Influence of physical activity and postural habits in schoolchildren with scoliosis

Association between postural habits and lifestyle factors of adolescent idiopathic scoliosis in Syria

Adolescent idiopathic scoliosis (AIS) is the most common type of scoliosis in children between the ages of 10 and 16. Nevertheless, risk factors for AIS, especially adjustable ones, are still poorly understood. This study seeks to examine the associations of lifestyle and social environment factors with AIS in Syrian schoolchildren. This matched case-control study uses survey data from a school-based scoliosis screening approach. We utilized logistic regression models to estimate the relative risk of AIS prevalence for each variable in the analysis. A multivariate logistic regression was performed to investigate the independent influence of each component on AIS development, with odds ratios (ORs) adjusted for the important factors. Overall, 1102 participants from 22 schools were included in this study, comprising 551 AIS cases and 551 controls. Mean age of the study population was 13.5 years ± 1.08. Six hundred and twenty (56.3%) of the study subjects were girls. After adjusting for other significant factors, age between 13 and 15 years (OR = 2.45; 95% CI, 1.37-6.17), inappropriate desk heights, either too low (OR = 1.53, 95% CI 1.12-1.85) or too high (OR = 1.46, 95% CI 1.13-1.87), standing with anterior pelvic tilt (OR = 1.97, 95% CI 1.46-3.43), and sleeping on the right side (OR = 1.92, 95% CI 1.54-2.23), remained associated with elevated AIS risks. In contrast, sitting normally and classroom sitting positions change regularly were associated with lower odds of AIS. The adjusted ORs were 0.73 (95% CI 0.43-0.94) for sitting normally, and 0.63 (95% CI 0.31-0.97) for sitting positions change. This study investigated the correlation between desk heights and AIS and revealed that incorrect desk heights were associated with more AIS risk. To prevent schoolchildren from developing AIS, stakeholders should consider installing height-adjustable desks in the classroom, changing students' sitting positions on an ongoing basis, and establishing training courses that assist students in keeping proper sitting postures.

Investigating the effects of postural habits and awareness on early adolescent's internet addiction levels

OBJECTIVES

Early adolescence is a period of growth and development determined by the onset of puberty, during which important changes in psychological development and social roles occur. Excessive use of the internet, especially in adolescents in this period, causes health problems such as postural disorders, vision problems, sedentary life, and unbalanced nutrition. When the studies are analyzed, it is observed that postural disorders are observed in children and adolescents. This study was planned to investigate the effect of postural habits and awareness on the level of internet addiction in early adolescents.

METHODS

Physical characteristics of the participants (age, height, weight, gender, body mass index) were recorded. Duration and purpose of internet use and internet addiction were determined with the Young Internet Addiction Test-Short Form, body composition sensitivity level with the Body Awareness Questionnaire, and postural awareness with the Postural Habit and Awareness Scale.

RESULTS

There was a significant positive correlation between internet addiction and duration of internet use (r=0.466) (p=0.000). In addition, there was no relationship between internet usage time and body awareness (r=-0.117) (p=0.084) and postural awareness and habit (r=-0.017) (p=0.798). When internet addiction was compared with body awareness, a significant relationship was found in the opposite direction (r=-0.145) (p=0.031). When internet addiction was compared with postural awareness and habit, a positive relationship was found (r=0.190) (p=0.005).

CONCLUSIONS

Our study showed that internet addiction negatively affects body awareness, and does not affect postural habits, but positively affects postural awareness.

Assessment of idiopathic scoliosis among adolescents and associated factors in Palestine

PURPOSE

This study aimed to investigate adolescent idiopathic scoliosis (AIS) and its related risk factors, including body mass index (BMI), physical activity (PA), gender, time of the first menstrual cycle, transportation, backpack weight and the way of carrying a backpack.

DESIGN AND METHOD

a cross-sectional quantitative design was utilized. A convenient sample of adolescent students in grades seven through ten was included in the study. A self-reported questionnaire with three sections: demographic data; physical data including height, weight and PA; and Adam's forward bend test to determine each student's spine's Cobb angle by measuring the angle of trunk rotation using a scoliometer. The data were analyzed using SPSS version 25, with confidence intervals of 95%.

RESULTS

A total of 820 schoolchildren participated in the study; 53.7% were female and 46.3% were male. Only 22% of these students engaged in vigorous exercise, compared to 36.7% who engaged in low PA; additionally, 10% of the adolescents had a low BMI. After the analysis, it was found that 5.4% of participants had AIS. Low PA (p = 0.001), being underweight (p = 0.038), and time of first menstrual period (p = 0.033) were significantly associated with AIS, while gender, backpack weight, and way of carrying were not statistically related to AIS. Binary logistic regression identified low PA as an independent predictor of AIS (OR = 7.22, 95%CI [1.64, 31.79]).

CONCLUSIONS

The frequency of AIS in Palestine was significant, which highlighted the importance of this issue at a national and global level. There was an association between AIS and BMI, PA, and the time of the first menstrual cycle, which signifies the importance of early detection of the problem to limit its burden later in life.

PRACTICE IMPLICATIONS

Teachers, teenagers, and their parents should be provided with programs that educate and clarify AIS, and a specific protocol should be established for scoliosis screening in schools.

Correlation between physical activity and adolescent idiopathic scoliosis: a systematic review

BACKGROUND

The multifactorial aetiology of scoliosis is well known. Physical activity is considered both a treatment and causative factor for idiopathic scoliosis; however, evidence for a causal relationship between physical activity levels and idiopathic scoliosis in adolescents is conflicting. Therefore, we aimed to summarise the current evidence regarding the association between adolescent idiopathic scoliosis and physical activity and further to assess whether the relationship is dose dependent.

METHODS

PubMed, Cochrane, Scopus, and Web of Science databases were searched from 1991 to July 2022 using the following main keywords: adolescent idiopathic scoliosis, physical activity, and risk factors, supplemented with manual searches, secondary citations, and reference searches. The quality of the included literature was evaluated using the Scale for Reporting Observational Studies in Enhanced Epidemiology guidelines.

RESULTS

Eight studies were included in this review, of which six reported an association between adolescent idiopathic scoliosis and physical activity levels and two reported no association. One British study reported reduced physical function early in life as a new risk factor for scoliosis onset.

CONCLUSIONS

Physical activity is strongly associated with adolescent idiopathic scoliosis. Physical activity should be encouraged as it plays an important role in the prevention of adolescent idiopathic scoliosis. Further research is needed to determine the dose-dependent relationship between physical activity and prevention of adolescent idiopathic scoliosis.

Overview of adolescent idiopathic scoliosis and associated factors: a scoping review

Around the world, idiopathic scoliosis accounts for the majority of occurrences of adolescent scoliosis. The absence of underlying congenital or neuromuscular problems distinguishes adolescent idiopathic scoliosis (AIS), which affects children ages 13 to 18, from other kinds of scoliosis. The prevalence of AIS is influenced by a number of variables, such as physical activity, gender, backpacks, body mass index, and others. AIS has an impact on the child's development not just physically but also psychologically, emotionally, and mentally. This study used nationwide databases to describe the prevalence of adolescent idiopathic scoliosis and associated risk variables. The current review analysis showed that AIS was significant worldwide and that adolescent gender, physical activity, body mass index, backpack carrying and backpack weight were all significant risk factors for developing AIS.

Association between physical activity and body posture: a systematic review and meta-analysis

OBJECTIVE

To estimate the possible associations between posture and physical activity (PA).

DESIGN

A systematic review and meta-analysis.

DATA SOURCES

The search was conducted in seven databases (PubMed, Web of Science, SportDiscus, EMBASE, Scopus, Cochrane Library, and CINAHL) for studies published from inception to January 2023.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Studies were required to meet following criteria: (1) study design: cross-sectional, case control and cohort studies. (2) Participants: people of all ages without any diagnosed diseases. (3) Exposure and outcome: studies that examined the possible effect or correlations between PA, physical inactivity, physical exertion and human body posture.

RESULTS

Sixteen cross-sectional studies, two cohort studies and one case control study involving a total of 16772 participants aged from 6 to 79 years were included. Correlational studies showed that there was a significant relationship between PA and posture (C = 0.100, CI 95% = 0.012-0.186). However, regression studies demonstrated that there was not a significant association between PA and posture (C = 1.00, CI 95% = 0.998-1.002). Three studies investigated the association between PA and the lumbar lordosis and showed that there was not a significant association between the lordosis and PA (CI 95%: -0.253-0.048, P = 0.180). In addition, four studies showed that there were not any associations between scoliosis and PA (CI 95%: 0.819, 1.123, P = 0.607). The evidence of heterogeneity and publication bias was found among all analyzed data (P < 0.05). Also, meta regression was used for age and BMI and the results were not significant.

CONCLUSION

Although a weak correlation was shown to exist between PA and human posture, the odds ratio indicated that there was not a significant association between PA and human posture. The lack of a significant relationship may indicate that multiple biopsychosocial factors may be involved in human posture. In summary, our study highlights the need for caution when interpreting the results of meta-analyses, particularly when there is significant heterogeneity and publication bias in the included studies.

The Impact of Physical Activity on Adolescent Idiopathic Scoliosis

The prevalence of adolescent idiopathic scoliosis (AIS) is increasing, partly due to a lack of physical activity. In a cross-sectional study with 18,216 pupils (5th, 6th, and 8th grades) from four Croatian counties using the forward bend test (FBT; presumed AIS), the prevalence of AIS and its correlation with physical activity were evaluated. Pupils with presumed AIS were less physically active than their peers without scoliosis (p < 0.001). Abnormal FBT was more prevalent among girls than boys (8.3% vs. 3.2%). Boys were more physically active than girls (p < 0.001). Pupils with presumed AIS were less physically active than their peers without scoliosis (p < 0.001). A higher prevalence of presumed AIS was found among inactive or just recreationally active schoolchildren than among those engaged in organized sports (p = 0.001), girls especially. Pupils with presumed AIS were less active and had fewer weekly sports sessions than their peers without scoliosis (p < 0.001). Notably low prevalence of AIS was detected among pupils engaged in soccer (2.8%, p < 0.001), handball (3.4%, p = 0.002), and martial arts (3.9%, p = 0.006), while it was higher than expected in swimming (8.6%, p = 0.012), dancing (7.7%, p = 0.024), and volleyball (8.2%, p = 0.001) participants. No difference was detected for other sports. A positive correlation was found between time spent using handheld electronic devices and the prevalence of scoliosis (r_s = 0.06, p < 0.01). This study confirms the increasing prevalence of AIS, particularly among less athletic girls. Further, prospective studies in this field are required to explain whether the higher prevalence of AIS in these sports is due to referral or other aspects.

Associations Between Physical Activity and Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-analysis

OBJECTIVE

To investigate the associations between adolescent idiopathic scoliosis (AIS) and physical activity (PA).

DATA SOURCES

MEDLINE, EMBASE, AMED, SPORTDiscus, Cochrane Library, and CINAHL electronic databases were searched from inception to August 2022/plus citation tracking.

STUDY SELECTION

Observational studies of participants with radiographically confirmed AIS with ≥10° lateral spinal curvature (Cobb method) and comparator groups without AIS that measured PA were selected by 2 reviewers.

DATA EXTRACTION

Data were extracted independently and cross-checked by 2 reviewers. Risk of bias was evaluated using Newcastle Ottawa Scales and overall confidence in the evidence using the GRADE approach.

DATA SYNTHESIS

Sixteen studies with 9627 participants (9162, 95% women) were included. A history of vigorous PA significantly reduced the odds of being newly diagnosed with AIS by 24% (odds ratio [OR] 0.76, 95% confidence interval [CI] 0.65-0.89) (high certainty). Moderate PA reduced odds by 13% (moderate certainty) and light PA increased odds by 9% (low certainty), but neither analysis was statistically significant. Ballet or gymnastics (OR 1.47, 95% CI 3.08 (1.90, 5.00) were the only individual sports significantly associated with AIS diagnosis (moderate certainty). Case-control studies of people with and without AIS provided greater evidence that having AIS reduces vigorous PA and sports participation, and less evidence light PA and walking are affected.

CONCLUSION

Adolescents who participate in more vigorous PA are less likely to be diagnosed with AIS. Ballet and gymnastics are associated with AIS diagnosis, but the direction of this association is uncertain. People with AIS are likely to do less vigorous physical and sporting activity compared with those without AIS, which could negatively affect health and quality of life. Further research is warranted into the inter-relations between PA and AIS, studies need to be of sufficient size, include men, and evaluate vigorous including higher-impact PA compared with moderate or light PA.

Associations of physical activity and screen time with adolescent idiopathic scoliosis

BACKGROUND

Adolescent idiopathic scoliosis (AIS) is the most common type of idiopathic scoliosis, affecting approximately 0.61%-6.15% adolescents worldwide. To date, the results on the relationship between moderate-to-vigorous physical activity (MVPA) and AIS were inconsistent, and the association between screen time (ST) and AIS remained unclear. This study aimed to describe MVPA and ST among adolescents, and to explore the independent and joint associations between PA, ST, and AIS.

METHODS

A frequency-matched case-control study based on the 2021 Chinese School-based Scoliosis Screening Program in Shenzhen city, south China, was conducted. The research involved 494 AIS patients (aged 9-17 years) and 994 sex- and age-matched healthy controls. MVPA and ST were measured using a self-administered questionnaire. Logistic regression models estimated associations between PA, ST, and AIS.

RESULTS

Compared to subjects meeting the recommended 60-min daily of MVPA, adolescents reporting daily MVPA time less than 60 min had 1.76 times higher odds of experiencing AIS (95% CI: 1.32-2.35) and adolescents reporting daily MVPA in inactive status had 2.14 times higher odds of experiencing AIS (95% CI: 1.51-3.03). Moreover, participants reporting ST for 2 hours or more had 3.40 times higher odds of AIS compared with those reporting ST less than 2 hours (95% CI: 2.35-4.93). When compared with the adolescents reporting both ST and MVPA meeting the guidelines recommended times (ST < 2 h and MVPA ≥ 60 min/day), those reporting both ST ≥ 2 h and MVPA in inactive status are 8.84 times more likely to develop AIS (95% CI: 3.99-19.61).

CONCLUSIONS

This study reported that the insufficient MVPA, especially MVPA in inactive status, and excessive ST were risk factors for AIS. Additionally, the joint effects of insufficient MVPA and excessive ST probably increase the risk of AIS.

Dynamic knee valgus prevalence in children and its association with pain intensity, foot mobility, and sex- A cross-sectional study

Introduction

Knee pain can impact the performance of activities and sports participation in children. Dynamic knee valgus is a movement pattern commonly related to health conditions that may be associated with sex and foot kinematics in children.

Objective

To assess the prevalence of dynamic knee valgus and its relationship with foot mobility, sex, and knee pain in children.

Method

A cross-sectional observational study was carried out with 144 children (10-18 years old). The pain level was investigated using the Visual Analog Pain Scale and categorized into no pain/minor pain (≤2 cm), moderate pain (3-4,9 cm), and severe pain (≥5.0 cm). Foot mobility was assessed using the adapted navicular drop test and categorized into poor/adequate foot mobility (0.0 cm-0.9 cm) and greater foot mobility (≥1.0 cm). The dynamic knee valgus presence was checked using the step-down test. The association analysis was performed using simple tabulation considering the cluster effect. The Prevalence Ratios and the respective confidence intervals (95%) were estimated from Multiple Poisson Regression with robust variance. A significance level of 5% was adopted.

Results

The dynamic knee valgus prevalence was 26.3% and 26.9% in the right and left lower limbs, respectively. Females presented greater dynamic knee valgus frequency in the left lower limb than males. The dynamic knee valgus presence in males was associated with foot mobility in right (p = 0.001) (Prevalence Ratio: 9.33 Confidence Interval: 2.93-29.72) and left lower limbs (p = 0.003) (Prevalence Ratio: 6.25 Confidence Interval: 1.7-22.62).

Conclusion

Male and female children showed different relationships of the analyzed factors, suggesting that characteristics related to sex may impact the aspects linked to dynamic knee in children.

The role of school medicine in the early detection and management of adolescent idiopathic scoliosis

Objective

To analyze the trends in scoliosis screenings over 10 years (2010 vs. 2020). To assess the management of schoolchildren with a preliminary diagnosis of adolescent idiopathic scoliosis by school medicine specialists.

Methods

Historical data were used for the year 2009/2010, and a cross-sectional study was conducted during the school year 2019/2020 on 18,216 pupils of 5th, 6th, and 8th elementary school grades. A forward bend test was used to detect clinical features of scoliosis and some positive findings were referred to orthopedists or physiatrists for further evaluation.

Results

In the analyzed 10-year period abnormal forward bend test findings increased from 4.9 to 5.8% (by 18.4%; P < 0.001). While its prevalence escalated markedly in girls (from 5.8 to 8.3%; P < 0.001), a modest but significant decrease, from 3.8 to 3.2% (P = 0.018), was noted in boys. Most pupils had low to moderate curves, and its prevalence was some 6.5 times higher in girls (P < 0.001). The forward bend test positive predictive value was 84.7%. Discrete forward bend test aberrations were managed by school medicine specialists only.

Conclusion

While actively promoting scoliosis screening in children, we have shown that forward bend test is an acceptable tool for early adolescent idiopathic scoliosis detection in school medicine. In collaboration with other specialists and using additional diagnostic methods, school medicine specialists can ensure early detection and appropriate interventions, avoiding the potential harms of radiation exposure.

DEVELOPMENT OF THE POSTURAL HABITS AND AWARENESS SCALE (PHAS): A RELIABILITY AND VALIDITY STUDY

Objectives. The aim of this study was to develop a scale that assesses postural awareness and habits, as well as to establish the validity and reliability thereof. Methods. The 19-item Postural Habits and Awareness Scale was developed. The scale has a score range of 0-95, with a higher score indicating good posture and awareness. 278 healthy adults with an age range of 18-65 years were included in the study. The sociodemographic form, Short Form 36 Health Survey (SF-36), and Body Awareness Questionnaire (BAQ) were used to test the validity and reliability of this newly developed scale. Results. From factor analyses, it was observed that the items clustered in 4 factors, which explained 55.99% of the variance. The Cronbach's α for each factor of the scale varied between 0.619 and 0.832. A high correlation was observed regarding test-retest reliability of the scale (r: 0.905). Conclusion. This newly developed self-reported scale allows for the comprehensive determination of both postural habits and awareness together. The PHAS is a valid and reliable scale that can be used by professionals who are interested in posture.