The Impact of Childhood Obesity on Joint Alignment: A Systematic Review and Meta-Analysis

Relevance of instrumented gait analysis in the prediction of the rebound phenomenon after guided growth intervention

Predictors of rebound after correction of coronal plane deformities using temporary hemiepiphysiodesis (TH) are not well defined. The following research questions were tested: (1) Is the dynamic knee joint load useful to improve rebound prediction accuracy? (2) Does a large initial deformity play a critical role in rebound development? (3) Are BMI and a young age risk factors for rebound? Fifty children and adolescents with idiopathic knee valgus malalignment were included. A deviation of the mechanical femorotibial angle (MFA) of ≥ 3° into valgus between explantation and the one-year follow-up period was chosen to classify a rebound. A rebound was detected in 22 of the 50 patients (44%). Two predictors of rebound were identified: 1. reduced peak lateral knee joint contact force in the first half of the stance phase at the time of explantation (72.7% prediction); 2. minor initial deformity according to the MFA (70.5% prediction). The best prediction (75%) was obtained by including both parameters in the binary logistic regression method. A TH should not be advised in patients with a minor initial deformity of the leg axis. Dynamic knee joint loading using gait analysis and musculoskeletal modeling can be used to determine the optimum time to remove the plates.

The Effect of Breast Size on Spinal Posture

Macromastia can cause various clinical symptoms, such as low back and shoulder pain as well as sacro-iliac disorders. Because of these symptoms, some women consider breast reduction surgery. So far there does not exist a clear correlation between breast size and back pain. Purpose of this study was to evaluate if increasing breast size has a measurable effect on women's posture using radiation free surface topography.A total of 100 women were grouped according to their breast cup size into four groups (Cup Size: A, B, C, D). All female subjects were measured with a surface topography system, and their spinal posture and pelvic position were analysed accordingly.Our results showed that cup size affects kyphotic angle (p = 0.027) and surface rotation (p = 0.039) significantly. Kyphotic angle increased with cup size. Multiple linear regression analysis, however, revealed that the body mass index has the greatest influence on woman's posture, showing significant correlation to kyphotic and lordotic angle (p < 0.01), as to trunk (p < 0.01) and pelvic inclination (p = 0.02).This is the first study that evaluates the influence of increasing breast size on posture using surface topography. The results match with previous studies using different measuring techniques. However, the great influence of BMI on posture is also confirmed. Therefore, in clinical practice these factors should be taken into account and be approached. Surface topography seems to be a promising tool to further investigate the influence of breast size on posture.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Trials and tribulations of transparency related to inconsistencies between plan and conduct in peer-reviewed physiotherapy publications: A methodology review

RATIONALE

The physiotherapy profession strives to be a leader in providing quality care and strongly recognizes the value of research to guide clinical practice. Adherence to guidelines for research reporting and conduct is a significant step towards high-quality, transparent and reproducible research.

AIM/OBJECTIVE

Assess integrity between planned and conducted methodology in randomized controlled trials (RCTs) and systematic reviews (SRs) published in physiotherapy journals.

METHODS

Eighteen journals were manually searched for RCTs and SRs published from 1 July 2021 through 31 December 2021. Studies were included if the journal or specific study was indexed in PubMed and published/translated in English. Descriptive statistics determined congruence between preregistration data and publication.

RESULTS

Forty RCTs and 68 SRs were assessed. Forty-three SRs included meta-analysis (MA). Of the 34 registered RCTs, 7 (20.6%) had no discrepancy between the registration and publication. Two trials (5.9%) addressed all discrepancies, 4 (11.8%) addressed some and 21 (61.8%) did not address any discrepancies. Of the 36 registered MAs, 33 (91.7%) had discrepancies between the registration and publication. Two (5.6%) addressed all discrepancies and three (8.3%) had no discrepancies. Eight SRs without MA published information not matching their registration, and none provided justification for the discrepancies.

CONCLUSION

Most RCTs/SRs were registered; the majority had discrepancies between preregistration and publication, potentially influencing the outcomes and interpretations of findings. Journals should require preregistration and compare the submission with the registration information when assessing publication suitability. Readers should be aware of these inconsistencies and their implications when interpreting and translating results into practice.

Childhood obesity and its impact on the characteristics of gait stance phases: a cross-sectional study

This study aimed to investigate the variations in foot type, laxity, dynamic characteristics of gait, and the characteristics of the stance phase of gait, in relation to body mass index (BMI) and groups of children of different ages. Additionally, it aimed to explore the correlations between BMI and these variables across children groups of different ages. A cross-sectional study was conducted involving 196 infants aged between 5 and 10 years old. The variables assessed included BMI, foot type, laxity, dynamic variables, and characteristics of the stance phase of gait. Significant variations were observed in foot type, laxity, certain dynamic variables, and characteristics of the stance phase of gait between normoweight (NW) and overweight/obese (OW/OB) groups among children aged between 5 and 10 years old (p ranged between 0.019 and 0.050). Moreover, BMI was also positively associated with the initial forefoot contact, heel off, total duration of the step, and forefoot contact phase of children 7 to 10 years of age (p ranged between < 0.010 and 0.040).   Conclusion: Children who are OW/OB had alterations at different stages of gait. Being OW/OB is related to alterations of the phases of gait mainly from 7 to 10 years of age, and spending more time in each of the phases of walking. This could indicate that children who are OW/OB, in addition to walking slower, overload the musculoskeletal system, subjecting their joints and muscles to greater stress. What is Known: • Children who are overweight (OW) and obese (OB) can experience changes in their musculoskeletal systems, posture, and gait due to increased body mass index. • OW and OB children experience additional stress on their musculoskeletal systems, impacting posture, biomechanics, mobility, physical activity, and daily tasks. Excessive plantar loading is linked to foot pain in adults. What is New: • Body mass index was positively associated with initial forefoot contact, heel off, total duration of the step, and forefoot contact phase in children aged 7 to 10 years old. OW/OB children aged 5-6 exhibited less ankle dorsiflexion and smaller relaxed calcaneal stance position (RCSP) as compared to normal-weight children. • Obese children aged 5-6 showed less pronation excursion, suggesting altered frontal plane movement due to RCSP differences. Children aged 7-8 who are OW/OB spent more time in certain gait phases, particularly in the forefoot contact phase. Being OW/OB is linked to altered gait parameters such as initial forefoot, heel off, total step duration, and forefoot contact phase. Being OW/OB was associated with a longer forefoot contact phase, particularly in the right foot.

Optimal Sequence of Corrective Surgeries for Concomitant Valgus Knee and Rigid Pes Planus Deformities: The Knee-First Approach

In patients requiring surgical correction of ipsilateral valgus knee and rigid pes planovalgus deformities, the optimal operative sequence is controversial. Growing evidence suggests these 2 deformities are related in etiology and interrelated in disease course. We present the case of a 72-year-old female with concomitant valgus knee and rigid pes planovalgus deformities successfully treated with total knee arthroplasty followed by triple arthrodesis and Achilles lengthening. Surgical correction of these deformities must be carefully planned between the operating surgeons to avoid over- or under-correction of alignment that could further impact gait. In contrast with the limited available literature, the authors recommend correction at the knee first and the foot and ankle second. Further prospective studies are needed to elucidate the best operative sequence in these patients.

Investigating the Effects of the COVID-19 Pandemic on Pediatric Body Mass Index, and Health Status in an Inner-City, Low-Income Setting

INTRODUCTION

The COVID-19 pandemic required unprecedented containment measures, including prolonged stay-at-home orders, to combat spread and prevent loss of life. One of the consequences of these mandates was the closure of schools. Children in resource-limited communities already experiencing disparities were placed at a significant disadvantage by the closure of schools. Many depended on the school systems as their primary source of nutrient-rich food. Additionally, for many, schools provide the only safe place for outdoor play and physical activity. The unintended consequences of the COVID-19 stay-at-home orders for these high-risk children are now being investigated.

METHOD

This article reports a retrospective chart review of children aged 9-11 years in a low-income, inner-city practice in a moderately sized Southeastern city. Baseline data were obtainef fro 2019 and compared to 2020 and/or 2021.

RESULTS

Findings indicate statistically significant increases in body mass index in this high-risk population of children. Additionally. chronic condistion associate with obesity were identified in many of the unhealthy weight children in the study.

DISCUSSION

This study identifies unintended consequences form the pandemic containment measures that are consistent with other emerging research related to the pandemic's effects on body mass index in children.

Upper crossed syndrome in secondary school students: A mixed-method study

Objective

The study objectives were to identify the prevalence of upper crossed syndrome (UCS) and its associated factors in a population of Spanish adolescents, and to explore these associations through focus groups.

Methods

The study used a sequential explanatory mixed method design. The quantitative phase consisted of a cross-sectional study in which 45 students underwent photogrammetry measurements and evaluations with the Kiddo-KINDL and VISA-TEEN questionnaires. Subsequently, several focus groups were conducted to discuss the quantitative results.

Results

The results indicated a 37.8% prevalence of UCS, a 48.9% prevalence of forward head posture (FHP) and an 80% prevalence of forward shoulder posture (FSP). A positive FSP was indicated by an angle represented by the intersection of the line between the midpoint of the humerus and the spinous process of C7 of <52°. FSP was significantly higher in boys (mean [M] = 43.59, standard deviation [SD] = 6.9) than in girls (M = 47.98, SD = 6.33; p < 0.05). Boys showed significant moderate associations of FSP with body mass index (BMI) (r = -0.48, p < 0.05) and hygiene habits (r = -0.46, p < 0.05), and of FHP with worse use of technology (r = 0.53, p < 0.05). Those with UCS showed significant differences in school performance (M = 47.22, SD = 8.33, p < 0.05). Analysis of the qualitative results led to the identification of 33 codes and five categories.

Conclusions

UCS was associated with factors such as BMI, school performance, use of technology and physical activity. Correcting posture in adolescence was generally believed to be necessary. Physical exercise and postural health were considered highly important among adolescents.

Childhood Obesity and Incorrect Body Posture: Impact on Physical Activity and the Therapeutic Role of Exercise

Obesity is associated with various dysfunctions of the organism, including musculoskeletal problems. In this narrative review, we aim to consider postural problems in children and adolescents with obesity, focusing on the relationship with its negative impact on physical activity, and to discuss the role of exercise as a therapeutic approach. The body reacts to excess weight by changing its normal balance, and the somatosensory system of children with obesity is forced to make major adjustments to compensate for postural problems. These adaptations become more difficult and tiring if activities that require continuous postural changes and multi-tasking are engaged in. Children with obesity have less body control and functional ability due to the excess fat mass, which reduces their ability to perform motor skills and take part in physical activity. Appropriate early interventions for the management of musculoskeletal problems are needed to ensure healthy growth and to prevent comorbidities in childhood and adulthood. Prevention programs must be based not only on the reduction of body weight but also on the definition of correct postural habits from an early age. It is equally important to provide correct information on the types and doses of physical activity that can help prevent these problems.

Effect of Insoles Treatment on School-Age Children with Symptomatic Flexible Flatfoot: A 2-Year Follow-Up Study

Background

Flatfoot is common among children. Symptomatic flexible flatfoot is one of the various types which needs treatment. Wearing insoles is considered one of the conservative therapies, but its effects are still uncertain. This study aims to provide evidence for the efficacy of insoles treatment among school-aged children with symptomatic flexible flatfoot.

Methods

Patient who were Children who were diagnosed with symptomatic flexible flatfoot and received insoles treatment in authors' institute were retrospectively included. Their ages, body mass index, pain positions, pain frequency, valgus angle, arch index and visual analogue scale (VAS) score were collected before and after insole treatment.

Results

A total of 32 children were included in this study. The results showed that wearing insoles for 2 years caused a significant improvement in pain frequency, valgus angle, arch index and VAS score.

Conclusions

This study indicated that pediatric symptomatic flexible flatfoot could be relieved by wearing insoles for 2 years. Insole treatment might be a workable option for pediatric symptomatic flexible flatfoot in children older than 6 years old.

Biomechanical variations in children who are overweight and obese during high-impact activities: A systematic review and meta-analysis

Youth who are obese or overweight demonstrate evidence of poor lower extremity joint health and alterations in gait characteristics compared with youth who are healthy weight. However, there is no consensus if altered movement patterns are still present during high-impact activities. The purpose of this review was to determine if spatiotemporal and kinematic and kinetic variables during high-impact activities were significantly different between youth who are overweight and obese compared with youth who are healthy weight. An electronic search of five databases was conducted, and a meta-analysis and qualitative evidence synthesis was performed to determine the level of evidence, analyzing three tasks: running, jumping, and hopping. The findings of this review include the following: (1) overweight/obese (OW/OB) had higher stance phase time during running, (2) OW/OB had decreased hip flexion angles during running and stationary running, (3) OW/OB had decreased knee flexion angles during landing phase of jumping and hopping, and (4) OW/OB had increased hip abduction moments during running and jumping. These altered kinematic and kinetic variables at the hip and knee may result in mechanical inefficiency with high-impact activities, as well as potentially increased risk of joint degradation and poor joint health into adulthood.