only for the variable of BETA angle. Bland-Altman coefficient for the respective angles was: ALFA 2.0%, BETA 4%, GAMMA 0%, LLA 2% and TKA 0%. CONCLUSIONS The results acquired with gravitational inclinometer and with photogrammetric technique are comparable, as the parameters of anteroposterior spinal curvatures acquired with these two methods are found to be compatible in the case of measurements of lumbar lordosis and thoracic kyphosis.
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Affiliation(s)
- Katarzyna Walicka-Cupryś
- Medical Faculty, Institute of Physiotherapy, University of Rzeszow, Aleja Rejtana 16c, 35-959, Rzeszow, Poland. .,Medical Faculty, Centre for Innovative Research in Medical and Natural Sciences, University of Rzeszow, Warzywna 1a, 35-310, Rzeszow, Poland. .,Medical Faculty, Institute of Physiotherapy, University of Rzeszów, Warszawska 26a, Rzeszow, Poland.
| | - Justyna Wyszyńska
- Medical Faculty, Institute of Physiotherapy, University of Rzeszow, Aleja Rejtana 16c, 35-959, Rzeszow, Poland.,Medical Faculty, Centre for Innovative Research in Medical and Natural Sciences, University of Rzeszow, Warzywna 1a, 35-310, Rzeszow, Poland
| | - Justyna Podgórska-Bednarz
- Medical Faculty, Institute of Physiotherapy, University of Rzeszow, Aleja Rejtana 16c, 35-959, Rzeszow, Poland.,Medical Faculty, Centre for Innovative Research in Medical and Natural Sciences, University of Rzeszow, Warzywna 1a, 35-310, Rzeszow, Poland
| | - Justyna Drzał-Grabiec
- Medical Faculty, Institute of Physiotherapy, University of Rzeszow, Aleja Rejtana 16c, 35-959, Rzeszow, Poland.,Medical Faculty, Centre for Innovative Research in Medical and Natural Sciences, University of Rzeszow, Warzywna 1a, 35-310, Rzeszow, Poland
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23
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Miyakoshi N, Kudo D, Hongo M, Kasukawa Y, Ishikawa Y, Shimada Y. Comparison of spinal alignment, muscular strength, and quality of life between women with postmenopausal osteoporosis and healthy volunteers. Osteoporos Int 2017; 28:3153-3160. [PMID: 28785980 DOI: 10.1007/s00198-017-4184-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 07/30/2017] [Indexed: 01/14/2023]
Abstract
UNLABELLED This study compared spinal alignment, muscular strength, and quality of life (QOL) between women with postmenopausal osteoporosis and healthy volunteers. The results indicated that lower QOL in osteoporosis patients may be associated with increased thoracic kyphosis, reduced lean muscle mass, and generalized muscle weakness. INTRODUCTION Increased spinal kyphosis is common in patients with osteoporosis and negatively impacts quality of life (QOL). Muscular strength is also important for QOL in patients with osteoporosis. However, spinal kyphosis and muscle weakness also occur in healthy individuals with advancing age. The purposes of this study were thus to compare spinal alignment, muscular strength, and QOL between women with postmenopausal osteoporosis and healthy volunteers. METHODS Participants comprised 236 female patients with postmenopausal osteoporosis (mean age, 68.7 years) and 93 healthy volunteer women (mean age, 71.0 years). Body mass index (BMI), angles of spinal kyphosis, back extensor strength, grip strength, and QOL were compared between groups. RESULTS BMI, back extensor strength, and grip strength were significantly higher in the volunteer group than in the osteoporosis group (p < 0.01). Both thoracic kyphosis and lumbar lordosis were significantly greater in the osteoporosis group than in the volunteer group (p < 0.01). With regard to QOL, the 36-Item Short-Form Health Survey (SF-36) subscale scores of role physical, bodily pain, general health, and role emotional were all significantly lower in the osteoporosis group than in the volunteer group (p < 0.05 each). SF-36 physical component summary (PCS) score was significantly lower in the osteoporosis group than in the volunteer group (p < 0.001). SF-36 PCS score correlated positively with thoracic kyphosis and negatively with BMI only in the osteoporosis group (p < 0.05 each). CONCLUSIONS These results indicated that lower QOL in osteoporosis patients may be associated with increased thoracic kyphosis, reduced lean muscle mass, and generalized muscle weakness.
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Affiliation(s)
- N Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
| | - D Kudo
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - M Hongo
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Y Kasukawa
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Y Ishikawa
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Y Shimada
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
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24
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Ristolainen L, Kettunen JA, Kujala UM, Heinonen A, Schlenzka D. Progression of untreated mild thoracic Scheuermann's kyphosis - Radiographic and functional assessment after mean follow-up of 46 years. J Orthop Sci 2017; 22:652-657. [PMID: 28420562 DOI: 10.1016/j.jos.2017.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/06/2017] [Accepted: 03/15/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND There is no data available on the radiographic development of the Scheuermann's deformity. Our purpose was to investigate radiographic deformity progression and the relation between kyphosis progression and clinical outcome in patients with untreated Scheuermann's kyphosis. METHODS Thoracic kyphosis (Th4-Th12) was measured from standing lateral radiographs in 19 patients at baseline and after mean 46-year follow-up. Mean age at baseline was 19.2 and at follow-up 64.7 years. At follow-up, height, weight, hand grip strength, and hamstring tightness were measured, and sit-to-stand and walking tests were performed. Additionally general health and quality of life questionnaires were administered. RESULTS The mean thoracic kyphosis increased from 46° (range 25°-78°) at baseline to 60° (34°-82°) (p < 0.001) at follow-up. Mean of the vertebrae wedge increased from 8.8° to 9.9° (p = 0.046). There was no correlation between extent of kyphosis progression and function at follow-up. CONCLUSIONS Among patients with Scheuermann's disease the degree of radiographic deformity progressed slightly during long-term follow-up. Progression did not predict symptoms.
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Affiliation(s)
- Leena Ristolainen
- Orton Orthopaedic Hospital and Orton Research Institute, Orton Foundation, Tenholantie 10, PL 29, 00281, Helsinki, Finland.
| | - Jyrki A Kettunen
- Arcada, University of Applied Sciences, Jan-Magnus Janssonin aukio 1, 00560, Helsinki, Finland.
| | - Urho M Kujala
- Unit of Health Sciences, Faculty of Sport and Health Sciences, University of Jyväskylä, PL 35, 40014, Jyväskylä, Finland.
| | - Ari Heinonen
- Unit of Health Sciences, Faculty of Sport and Health Sciences, University of Jyväskylä, PL 35, 40014, Jyväskylä, Finland.
| | - Dietrich Schlenzka
- Orton Orthopaedic Hospital and Orton Research Institute, Orton Foundation, Tenholantie 10, PL 29, 00281, Helsinki, Finland.
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25
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Lorbergs AL, O'Connor GT, Zhou Y, Travison TG, Kiel DP, Cupples LA, Rosen H, Samelson EJ. Severity of Kyphosis and Decline in Lung Function: The Framingham Study. J Gerontol A Biol Sci Med Sci 2017; 72:689-694. [PMID: 27341855 DOI: 10.1093/gerona/glw124] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 06/10/2016] [Indexed: 11/13/2022] Open
Abstract
Background Hyperkyphosis reduces the amount of space in the chest, mobility of the rib cage, and expansion of the lungs. Decline in pulmonary function may be greater in persons with more severe kyphosis; however, no prospective studies have assessed this association. We conducted a longitudinal study to quantify the impact of kyphosis severity on decline in pulmonary function over 16 years in women and men. Methods Participants included a convenience sample of 193 women and 82 men in the Framingham Study original cohort (mean age: 63 years; range: 50-79 years), who had measurements of kyphosis angle from lateral spine radiographs obtained in 1972-1976 and forced expiratory volume in 1 second (FEV1) from spirometry taken four times over 16 (±1.87) years from 1972 through 1988. Results Kyphosis severity was associated with greater decline in FEV1 in women but not in men. Adjusted mean change in FEV1 over 16 years was -162, -245, and -261mL (trend, p = .02) with increasing tertile of kyphosis angle in women and -372, -297, and -257mL (trend, p = .20) in men, respectively. Conclusions This longitudinal study found that kyphosis severity increased subsequent decline in pulmonary function in women but not in men. Reasons for an association between kyphosis and pulmonary function in women but in not men may be due, at least in part, to the small number of men in our study. Nevertheless, our findings suggest that preventing or slowing kyphosis progression may reduce the burden of pulmonary decline in older adults.
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Affiliation(s)
- Amanda L Lorbergs
- Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts.,Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - George T O'Connor
- The National Heart Lung and Blood Institute's Framingham Heart Study, Massachusetts.,Pulmonary Center and Department of Medicine, Boston University School of Medicine, Massachusetts
| | - Yanhua Zhou
- School of Public Health, Boston University, Massachusetts
| | - Thomas G Travison
- Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts.,Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Douglas P Kiel
- Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts.,Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - L Adrienne Cupples
- The National Heart Lung and Blood Institute's Framingham Heart Study, Massachusetts.,Pulmonary Center and Department of Medicine, Boston University School of Medicine, Massachusetts
| | - Hillel Rosen
- Department of Medicine, Harvard Medical School, Boston, Massachusetts.,Division of Endocrinology and Metabolism, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Elizabeth J Samelson
- Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts.,Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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