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Veiskarami M, Aboutorabi A, Mohammadi R, Gholami M, Khamesi E. The effect of elderly-specific spinal orthoses on muscle function and kyphosis angle in elderly subjects: systematic review and meta-analysis. Disabil Rehabil 2024:1-15. [PMID: 38989896 DOI: 10.1080/09638288.2024.2374495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 06/24/2024] [Indexed: 07/12/2024]
Abstract
PURPOSE Age-related postural hyper-kyphosis is an exaggerated anterior curvature of the thoracic spine, that impairs balance and increases the risk of falls and fractures in elderly subjects. Our objectives are to review the effect of elderly-specific spinal orthoses on muscle function and kyphosis angle in this subjects. MATERIALS AND METHODS We searched PubMed, Scopus, ISI web of Knowledge, ProQuest and Cochrane library to identify relevant studies that assessed efficacy of spinal orthoses on muscle function and kyphosis angle of elderly subjects with elderly with hyper-kyphosis. Quality assessment was implemented using the Downs and Black scale. RESULTS Results for 709 individuals were described in 18 articles which 12 studies involved RCT. There was significant difference for kyphosis angle after use of orthosis of 148 participants (SMD: -3.79, 95% CI -7.02 to -0.56, p < 0.01). Except one study, all of studies showed significantly increased on the back muscle strength when the participants wore the spinal orthosis and this effect was significantly better in long-term follow up (MD: 84.73; 95% CIs, 23.24 to 146.23; p < 0.01). In the outcome of pain, the efficacy brought by orthosis was large and significant (SMD: -1.66; 95% CIs, -2.39 to 0.94; p < 0.01). CONCLUSIONS Spinal orthosis may be an effective treatment for elderly hyper-kyphosis. However, the small number, and heterogeneity of the included studies, indicate that higher-quality studies should be conducted to verify the effectiveness and orthosis in hyper-kyphosis.
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Affiliation(s)
- Masoumeh Veiskarami
- Department of Physiotherapy, School of Allied Medical Sciences, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Atefeh Aboutorabi
- Department of Orthotics and Prosthetics, School of Rehabilitation, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Rasool Mohammadi
- Social Determinants of Health Research Center, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mehrdad Gholami
- Department of Medical Physics, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Ebrahim Khamesi
- Department of Neurosurgery, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
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Eldemir K, Eldemir S, Ozkul C, Guclu-Gunduz A. The immediate efficacy of the spinomed orthosis and biofeedback posture orthosis on balance and gait in older people with thoracic hyperkyphosis. Gait Posture 2024; 111:136-142. [PMID: 38691976 DOI: 10.1016/j.gaitpost.2024.04.019] [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: 10/30/2023] [Revised: 02/26/2024] [Accepted: 04/20/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Increased kyphosis is a common condition among older people that may, directly or indirectly, be a risk factor for poor balance and gait. Spinomed and Biofeedback Posture Trainer (BPT) orthoses is an effective treatment approach for hyperkyphosis. This study aimed to compare the immediate effects of the Spinomed and BPT orthoses on balance and gait in the older population. METHODS A total of 52 volunteer older people with hyperkyphosis (kyphosis angle>40°) participated in this study and were randomly allocated into two groups, to either the Spinomed orthosis (n = 26, mean age = 65.50 ± 5.50) or the BPT (n = 26, mean age = 65.38 ± 5.69) orthosis. All participants were asked to wear the orthoses for 1.5 h to get used to them. Balance parameters, which are Postural Stability Test (PST), Limits of Stability (LOS), and Clinical Test of Sensory Integration for Balance (m-CTSIB) were assessed using the Biodex Balance System, while walking parameters were assessed using the G-Walk with and without orthosis. RESULTS The Spinomed had a positive effect on balance parameters (p < 0.05) except for the closed eyes firm surface and the opened eyes foam surface conditions of the m-CTSIB (p > 0.05). BPT had a significant impact on the PST score, LOS, and the closed eyes firm surface condition of the m-CTSIB (p < 0.001). Spinomed had a significant effect on cadence, speed, gait cycle duration, elaborated steps, and symmetry index of pelvic angles (p < 0.05), while the BPT had a significant effect only on step length and rotation symmetry index. No significant difference was detected between the two types of orthoses in the balance and gait parameters (p > 0.05). CONCLUSIONS Spinomed and BPT were both effective in improving balance performance, with similar improvements demonstrated by both orthoses. Additionally, Spinomed may provide significant improvements in cadence, speed, gait cycle duration, elaborated steps, and all symmetry indexes of pelvic angles in the short term.
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Affiliation(s)
- Kader Eldemir
- Ordu University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ordu, Türkiye.
| | - Sefa Eldemir
- Sivas Cumhuriyet University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Sivas, Türkiye
| | - Cagla Ozkul
- Gazi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Türkiye
| | - Arzu Guclu-Gunduz
- Gazi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Türkiye
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Tangpakkakul S, Manimmanakorn N, Manimmanakorn A, Vichiansiri R, Hamlin MJ. Effects of elastic taping on kyphosis and body balance in the elderly: a randomized crossover study. Sci Rep 2024; 14:1428. [PMID: 38228810 DOI: 10.1038/s41598-024-52047-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 01/12/2024] [Indexed: 01/18/2024] Open
Abstract
Kyphosis produces abnormal posture and reduced body balance in the elderly. Elastic tape may be useful at improving kyphotic posture and body balance. This study aims to evaluate the effects of elastic taping on kyphosis and body balance in the elderly. Ten elderly participants with degenerative kyphotic posture were recruited and randomly assigned to two groups (back taped with stretched elastic tape for 15 min and back taped with non-stretched elastic tape for 15 min). After a 1-h washout period, the groups were swapped over to receive the other intervention. The outcomes measured after each taping technique were Cobb's angle measurement by inclinometer, perceived pain, and balance measurements by single leg stance test, time up and go test, center of gravity alignment (COG) and modified clinical test of sensory interaction on balance test (mCTSIB). There was a significant reduction in kyphotic angle and back pain in both the stretched and non-stretched taping groups (p < 0.05). We also found both taping techniques significantly reduced sway velocity on a foam surface with eyes closed and open (p < 0.05). However, there was no significant difference between taping groups for kyphotic angle, pain reduction or balance. The application of 15 min of stretched and non-stretched elastic tape in the elderly reduced kyphotic angle, back pain, and sway velocity while standing on foam surface in the mCTSIB test. If these changes persist over the long term (days and weeks) taping may be a useful intervention for elderly patients with kyphosis.
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Affiliation(s)
- Surapa Tangpakkakul
- Department of Rehabilitation Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Nuttaset Manimmanakorn
- Department of Rehabilitation Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
| | - Apiwan Manimmanakorn
- Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Ratana Vichiansiri
- Department of Rehabilitation Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Michael J Hamlin
- Department of Tourism, Sport and Society, Lincoln University, Christchurch, New Zealand
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Keshavarzi F, Arazpour M. Effect of spinal orthoses on osteoporotic elderly patients kyphosis, back muscles strength, balance and osteoporotic vertebral fractures: (A systematic review and meta-analysis). J Rehabil Assist Technol Eng 2024; 11:20556683241268605. [PMID: 39211735 PMCID: PMC11359449 DOI: 10.1177/20556683241268605] [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: 01/05/2024] [Accepted: 07/16/2024] [Indexed: 09/04/2024] Open
Abstract
In this review and meta-analysis, we aimed to investigate the effect of spine orthotics in osteoporotic patients. The relationship between osteoporosis, osteoporotic vertebral fractures (OVFs), and age-related hyperkyphosis has made this effect unclear. We believe that taking participants' conditions into consideration may help to alleviate this controversy. The electronic database includes Web of Science, PubMed, Cochrane Library, Medline, and ClinicalTrials.gov. For English language literature was searched up to March 2023, and 34 articles were included in the review and 15 article had sufficient quality for meta-analysis based on the methodology quality index. There was no significant effect found from using either rigid or soft orthoses alone during the acute phase of one level (OVFs). Both semi-rigid and weighted orthoses have shown a positive significant effect on thoracic kyphosis angle and back extensor muscle strength in osteoporotic or older hyperkyphotic patients. The results of this review indicate that using a soft or rigid orthosis alone does not have a superior effect in the acute phase of one-level (OVFs) compared to not using an orthosis. However, using a semi-rigid or weighted orthosis in osteoporotic or hyperkyphotic older adults with or without (OVFs) can benefit thoracic kyphosis angle, back muscle strength, and balance.
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Affiliation(s)
- Fatemeh Keshavarzi
- Student Research Committee, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Orthotics and Prosthetics Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mokhtar Arazpour
- Orthotics and Prosthetics Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Chu VWT, Dusing SC. Development and pilot testing of an early childhood somatosensory assessment: Somatosensory test of reaching. Dev Psychobiol 2022; 64:e22334. [PMID: 36426787 PMCID: PMC9827902 DOI: 10.1002/dev.22334] [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: 06/09/2022] [Revised: 08/23/2022] [Accepted: 09/19/2022] [Indexed: 11/06/2022]
Abstract
Thirty-two children (50% female, 59.3% White, 7-60 months), from middle to high socioeconomic status families, participated in pilot feasibility and validity testing of the somatosensory test of reaching (STOR). STOR tested the child's accuracy of reach to visual and somatosensory targets. All children were able to complete the assessment. Statistically significant differences were found between age groups (p = .0001), showing developmental trends, and between test conditions (p < .001), showing that the ability to reach to visible targets develops before somatosensory targets. STOR also showed a moderate correlation with the Developmental Assessment of Young Children 2nd edition. STOR appears to be a promising tool for assessing somatosensory processing in very young children, and it warrants additional testing in larger participant samples.
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Affiliation(s)
- Virginia Way Tong Chu
- Department of Occupational TherapyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Stacey C. Dusing
- Department of Biokinesiology and Physical TherapyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
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KIM SH, RAMANI PS, JAHAGIRDAR VR, ROITBERG B, ZILELI M. Endocrine assessment, chemotherapy, nonsurgical treatment, and rehabilitation for osteoporotic spine fractures: WFNS spine committee recommendations. J Neurosurg Sci 2022; 66:300-310. [DOI: 10.23736/s0390-5616.22.05641-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Alin CK, Grahn-Kronhed AC, Uzunel E, Salminen H. Wearing an Activating Spinal Orthosis and Physical Training in Women With Osteoporosis and Back Pain: A Postintervention Follow-Up Study. Arch Rehabil Res Clin Transl 2022; 3:100154. [PMID: 34977537 PMCID: PMC8683839 DOI: 10.1016/j.arrct.2021.100154] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective To assess the duration of benefits on back pain and back extensor strength in women with osteoporosis who had previously participated in a randomized controlled trial (RCT) involving either exercise or wearing a spinal orthosis. Design A 6-month postintervention follow-up of women who were involved in the interventions in the RCT. Setting The study was conducted in a primary health care center in Stockholm, Sweden. Participants In this follow-up study 31 women participated in the spinal orthosis group, and 31 women participated in the exercise group, with a median age of 76 years in both groups (N=62). All women were diagnosed as having osteoporosis, had back pain with or without vertebral fracture, and were 60 years or older, which were the inclusion criteria in the RCT. Interventions The participants received no controlled supervision. The spinal orthosis group was asked to wear the orthosis, and the training group was asked to follow an exercise program for another 6 months voluntarily. Main Outcome Measures Back extensor strength was measured with a computerized device; back pain was estimated by the visual analog scale and by Borg CR-10. Results After 6 months there were no significant differences between the groups in back extensor strength or back pain. Analyses within the groups showed that achieved results during 6 months intervention in the RCT were maintained after 6 months of voluntary use of the spinal orthosis and training. In the spinal orthosis group, back extensor strength mean was 81.7 N, and back pain median was 3 mm. In the training group back extensor strength mean was 72.8 N, and back pain median was 3 mm. There were no changes for any other measurements performed. Conclusions Voluntary use of the spinal orthosis or exercise during a 6-month follow-up period maintained the increase in back extensor muscle strength obtained during the RCT. Estimation of back pain was not influenced. This indicates that the women had continued to use the spinal orthosis and exercise.
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Affiliation(s)
- Christina Kaijser Alin
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Solna, Sweden
| | - Ann-Charlotte Grahn-Kronhed
- Rehab Väst, Local Health Care Services in the West of Östergötland, Mjölby, Sweden.,Division of Prevention, Rehabilitation and Community Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Elin Uzunel
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Solna, Sweden
| | - Helena Salminen
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Solna, Sweden.,Academic Primary Healthcare Centre Stockholm, Stockholm, Sweden
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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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Joint position statement on management of patient with osteoporosis during COVID-19 contingency from the AMMOM, CONAMEGER, FELAEN, FEMECOG, FEMECOT, and ICAAFYD. Arch Osteoporos 2021; 16:18. [PMID: 33495916 PMCID: PMC7833891 DOI: 10.1007/s11657-020-00869-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/25/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED Infection by SARS-Cov-2 (COVID-19) has affected practically all the world. This joint position statement of Latin American Medical Societies provides an updated guide for the prevention, diagnosis, and treatment of osteoporotic patients in the face of possible clinical scenarios posed by the COVID-19 health crisis. BACKGROUND Infection by SARS-Cov-2 (COVID-19) has affected practically all the world. Characterized by high contagiousness, significative morbidity, and mortality in a segment of those infected, it has overwhelmed health services and forced to redirect resources to the emergency while impacting the attention of acute non-COVID-19 and many chronic conditions. OBJECTIVE The objective of this study is to provide an updated guide for the prevention, diagnosis, and treatment of osteoporotic patients in the face of possible clinical scenarios posed by the COVID-19 health crisis. METHODS A task force, of bone specialists with a wide range of disciplines in the field of osteoporosis and fragility fracture, was convened with the representation of several professional associations, namely, the Mexican Association of Bone and Mineral Metabolism (AMMOM), the National College of Geriatric Medicine (CONAMEGER), the Latin American Federation of Endocrinology (FELAEN), the Mexican Federation of Colleges of Obstetrics and Gynecology (FEMECOG), the Mexican Federation of Colleges of Orthopedics and Traumatology (FEMECOT), and the Institute of Applied Sciences for Physical Activity and Sports of the University of Guadalajara (ICAAFYD). Clinical evidence was collated, and an evidence report was rapidly generated and disseminated. After finding the gaps in the available evidence, a consensus opinion of experts was made. The resulting draft was reviewed and modified accordingly, in 4 rounds, by the participants. RESULTS The task force approved the initial guidance statements, with moderate and high consensus. These were combined, resulting in the final guidance statements on the (1) evaluation of fracture risk; (2) stratification of risk priorities; (3) indications of bone density scans and lab tests; (4) initiation and continuation of pharmacologic therapy; (5) interruptions of therapy; (6) treatment of patients with incident fracture; (7) physical therapy and fall prevention; and (8) nutritional interventions. CONCLUSION These guidance statements are provided to promote optimal care to patients at risk for osteoporosis and fracture, during the current COVID-19 pandemic. However, given the low level of available evidence and the rapidly evolving literature, this guidance is presented as a "living document" and future updates are anticipated.
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Takahashi Y, Saito K, Matsunaga T, Iwami T, Kudo D, Tate K, Miyakoshi N, Shimada Y. Relationship between Dynamic Trunk Balance and the Balance Evaluation Systems Test in Elderly Women. Prog Rehabil Med 2020; 5:20200004. [PMID: 32789272 PMCID: PMC7365219 DOI: 10.2490/prm.20200004] [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: 11/20/2019] [Accepted: 02/05/2020] [Indexed: 11/16/2022] Open
Abstract
Objective Falls are major contributors to elderly subjects becoming bedridden. Consequently, it
is important to evaluate and minimize the risk of falls in the elderly. Trunk stability
is important for balance function and is related to fall prevention in elderly women. We
developed a balance-measuring device that uses a dynamic sitting position to safely
measure balance function. The Balance Evaluation Systems Test (BESTest) is useful method
to assess balance function, a recently developed balance evaluation test that can detect
minor balance problems not captured by previous tests. The purpose of the present study
was to examine the relationship between dynamic trunk balance and findings of the
BESTest in elderly women. Methods Thirty-one healthy women aged 60 years or more participated in this study. The
evaluation items were the BESTest total score, scores for each of the six elements of
the BESTest, dynamic sitting balance, static postural balance, and muscle strength. Results The mean total BESTest score was 85.4 points. The mean total trajectory length of the
center of gravity (COG) during the dynamic sitting balance test was 1447.5 mm. A
negative correlation (r=–0.481, P= 0.006) was observed between the total COG trajectory
length and the BESTest score. A negative correlation was also found between the total
COG trajectory length and biomechanical constraints (r=–0.492, P=0.005) and anticipatory
postural adjustments (r=–0.532, P=0.002). There were no correlations between the dynamic
sitting balance total COG trajectory length and the stationary standing COG trajectory
length or muscle strength. Conclusions In elderly women, the total COG trajectory length during dynamic sitting was
negatively correlated with the BESTest total score.
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Affiliation(s)
- Yasuhiro Takahashi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Kimio Saito
- Department of Rehabilitation Medicine, Akita University Hospital, Akita, Japan
| | - Toshiki Matsunaga
- Department of Rehabilitation Medicine, Akita University Hospital, Akita, Japan
| | - Takehiro Iwami
- Department of Systems Design Engineering, Faculty of Engineering Science, Akita University Graduate School of Engineering Science, Akita, Japan
| | - Daisuke Kudo
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Kengo Tate
- Department of Systems Design Engineering, Faculty of Engineering Science, Akita University Graduate School of Engineering Science, Akita, Japan
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoichi Shimada
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
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Takahashi S, Hoshino M, Takayama K, Sasaoka R, Tsujio T, Yasuda H, Kanematsu F, Kono H, Toyoda H, Ohyama S, Hori Y, Nakamura H. The natural course of the paravertebral muscles after the onset of osteoporotic vertebral fracture. Osteoporos Int 2020; 31:1089-1095. [PMID: 32060561 DOI: 10.1007/s00198-020-05338-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 02/06/2020] [Indexed: 10/25/2022]
Abstract
UNLABELLED This study revealed the change in the paravertebral muscles in patients with osteoporotic vertebral fracture. Increased pain is likely to be the driver for reduced activity, reduced activities of daily living, and consequent increase in fat infiltration of the paravertebral muscles, assumed to be secondary to reduced activity level or, conversely, partial immobilization. INTRODUCTION To reveal the time courses and impact of the paravertebral muscles (PVMs) on the healing process of osteoporotic vertebral fractures and risk factors for PVM decrease. METHODS Consecutive patients with symptomatic osteoporotic vertebral fractures were enrolled in 11 hospitals. At enrollment and 3- and 6-month follow-up, PVMs, including the multifidus and erector spinae, were examined using magnetic resonance imaging (MRI). The PVM cross-sectional area (CSA) and fat signal fraction (FSF) were measured at L3. Low back pain (LBP), activities of daily living (ADLs), and risk factors for PVM decrease at the 6-month follow-up were investigated. PVM decrease was defined as > 1 standard deviation decrease of the CSA or > 1 standard deviation increase of the FSF. RESULTS Among 153 patients who completed the 6-month follow-up, 117 (92 women, 79%) had MRI of L3 at enrollment and 3- and 6-month follow-up (mean age at enrollment, 78.5 years). The CSA did not change 6 months from onset (p for trend = 0.634), whereas the FSF significantly increased (p for trend = 0.033). PVM decrease was observed in 30 patients (26%). LBP was more severe, and delayed union was more frequent in patients with PVM decrease (p = 0.021 mixed-effect model and p = 0.029 chi-square test, respectively). The risk factors for PVM decrease were ADL decline at the 3-month follow-up (adjusted odds ratio = 5.35, p = 0.026). CONCLUSION PVM decrease was significantly related to LBP and delayed union after osteoporotic vertebral fracture onset. ADL decline at the 3-month follow-up was a risk factor for PVM decrease. Therefore, restoring ADLs within 3 months after onset is important.
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Affiliation(s)
- S Takahashi
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - M Hoshino
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
| | - K Takayama
- Department of Orthopaedic Surgery, Seikeikai Hospital, Osaka, Japan
| | - R Sasaoka
- Department of Orthopaedic Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | - T Tsujio
- Department of Orthopaedic Surgery, Shiraniwa Hospital, Nara, Japan
| | - H Yasuda
- Department of Orthopaedic Surgery, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
| | - F Kanematsu
- Department of Orthopaedic Surgery, Saiseikai Nakatsu Hospital, Osaka, Japan
| | - H Kono
- Department of Orthopaedic Surgery, Ishikiri Seiki Hospital, Osaka, Japan
| | - H Toyoda
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - S Ohyama
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Y Hori
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - H Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
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Jang HJ, Hughes LC, Oh DW, Kim SY. Effects of Corrective Exercise for Thoracic Hyperkyphosis on Posture, Balance, and Well-Being in Older Women: A Double-Blind, Group-Matched Design. J Geriatr Phys Ther 2020; 42:E17-E27. [PMID: 28914720 DOI: 10.1519/jpt.0000000000000146] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to identify the effects of a corrective exercise for thoracic hyperkyphosis on posture, balance, and well-being in Korean community-dwelling older women. METHODS Fifty women 65 years of age and older, recruited from 2 senior centers, participated in this study. Participants were assigned to either the experimental group (EG) or the control group (CG) on the basis of convenience of location, and 22 in each were analyzed. Participants in the EG underwent a thoracic corrective exercise program 1 hour each session, twice per week for 8 weeks (a total of 16 sessions), which consisted of specific exercises to enhance breathing, thoracic mobility and stability, and awareness of thoracic alignment. The CG received education on the same thoracic corrective exercise program and a booklet of the exercises. Outcome measures included the extent of postural abnormality (angle of thoracic kyphosis, kyphosis index calculated both in relaxed- and best posture using flexicurve, the ratio of the kyphosis index calculated best posture/relaxed posture, craniovertebral angle, and tragus-to-wall distance), balance (Short Physical Performance Battery and limit of stability), and well-being (Geriatric Depression Scale Short Form and the 36-Item Short Form Health Survey [SF-36]). All data were collected by 6 blinded assessors at baseline, at 8 weeks after the completion of intervention, and at 16 weeks for follow-up. RESULTS AND DISCUSSION For participants of the EG, means of all parameters showed significant improvements over time (P < .05), with improved values both in comparison of baseline to postintervention and baseline to follow-up. Means of CG parameters were significantly improved in only the angle of thoracic kyphosis and the tragus-to-wall distance (P < .05). Furthermore, in all parameters, percent change between baseline and postintervention data was significantly (P < .05) higher for the EG than that for the CG, except for the limit of stability and SF-36 which improved but not significantly. All parameters between baseline and follow-up data were significantly (P < .05) higher for the EG than those for the CG, except for the limit of stability. CONCLUSIONS The findings of this study suggest that a well-designed exercise program may be beneficial to improve spinal posture, balance, and well-being in older women with thoracic hyperkyphosis. We recommend the use of the therapeutic strategies utilized in this study to enhance thoracic posture, balance, and well-being of older women with thoracic hyperkyphosis. Future research is needed to apply this exercise protocol on a larger and more diverse population.
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Affiliation(s)
- Hyun-Jeong Jang
- Department of Physical Therapy, School of Health Professions, The University of Texas Medical Branch, Galveston
| | - Lynne C Hughes
- Department of Physical Therapy, School of Health Professions, The University of Texas Medical Branch, Galveston
| | - Duck-Won Oh
- Department of Physical Therapy, College of Health Science, Cheongju University, Chungcheong Province, South Korea
| | - Suhn-Yeop Kim
- Department of Physical Therapy, College of Health and Medical Science, Daejeon University, Daejeon, South Korea
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13
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McArthur C, Gibbs JC, Ashe MC, Cheung AM, Hill KD, Kendler DL, Khan A, Prasad S, Thabane L, Wark JD, Giangregorio LM. The association between trunk muscle endurance, balance and falls self-efficacy in women with osteoporotic vertebral fractures: an exploratory analysis from a pilot randomized controlled trial. Disabil Rehabil 2019; 43:2268-2274. [PMID: 31786954 DOI: 10.1080/09638288.2019.1696418] [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: 10/25/2022]
Abstract
BACKGROUND Trunk muscle endurance may be associated with balance and falls self-efficacy for people with osteoporosis. However, all previous studies have examined trunk muscle strength rather than endurance. PURPOSE To explore the relationships between trunk muscle endurance and standing balance and falls self-efficacy for women with vertebral fractures. MATERIALS AND METHODS This is an exploratory, secondary analysis of baseline data of a pilot randomized controlled trial in Ontario, Canada. Thirty-one women with osteoporosis, aged 65 years or older, with at least one vertebral fracture were included. The associations between balance (Balance Outcome Measure for Elder Rehabilitation) and trunk muscle endurance (Timed Loaded Standing Test) and falls self-efficacy (Falls Efficacy Scale International) and trunk muscle endurance were tested via Spearman rank order correlation with Fisher's z transformations. RESULTS Trunk muscle endurance was correlated with better balance performance on the Balance Outcome Measure for Elder Rehabilitation [Spearman correlation coefficient, 0.71; 95% confidence interval: 0.47-0.85; p < 0.001], but not with falls self efficacy (Spearman correlation coefficient; -0.22; 95% confidence interval: -0.53 to 0.14; p = 0.23). CONCLUSIONS Trunk muscle endurance was moderately associated with better standing balance performance but not falls self-efficacy, highlighting the importance of trunk muscle endurance for standing balance for older adults with osteoporosis and vertebral fractures.Implications for RehabilitationOlder adults with osteoporosis and vertebral fractures who have better trunk muscle endurance may also have better standing balance.There was no association between trunk muscle endurance and how confident a person is that they will not fall while completing various activities of daily living.Trunk muscle endurance training could be included as part of a standing balance rehabilitation program for this population.
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Affiliation(s)
| | - Jenna C Gibbs
- Department of Kinesiology and Physical Activity, McGill University, Montreal, Canada
| | - Maureen C Ashe
- Department of Family Medicine, University of British Columbia, Vancouver, Canada
| | - Angela M Cheung
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Keith D Hill
- Department of Rehabilitation, Ageing and Independent Living, Curtin University, Victoria, Australia
| | - David L Kendler
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Aliya Khan
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Sadhana Prasad
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Lehana Thabane
- Department of Medicine, McMaster University, Hamilton, Canada
| | - John D Wark
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Lora M Giangregorio
- Department of Kinesiology, University of Waterloo, Waterloo, Canada.,Schlegel-UW Research Institute on Aging, Waterloo, Canada
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14
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Barker KL, Newman M, Stallard N, Leal J, Minns Lowe C, Javaid MK, Noufaily A, Adhikari A, Hughes T, Smith DJ, Gandhi V, Cooper C, Lamb SE. Exercise or manual physiotherapy compared with a single session of physiotherapy for osteoporotic vertebral fracture: three-arm PROVE RCT. Health Technol Assess 2019; 23:1-318. [PMID: 31456562 DOI: 10.3310/hta23440] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND A total of 25,000 people in the UK have osteoporotic vertebral fracture (OVF). Evidence suggests that physiotherapy may have an important treatment role. OBJECTIVE The objective was to investigate the clinical effectiveness and cost-effectiveness of two different physiotherapy programmes for people with OVF compared with a single physiotherapy session. DESIGN This was a prospective, adaptive, multicentre, assessor-blinded randomised controlled trial (RCT) with nested qualitative and health economic studies. SETTING This trial was based in 21 NHS physiotherapy departments. PARTICIPANTS The participants were people with symptomatic OVF. INTERVENTIONS Seven sessions of either manual outpatient physiotherapy or exercise outpatient physiotherapy compared with the best practice of a 1-hour single session of physiotherapy (SSPT). MAIN OUTCOME MEASURES Outcomes were measured at 4 and 12 months. The primary outcomes were quality of life and muscle endurance, which were measured by the disease-specific QUALEFFO-41 (Quality of Life Questionnaire of the European Foundation for Osteoporosis - 41 items) and timed loaded standing (TLS) test, respectively. Secondary outcomes were (1) thoracic kyphosis angle, (2) balance, evaluated via the functional reach test (FRT), and (3) physical function, assessed via the Short Physical Performance Battery (SPPB), 6-minute walk test (6MWT), Physical Activity Scale for the Elderly, a health resource use and falls diary, and the EuroQol-5 Dimensions, five-level version. RESULTS A total of 615 participants were enrolled, with 216, 203 and 196 randomised by a computer-generated program to exercise therapy, manual therapy and a SSPT, respectively. Baseline data were available for 613 participants, 531 (86.6%) of whom were women; the mean age of these participants was 72.14 years (standard deviation 9.09 years). Primary outcome data were obtained for 69% of participants (429/615) at 12 months: 175 in the exercise therapy arm, 181 in the manual therapy arm and 173 in the SSPT arm. Interim analysis met the criteria for all arms to remain in the study. For the primary outcomes at 12 months, there were no significant benefits over SSPT of exercise [QUALEFFO-41, difference -0.23 points, 95% confidence interval (CI) -3.20 to 1.59 points; p = 1.000; and TLS test, difference 5.77 seconds, 95% CI -4.85 to 20.46 seconds; p = 0.437] or of manual therapy (QUALEFFO-41, difference 1.35 points, 95% CI -1.76 to 2.93 points; p = 0.744; TLS test, difference 9.69 seconds (95% CI 0.09 to 24.86 seconds; p = 0.335). At 4 months, there were significant gains for both manual therapy and exercise therapy over SSPT in the TLS test in participants aged < 70 years. Exercise therapy was superior to a SSPT at 4 months in the SPPB, FRT and 6MWT and manual therapy was superior to a SSPT at 4 months in the TLS test and FRT. Neither manual therapy nor exercise therapy was cost-effective relative to a SSPT using the threshold of £20,000 per quality-adjusted life-year. There were no treatment-related serious adverse events. CONCLUSIONS This is the largest RCT to date assessing physiotherapy in participants with OVFs. At 1 year, neither treatment intervention conferred more benefit than a single 1-hour physiotherapy advice session. The focus of future work should be on the intensity and duration of interventions to determine if changes to these would demonstrate more sustained effects. TRIAL REGISTRATION Current Controlled Trials ISRCTN49117867. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 44. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Karen L Barker
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Meredith Newman
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Nigel Stallard
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jose Leal
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Catherine Minns Lowe
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Muhammad K Javaid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Angela Noufaily
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Anish Adhikari
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Tamsin Hughes
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - David J Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Varsha Gandhi
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Cyrus Cooper
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Forsyth AL, Joshi RY, Canning CG, Allen NE, Paul SS. Flexed Posture in Parkinson Disease: Associations With Nonmotor Impairments and Activity Limitations. Phys Ther 2019; 99:893-903. [PMID: 30830153 DOI: 10.1093/ptj/pzz033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 09/18/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND People with Parkinson disease (PD) are twice as likely to develop flexed truncal posture as the general older population. Little is known about the mechanisms responsible beyond associations with age, axial motor impairments, and disease severity. OBJECTIVE The objective was to explore: (1) the associations of the nonmotor impairments of PD with flexed posture, and (2) the relationships of flexed posture with activity limitations. DESIGN This was a cross-sectional study. METHODS Seventy people with PD participated. Posture was measured in standing as the distance between the seventh cervical vertebra and a wall. Nonmotor impairments (cognition, depression, pain, fatigue, and proprioception) and activity performance (upper limb activity, bed transfers, respiratory function, and speech volume) were variously assessed using objective measures and self-report questionnaires. Univariate and multivariate regression analyses were performed to ascertain relationships between nonmotor impairments and truncal posture, and between truncal posture and activities. RESULTS Greater disease severity, greater axial impairment, poorer spinal proprioception, greater postural fatigue, and male sex were significantly associated with flexed truncal posture. The multivariate model containing these factors in addition to age explained 30% of the variability in flexed truncal posture, with male sex and axial motor impairment continuing to make independent contributions. A significant association was found between greater flexed truncal posture and poorer upper limb activity performance and respiratory function. LIMITATIONS A limitation to this study was that participants had mild-to-moderate disease severity. CONCLUSIONS Spinal proprioception and postural fatigue were the only nonmotor impairments to make significant contributions to flexed posture. Given the negative influence of flexed posture on upper limb activity and respiratory function, interventions targeting spinal proprioception and postural awareness should be considered for people with PD who might develop flexed posture.
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Affiliation(s)
- Aimi L Forsyth
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney; and Lady Davidson Private Hospital, Sydney, Australia
| | - Riddhi Y Joshi
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Australia
| | - Colleen G Canning
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Australia
| | - Natalie E Allen
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Australia
| | - Serene S Paul
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney NSW 2141, Australia
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16
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Ebrahim Mousavi M, Ahmadi Bani M, Aboutorabi A, Zare H, Head J, Movahedi Yeghaneh M, Ahmadi E. The effect of a semi-rigid thoracolumbosacral orthosis (TLSO) on foot pressure in elderly subjects presenting with spinal hyperkyphosis. Disabil Rehabil Assist Technol 2019; 15:205-210. [PMID: 31204547 DOI: 10.1080/17483107.2018.1555289] [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: 10/26/2022]
Abstract
Purpose: The ageing process can be accompanied by a degeneration of the spine and increase the risk of thoracic hyperkyphosis (excessive spinal forward curvature) amongst elderly people. This condition can in turn impair mobility, reduce balance, and increase the risk of falling and mortality in affected individuals. The use of corrective orthotic bracing has been shown to improve spinal posture, and increase stability and balance amongst the elderly. However, there is little evidence that evaluates the use of corrective braces on foot pressure changes in these subjects.Methods: In this study, we evaluated the use of a thoracolumbosacral orthosis (TLSO) on 19 subjects over 60 years old who presented with hyperkyphosis. We measured foot pressure using the Pedar-X system before (without brace) and after (with brace) immediate using a TLSO in both static (quite standing) and dynamic (walking on a 5 meters freeway) scenarios.Results: The results demonstrated that using a TLSO immediately decreases forefoot pressures in stasis, and around the first metatarsal, as well as pressures relating to the second to fifth metatarsals under dynamic conditions. Hindfoot pressures were increased, but not significantly.Conclusion: This study showed that using a TLSO can be beneficial for elderly people with hyperkyphosis.Implications for rehabilitationThe ageing process can be accompanied by a degeneration of the spine and increase the risk of thoracic hyperkyphosis.The use of corrective orthotic bracing has been shown to improve spinal posture, and increase stability and balance amongst the elderly.Using a TLSO decreases forefoot pressures in stasis, and around the first metatarsal, as well as pressures relating to the second to fifth metatarsals under dynamic conditions.
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Affiliation(s)
| | - Monireh Ahmadi Bani
- Orthotics and Prosthetics Department, University of Social Welfare and Rehabilitation Sciences
| | - Atefeh Aboutorabi
- Orthotics and Prosthetics Department, University of Social Welfare and Rehabilitation Sciences
| | - Hessam Zare
- Orthotics and Prosthetics Department, University of Social Welfare and Rehabilitation Sciences
| | - John Head
- Institute for Health & Social Care Research (IHSCR), University of Salford, Salford, United Kingdom
| | | | - Elaheh Ahmadi
- Physical therapist, Allied Health Faculty Hacettepe University, Ankara, Turkey
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17
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Huang WNW, VanSwearingen J. An observational treatment-based gait pattern classification method for targeting interventions for older adult males with mobility problems: Validity based on movement control and biomechanical factors. Gait Posture 2019; 71:192-197. [PMID: 31078008 DOI: 10.1016/j.gaitpost.2019.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/20/2019] [Accepted: 04/09/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND A reliable and valid observational gait assessment intended to guide clinical intervention for gait deficits in older adults has not been proposed. A quick gait classification method which tailors clinical management for different patterns of gait dysfunction may be useful for clinicians with limited access to apply computer-assisted gait analyses. RESEARCH QUESTION This work aims to establish reliability and validity of the Treatment-Based Gait Pattern Classification (TBGPC) that can be used to quickly identify and classify mobility problems of older males, and possibly target interventions for specific gait deficits in clinical settings. METHOD Videotapes of 116 older male veterans referred for mobility problems were analyzed in this cross-sectional study. The TBGPC defined by movement control (consistent, inconsistent) and postural biomechanical factors (usual, flexed, extended, crouched) was validated by comparing means of individual items of the Modified Gait Abnormality Rating Scale (GARS-M) across groups. RESULTS Kappas for interrater reliability of the TBGPC movement control and biomechanical components were 0.59 and 0.75, respectively; for intrarater reliability, 0.82 and 0.72, respectively. Both movement control and biomechanical components were validated. All GARS-M items were different between older males with consistent and inconsistent gait. Within the consistent and inconsistent group, hip ROM was one of the most differentiating GARS-M item between older males with usual and flexed gait and flexed and crouched group. Total GARS-M score and guardedness were two differentiating factors between the usual and crouched group. SIGNIFICANCE Gait patterns of older males were reliably recognized and validated by mean differences in abnormal characteristics of gait across patterns. The TBGPC may be useful to quickly identify and classify mobility problems of older males and to guide clinical intervention.
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Affiliation(s)
- Wen-Ni Wennie Huang
- Department of Physical Therapy, I-Shou University, No.8, Yida Rd., Jiaosu Village Yanchao District, Kaohsiung, 82445, Taiwan, ROC.
| | - Jessie VanSwearingen
- Department of Physical Therapy, University of Pittsburgh, Bridgeside Point 1, Suite 233, 100 Technology Drive, Pittsburgh, PA, 15260, USA.
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Kocyigit BF, Berk E. Comparison of Lumbosacral Alignment in Geriatric and Non-Geriatric patients suffering low back pain. Pak J Med Sci 2018; 34:282-287. [PMID: 29805394 PMCID: PMC5954365 DOI: 10.12669/pjms.342.13969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Objective: Lumbosacral alignment is a crucial factor for an appropriate spinal function. Changes in spinal alignment lead to diminished body biomechanics. Additionally, lumbosacral alignment may affect quality of life, sagittal balance and fall risk in elderly. In this study, we aimed to compare lumbosacral alignment in geriatric and non-geriatric patients suffering from low back pain. Methods: A total of 202 (120 male and 82 female) patients who visited to physical medicine and rehabilitation clinic with low back pain between January 2017 and August 2017 were enrolled in this study. Standing lateral lumbar radiographs were obtained from the electronic hospital database. Lumbar lordosis angle, sacral tilt, lumbosacral angle and lumbosacral disc angle were calculated on lateral standing lumbar radiographs. Results: The mean age of the non-geriatric group was 43.02 ± 13.20 years, the geriatric group was 71.61 ± 6.42 years. In geriatric patients, lumbar lordosis angle, sacral tilt and lumbosacral disc angle were significantly smaller (p = 0.042, p = 0.017 and p = 0.017). No significant differences were observed in lumbosacral angle between the groups (p = 0.508). Conclusion: Our study indicates the specific changes in lumbosacral alignment with aging. Identifying these changes in lumbosacral alignment in the geriatric population will enable to create proper rehabilitation strategies.
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Affiliation(s)
- Burhan Fatih Kocyigit
- Dr. Burhan Fatih Kocyigit, Department of Physical Medicine and Rehabilitation, Kahramanmaras Sutcu Imam University School of Medicine, Kahramanmaras, Turkey
| | - Ejder Berk
- Dr. Ejder Berk, Department of Physical Medicine and Rehabilitation, Kahramanmaras Sutcu Imam University School of Medicine, Kahramanmaras, Turkey
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Aboutorabi A, Arazpour M, Ahmadi Bani M, Keshtkar AA. Effect of spinal orthoses and postural taping on balance, gait and quality of life in older people with thoracic hyperkyphosis: protocol for a systematic review and meta-analysis. BMJ Open 2018; 8:e015813. [PMID: 29391361 PMCID: PMC5829855 DOI: 10.1136/bmjopen-2016-015813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Thoracic hyperkyphosis is one of the most common spinal disorders in older people, creating impairment, postural instability, gait disorders and a reduced quality of life. The use of spinal orthoses and/or postural taping may be feasible conservative interventions, but their efficacy is uncertain. The aim of this review is therefore to investigate the effectiveness of spinal orthoses and taping on the balance and gait of older people with hyperkyphosis. METHODS AND ANALYSIS We will include randomised controlled trials and clinical trial studies which assess the efficacy of spinal orthoses and taping using the WHO International Classification of Functioning, Disability and Health (ICF) outcome measures in older people with hyperkyphosis of the thoracic spine. A search will be performed in PubMed, SCOPUS, ISI Web of Knowledge, CENTRAL, EMBASE, CINAHL, AMED, PEDro, REHAB DATA and RECAL databases with no restriction of language. Two independent reviewers will perform the study selection and data extraction. Quality assessment will be implemented using modified Down and Black checklists. Publication bias and data synthesis will be assessed by funnel plots, Begg's and Egger's tests, and plots using STATA software V.12.1 version. ETHICS AND DISSEMINATION No ethical issues are predicted. These findings will be published in a peer reviewed journal and presented at national and international conferences. PROSPERO REGISTRATION NUMBER CRD42016045880.
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Affiliation(s)
- Atefeh Aboutorabi
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Iranian Research Centre on Ageing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mokhtar Arazpour
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Paediatric Neurorehabilitation Research Centre, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Monireh Ahmadi Bani
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Iranian Research Centre on Ageing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Abbas Ali Keshtkar
- Department of Health Sciences Education Development, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Namdar N, Arazpour M, Ahmadi Bani M. Comparison of the immediate efficacy of the Spinomed ® back orthosis and posture training support on walking ability in elderly people with thoracic kyphosis. Disabil Rehabil Assist Technol 2017; 14:217-220. [PMID: 29265891 DOI: 10.1080/17483107.2017.1419295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The effect of spinal orthoses, including the Spinomed® and posture training support (PTS) in improving balance and reducing falls in older people has been previously evaluated. However, there is little evidence available regarding their effect on the walking ability of older individuals with thoracic hyperkyphosis. This study was therefore designed to compare the immediate effect of the Spinomed® orthosis and PTS on specific gait parameters in this patient group. METHODS A total of 34 older volunteer subjects with thoracic hyperkyphosis participated in this study and were randomly allocated into two groups, to either walk with the Spinomed® orthosis in situ or the PTS. The elderly mobility scale test (EMS), two-minute walk test (2-MWT), and 10-meter walk test (10-MWT) were used to evaluate their walking performance, the distance walked and their walking speed respectively. RESULTS There were no significant differences in the mean age, body mass index (BMI), kyphosis angle, EMS, 2-MWT, and 10-MWT between the groups at baseline. All parameters were uniform amongst the two groups. The Spinomed® orthosis and PTS both had a positive and significant effect on the EMS score, the 2-MWT, and the 10-MWT. No significant difference was detected between two the types of orthoses in terms of the EMS score, the 2-MWT, or the 10-MWT. CONCLUSIONS The Spinomed® and PTS were both effective in improving all the primary outcome measures, with similar improvements demonstrated by both orthoses. Implications for rehabilitations In this category, one of the approaches to treat the elderly with hyperkyphosis is the use of spinal orthoses such as Spinomed® orthosis and posture training support (PTS). The results showed that the anti-kyphosis orthosis including Spinomed® and PTS played effective roles in the elderly with hyperkyphosis to improve their walking function. According to the current study results, there was no significant difference between the efficacies of these orthoses in the mentioned parameters.
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Affiliation(s)
- Nategh Namdar
- a Student Research Commute , University of Social Welfare and Rehabilitation Sciences , Tehran , Islamic Republic of Iran
| | - Mokhtar Arazpour
- b Pediatric Neurorehabilitation Research Center , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran.,c Orthotics and Prosthetics Department , University of Social Welfare and Rehabilitation Sciences , Tehran , Islamic Republic of Iran
| | - Monireh Ahmadi Bani
- b Pediatric Neurorehabilitation Research Center , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran
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Harding AT, Weeks BK, Horan SA, Little A, Watson SL, Beck BR. Validity and test-retest reliability of a novel simple back extensor muscle strength test. SAGE Open Med 2017; 5:2050312116688842. [PMID: 28255442 PMCID: PMC5315361 DOI: 10.1177/2050312116688842] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 12/20/2016] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To develop and determine convergent validity and reliability of a simple and inexpensive clinical test to quantify back extensor muscle strength. METHODS Two testing sessions were conducted, 7 days apart. Each session involved three trials of standing maximal isometric back extensor muscle strength using both the novel test and isokinetic dynamometry. Lumbar spine bone mineral density was examined by dual-energy X-ray absorptiometry. Validation was examined with Pearson correlations (r). Test-retest reliability was examined with intraclass correlation coefficients and limits of agreement. Pearson correlations and intraclass correlation coefficients are presented with corresponding 95% confidence intervals. Linear regression was used to examine the ability of peak back extensor muscle strength to predict indices of lumbar spine bone mineral density and strength. RESULTS A total of 52 healthy adults (26 men, 26 women) aged 46.4 ± 20.4 years were recruited from the community. A strong positive relationship was observed between peak back extensor strength from hand-held and isokinetic dynamometry (r = 0.824, p < 0.001). For the novel back extensor strength test, short- and long-term reliability was excellent (intraclass correlation coefficient = 0.983 (95% confidence interval, 0.971-0.990), p < 0.001 and intraclass correlation coefficient = 0.901 (95% confidence interval, 0.833-0.943), p < 0.001, respectively). Limits of agreement for short-term repeated back extensor strength measures with the novel back extensor strength protocol were -6.63 to 7.70 kg, with a mean bias of +0.71 kg. Back extensor strength predicted 11% of variance in lumbar spine bone mineral density (p < 0.05) and 9% of lumbar spine index of bone structural strength (p < 0.05). CONCLUSION Our novel hand-held dynamometer method to determine back extensor muscle strength is quick, relatively inexpensive, and reliable; demonstrates initial convergent validity in a healthy population; and is associated with bone mass at a clinically important site.
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Affiliation(s)
- Amy T Harding
- Menzies Health Institute Queensland, Griffith University, Gold Coast campus, QLD, Australia; School of Allied Health Sciences, Griffith University, Gold Coast campus, QLD, Australia
| | - Benjamin Kurt Weeks
- Menzies Health Institute Queensland, Griffith University, Gold Coast campus, QLD, Australia; School of Allied Health Sciences, Griffith University, Gold Coast campus, QLD, Australia
| | - Sean A Horan
- Menzies Health Institute Queensland, Griffith University, Gold Coast campus, QLD, Australia; School of Allied Health Sciences, Griffith University, Gold Coast campus, QLD, Australia
| | - Andrew Little
- School of Medicine, Griffith University, Gold Coast campus, QLD, Australia
| | - Steven L Watson
- Menzies Health Institute Queensland, Griffith University, Gold Coast campus, QLD, Australia; School of Allied Health Sciences, Griffith University, Gold Coast campus, QLD, Australia
| | - Belinda Ruth Beck
- Menzies Health Institute Queensland, Griffith University, Gold Coast campus, QLD, Australia; School of Allied Health Sciences, Griffith University, Gold Coast campus, QLD, Australia; The Bone Clinic, Brisbane, QLD, Australia
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Conservative management of osteoporotic vertebral fractures: an update. Eur J Trauma Emerg Surg 2016; 43:19-26. [DOI: 10.1007/s00068-016-0747-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 11/29/2016] [Indexed: 12/14/2022]
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23
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Kang JI, Kwon HM, Jeong DK, Choi H, Moon YJ, Park JS. The effects on postural control and low back pain according to the types of orthoses in chronic low back pain patients. J Phys Ther Sci 2016; 28:3074-3077. [PMID: 27942123 PMCID: PMC5140803 DOI: 10.1589/jpts.28.3074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 07/19/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study investigated how types of lumbosacral orthoses applied to patients
with chronic lumbar pain affect postural control and low back pain. [Subjects and Methods]
Ten subjects were randomly selected and allocated to each a group wearing soft lumbosacral
orthoses and a group wearing rigid lumbosacral orthoses. They wore the lumbosacral
orthoses for 4 weeks. Pain index and postural control were measured on the first day of
wearing lumbosacral orthoses and 4 weeks later. Pain index was evaluated using a visual
analogue scale, and postural control was measured using a Balance measurement system. The
measurements examined included the overall balance index, anteroposterior balance index,
and mediolateral balance index. [Results] There were statistically meaningful within-group
differences in all variables, the visual analogue scale, overall balance index,
anteroposterior balance index, and mediolateral balance index, in the group wearing soft
lumbosacral orthoses. There were meaningful differences in visual analogue scale, overall
balance index, and mediolateral balance index in the group wearing rigid lumbosacral
orthoses. Furthermore, there was a meaningful difference in anteroposterior balance index
between the group wearing soft lumbosacral orthoses and the group wearing rigid
lumbosacral orthoses. [Conclusion] The results of the present study showed that wearing
soft lumbosacral orthoses was more effective than wearing rigid lumbosacral orthoses.
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Affiliation(s)
- Jeong-Il Kang
- Department of Physical Therapy, Sehan University: 1113 Noksaek-ro, Samho-eup, Youngam-gun, Jeonnam 526-702, Republic of Korea
| | - Hye-Min Kwon
- Department of Physical Therapy, Sehan University: 1113 Noksaek-ro, Samho-eup, Youngam-gun, Jeonnam 526-702, Republic of Korea
| | - Dae-Keun Jeong
- Department of Physical Therapy, Sehan University: 1113 Noksaek-ro, Samho-eup, Youngam-gun, Jeonnam 526-702, Republic of Korea
| | - Hyun Choi
- Department of Physical Therapy, Mokpo Mirae Hospital, Republic of Korea
| | - Young-Jun Moon
- Department of Physical Therapy, Mokpo Jung-ang Hospital, Republic of Korea
| | - Jun-Su Park
- Department of Physical Therapy, Sehan University: 1113 Noksaek-ro, Samho-eup, Youngam-gun, Jeonnam 526-702, Republic of Korea
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24
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Khalili A, Almasi MH, Raeissadat SA, Sedighipour L, Salek Zamani Y, Zohoor MRO. Long-term effects of back extensor strengthening exercises on quality of life in women with osteoporosis. J Women Aging 2016; 29:505-514. [PMID: 27710700 DOI: 10.1080/08952841.2016.1223968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The aim of the present study was to evaluate the long-term effect of back extensor strengthening exercises on health-related quality of life (QOL) in women with osteoporosis. In this randomized clinical trial, 183 women with osteoporosis were treated with pharmacotherapy and weight-bearing and balance-training exercises. The case group additionally performed back extensor exercises at home. Patients filled out the Persian version of the Short Form (SF-36) QOL questionnaire at baseline and 6 months post treatment. At the end, all physical and mental parameters of the SF-36 questionnaire improved significantly in the case group, except for one subscale of mental health, compared to the control group. In the control group, only some physical health dimensions (bodily pain, role limitation, physical function, vitality), and mental health status as a mental health subscale improved. In conclusion, considering a major impact of back extensor exercises on improving QOL in women with osteoporosis over the long term, these exercises should be prescribed in routine management of these patients.
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Affiliation(s)
- Ahmad Khalili
- a Department of Orthopedic Surgery, Boo-Ali Hospital , Islamic Azad University of Medical Sciences , Tehran , Iran
| | - Minoo Heidari Almasi
- b Boo-Ali Hospital , Islamic Azad University , Tehran Medical Branch, Tehran , Iran
| | - Seyed Ahmad Raeissadat
- c Physical Medicine and Rehabilitation Research Center , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Leyla Sedighipour
- d Clinical Research Development Center of Shahid Modarres Hospital , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Yaghoub Salek Zamani
- e Physical Medicine and Rehabilitation Research Center , Tabriz University of Medical Sciences , Tabriz , Iran
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25
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Brubaker ML, Sinaki M. Successful management of iliocostal impingement syndrome: A case series. Prosthet Orthot Int 2016; 40:384-7. [PMID: 26527757 DOI: 10.1177/0309364615605394] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 07/27/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND Iliocostal impingement syndrome is a rare, painful, and disabling condition associated with thoracic hyperkyphosis and kyphoscoliosis. There is little published literature regarding management of this syndrome. The purpose of this case series is to report treatment outcomes for iliocostal impingement syndrome with improving posture and back muscle strength. CASE DESCRIPTION AND METHODS Thirty-eight women with thoracic hyperkyphosis or kyphoscoliosis and back and/or flank pain were diagnosed with iliocostal impingement syndrome on the basis of symptoms and spine radiographs. They were instructed in weighted kypho-orthosis use and taught a home back-extensor strengthening program. Outcome measures included posture evaluation and pain level. FINDINGS AND OUTCOMES All patients reported immediate pain reduction with weighted kypho-orthosis trial. Nineteen patients returned within 2 years, and all had continued pain relief and posture improvement. CONCLUSIONS Our findings suggest that successful management of iliocostal impingement syndrome is possible with a weighted kypho-orthosis and back strengthening program focusing on posture improvement. CLINICAL RELEVANCE Iliocostal syndrome is a rare, painful, and disabling condition that severely affects quality of life. This report discusses our diagnostic and treatment approach to this syndrome, which has proven successful in our patient population.
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Affiliation(s)
- Morgan L Brubaker
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Mehrsheed Sinaki
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
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Anguera A, Barreiro J, Lara J, Lizcano D. Applying data mining techniques to medical time series: an empirical case study in electroencephalography and stabilometry. Comput Struct Biotechnol J 2016; 14:185-99. [PMID: 27293535 PMCID: PMC4887593 DOI: 10.1016/j.csbj.2016.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 05/03/2016] [Accepted: 05/08/2016] [Indexed: 11/02/2022] Open
Abstract
One of the major challenges in the medical domain today is how to exploit the huge amount of data that this field generates. To do this, approaches are required that are capable of discovering knowledge that is useful for decision making in the medical field. Time series are data types that are common in the medical domain and require specialized analysis techniques and tools, especially if the information of interest to specialists is concentrated within particular time series regions, known as events. This research followed the steps specified by the so-called knowledge discovery in databases (KDD) process to discover knowledge from medical time series derived from stabilometric (396 series) and electroencephalographic (200) patient electronic health records (EHR). The view offered in the paper is based on the experience gathered as part of the VIIP project. Knowledge discovery in medical time series has a number of difficulties and implications that are highlighted by illustrating the application of several techniques that cover the entire KDD process through two case studies. This paper illustrates the application of different knowledge discovery techniques for the purposes of classification within the above domains. The accuracy of this application for the two classes considered in each case is 99.86% and 98.11% for epilepsy diagnosis in the electroencephalography (EEG) domain and 99.4% and 99.1% for early-age sports talent classification in the stabilometry domain. The KDD techniques achieve better results than other traditional neural network-based classification techniques.
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Affiliation(s)
- A. Anguera
- Technical University of Madrid, School of Computer Science, Campus de Montegancedo, s/n - 28660, Boadilla del Monte, Madrid, Spain
| | - J.M. Barreiro
- Technical University of Madrid, School of Computer Science, Campus de Montegancedo, s/n - 28660, Boadilla del Monte, Madrid, Spain
| | - J.A. Lara
- Open University of Madrid, UDIMA - Facultad de Enseñanzas Técnicas, Ctra. De la Coruña, km 38.500 – Vía de Servicio, 15 - 28400, Collado Villalba, Madrid, Spain
| | - D. Lizcano
- Open University of Madrid, UDIMA - Facultad de Enseñanzas Técnicas, Ctra. De la Coruña, km 38.500 – Vía de Servicio, 15 - 28400, Collado Villalba, Madrid, Spain
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Paolucci T, Saraceni VM, Piccinini G. Management of chronic pain in osteoporosis: challenges and solutions. J Pain Res 2016; 9:177-86. [PMID: 27099529 PMCID: PMC4824363 DOI: 10.2147/jpr.s83574] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Osteoporosis (OP) is a pathological condition that manifests clinically as pain, fractures, and physical disability, resulting in the loss of independence and the need for long-term care. Chronic pain is a multidimensional experience with sensory, affective, and cognitive aspects. Age can affect each of these dimensions and the pain that is experienced. In OP, chronic pain appears to have sensory characteristics and properties of nociceptive and neuropathic pain. Its evaluation and treatment thus require a holistic approach that focuses on the specific characteristics of this population. Pain management must therefore include pharmacological approaches, physiotherapy interventions, educational measures, and, in rare cases, surgical treatment. Most rehabilitative treatments in the management of patients with OP do not evaluate pain or physical function, and there is no consensus on the effects of rehabilitation therapy on back pain or quality of life in women with OP. Pharmacological treatment of pain in patients with OP is usually insufficient. The management of chronic pain in patients with OP is complicated with regard to its diagnosis, the search for reversible secondary causes, the efficacy and duration of oral bisphosphonates, and the function of calcium and vitamin D. The aim of this review is to discuss the most appropriate solutions in the management of chronic pain in OP.
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Affiliation(s)
- Teresa Paolucci
- Physical Medicine and Rehabilitation Unit, Azienda Policlinico Umberto I, Rome, Italy
| | | | - Giulia Piccinini
- Physical Medicine and Rehabilitation Unit, Azienda Policlinico Umberto I, Rome, Italy
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Newman M, Minns Lowe C, Barker K. Spinal Orthoses for Vertebral Osteoporosis and Osteoporotic Vertebral Fracture: A Systematic Review. Arch Phys Med Rehabil 2015; 97:1013-25. [PMID: 26615791 DOI: 10.1016/j.apmr.2015.10.108] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 10/27/2015] [Accepted: 10/31/2015] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To systematically review the evidence of effectiveness of spinal orthoses for adults with vertebral osteoporosis. DATA SOURCES We conducted a systematic literature search using the databases of PubMed, MEDLINE, EMBASE, AMED, CINAHL, PEDro, and the Cochrane Library from January 1995 to October 2014. STUDY SELECTION Two reviewers evaluated eligibility. Randomized controlled trials (RCTs), pilot RCTs, and prospective nonrandomized controlled studies of spinal orthoses for people with vertebral osteoporosis or osteopenia with and without osteoporotic vertebral fracture (OVF) that examined outcomes related to fracture consolidation, pain, strength, posture, balance, physical function, quality of life, and complications were eligible. DATA EXTRACTION Two reviewers independently extracted data and evaluated methodological quality using a domain-based risk-of-bias approach. DATA SYNTHESIS Twelve studies were included: 8 RCTs or pilot RCTs and 4 nonrandomized studies involving 626 participants. Three studies (n=153) evaluated orthoses after acute OVF; none were of high quality. Complications were highest with rigid orthoses. Evidence that orthoses could affect vertebral deformity was lacking. Nine studies (n=473) of varying quality considered orthoses in subacute and longer rehabilitation. Three suggested a semirigid backpack thoracolumbar orthosis (TLO) could benefit strength, pain, posture, and quality of life. One found a weighted kypho-orthosis (WKO) improved balance. CONCLUSIONS The limited evidence about orthoses after acute OVF is inconclusive; better evidence of efficacy is needed, particularly when considering complications. The promising evidence regarding the backpack TLO and WKO needs to be explored further in studies of sufficient size and quality that include men.
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Affiliation(s)
- Meredith Newman
- Physiotherapy Research Unit, Oxford University Hospitals NHS Trust, Nuffield Orthopaedic Centre, Oxford, England; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England.
| | - Catherine Minns Lowe
- Physiotherapy Research Unit, Oxford University Hospitals NHS Trust, Nuffield Orthopaedic Centre, Oxford, England
| | - Karen Barker
- Physiotherapy Research Unit, Oxford University Hospitals NHS Trust, Nuffield Orthopaedic Centre, Oxford, England; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England
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29
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Ota S, Kano R, Fukuta S, Miyai R, Masaoka N, Yoshida A. Does decrease of the thoracic kyphosis influence decrease knee adduction moment during gait? A preliminary study of a healthy population. J Phys Ther Sci 2015; 27:3077-9. [PMID: 26644647 PMCID: PMC4668138 DOI: 10.1589/jpts.27.3077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 07/06/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to investigate the influence of a decrease in
thoracic kyphosis angle on the knee adduction moment during gait in healthy young
individuals. [Subjects and Methods] Twenty-nine healthy adults, consisting of 15 males and
14 females (21.6 ± 1.1 years old), participated. The draw-in maneuver was used to decrease
thoracic kyphosis, and thoracic kyphosis was measured using a SpinalMouse during normal
standing and standing with the draw-in maneuver. The participants were required to
maintain the draw-in maneuver during gait. A 3-D motion analysis system and a force plate
were used to obtain knee adduction moment. [Results] Thoracic kyphosis angles during the
draw-in maneuver (41.0 ± 7.4 degrees) were significantly decreased compared with the
angles during normal standing (43.0 ± 7.9 degrees). Although the knee adduction moment
during gait with the draw-in maneuver was not significantly decreased compared with that
during level gait, in the 20 subjects who had decreased kyphosis due to the draw-in
maneuver, the 1st peak knee adduction moment (55.7 ± 24.3 × 10−3) with the
draw-in maneuver was significantly decreased compared with the knee adduction moment (57.0
± 16.3 × 10−3) during level gait. [Conclusion] Knee adduction moment in the
case of a decreased thoracic kyphosis angle due to the draw-in maneuver was decreased
compared with that during level gait.
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Affiliation(s)
- Susumu Ota
- Department of Rehabilitation and Care, Seijoh University, Japan
| | - Rika Kano
- Department of Rehabilitation and Care, Seijoh University, Japan
| | - Shoya Fukuta
- Department of Rehabilitation and Care, Seijoh University, Japan
| | - Ryo Miyai
- Department of Rehabilitation and Care, Seijoh University, Japan
| | - Nao Masaoka
- Department of Rehabilitation and Care, Seijoh University, Japan
| | - Akihiro Yoshida
- Department of Rehabilitation and Care, Seijoh University, Japan
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Vieira ER, Tappen R, Engstrom G, da Costa BR. Rates and factors associated with falls in older European Americans, Afro-Caribbeans, African-Americans, and Hispanics. Clin Interv Aging 2015; 10:1705-10. [PMID: 26604718 PMCID: PMC4629952 DOI: 10.2147/cia.s91120] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate rates and factors associated with older adult falls in different ethnic groups. PARTICIPANTS AND METHODS Information on demographics, medical and falls history, and pain and physical activity levels was collected from 550 community-dwelling older adults (75±9 years old, 222 European Americans, 109 Afro-Caribbeans, 106 African-Americans, and 113 Hispanics). RESULTS Taking medications for anxiety (risk ratio [RR] =1.4, 95% confidence interval [CI] =1.1-2.0), having incontinence (RR =1.4, 95% CI =1.1-1.8, P=0.013), back pain (RR =1.4, 95% CI =1.0-1.8), feet swelling (RR =1.3, 95% CI =1.1-1.7), and age ≥75 years (RR =1.3, 95% CI =1.0-1.6) were associated with falls. The associations were stronger for Afro-Caribbeans, but they presented approximately 40% lower prevalence of falls than the other groups. CONCLUSION Taking anxiety medication, incontinence, back pain, feet swelling, and age ≥75 years were associated with falls, and Afro-Caribbeans presented lower prevalence of falls. These findings need to be taken into consideration in clinical interventions in aging.
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Affiliation(s)
- Edgar Ramos Vieira
- Department of Physical Therapy, Florida International University, Miami, FL, USA ; Department of Neuroscience, Florida International University, Miami, FL, USA
| | - Ruth Tappen
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - Gabriella Engstrom
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - Bruno R da Costa
- Department of Physical Therapy, Florida International University, Miami, FL, USA
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31
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Ye BK, Kim HS, Kim YW. Correction of camptocormia using a cruciform anterior spinal hyperextension brace and back extensor strengthening exercise in a patient with Parkinson disease. Ann Rehabil Med 2015; 39:128-32. [PMID: 25750882 PMCID: PMC4351484 DOI: 10.5535/arm.2015.39.1.128] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 07/08/2014] [Indexed: 11/23/2022] Open
Abstract
Parkinson disease, one of the most common neurodegenerative diseases, is characterized by cardinal motor features including bradykinesia, rigidity, resting tremor, postural instability, freezing gait, and fatigue. Of these, postural instability in the form of hyperflexion of the thoracolumbar spine upon standing and walking that disappears on recumbent positioning is called camptocormia. Many different trials have been conducted on the treatment of camptocormia, including physiotherapy, corsets, medications, and deep brain stimulation. However, there is insufficient evidence as to which treatment modality is the most valid in terms of effectiveness, cost, safety, and patient satisfaction. In this study, we present a patient whose symptom of camptocormia was effectively resolved using a cruciform anterior spinal hyperextension (CASH) brace and back extensor strengthening exercise which was modified through follow-ups based on a short-term outpatient setting for proper application with minimal discomfort. The patient was satisfied with the amount of correction provided by the brace and exercise.
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Affiliation(s)
- Byung Kook Ye
- Department of Rehabilitation Medicine and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyoung-Seop Kim
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Yong Wook Kim
- Department of Rehabilitation Medicine and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
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Zuo B, Zhu J, Li J, Wang C, Zhao X, Cai G, Li Z, Peng J, Wang P, Shen C, Huang Y, Xu J, Zhang X, Chen X. microRNA-103a functions as a mechanosensitive microRNA to inhibit bone formation through targeting Runx2. J Bone Miner Res 2015; 30:330-45. [PMID: 25195535 DOI: 10.1002/jbmr.2352] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 08/04/2014] [Accepted: 08/20/2014] [Indexed: 01/20/2023]
Abstract
Emerging evidence indicates that microRNAs (miRNAs) play essential roles in regulating osteoblastogenesis and bone formation. However, the role of miRNA in osteoblast mechanotransduction remains to be defined. In this study, we aimed to investigate whether miRNAs regulate mechanical stimulation-triggered osteoblast differentiation and bone formation through modulation of Runx2, the master transcription factor for osteogenesis. We first investigated the role of mechanical loading both in a mouse model and in an osteoblast culture system and the outcomes clearly demonstrated that mechanical stimuli can regulate osteogenesis and bone formation both in vivo and in vitro. Using bioinformatic analyses and subsequent confirmation by quantitative real-time PCR (qRT-PCR), we found that multiple miRNAs that potentially target Runx2 were responding to in vitro mechanical stimulation, among which miR-103a was fully characterized. miR-103a and its host gene PANK3 were both downregulated during cyclic mechanical stretch (CMS)-induced osteoblast differentiation, whereas Runx2 protein expression was upregulated. Overexpression of miR-103a significantly decreased and inhibition of miR-103a increased Runx2 protein level, suggesting that miR-103a acts as an endogenous attenuator of Runx2 in osteoblasts. Mutation of putative miR-103a binding sites in Runx2 mRNA abolishes miR-103a-mediated repression of the Runx2 3'-untranslated region (3'UTR) luciferase reporter activity, suggesting that miR-103a binds to Runx2 3'UTR. Osteoblast marker gene profiling and osteogenic phenotype assays demonstrated that miR-103a negatively correlates with CMS-induced osteogenesis. Further, the perturbation of miR-103a also has a significant effect on osteoblast activity and matrix mineralization. More importantly, we found an inhibitory role of miR-103a in regulating bone formation in hindlimb unloading mice, and pretreatment with antagomir-103a partly rescued the osteoporosis caused by mechanical unloading. Taken together, our data suggest that miR-103a is the first identified mechanosensitive miRNA that regulates osteoblast differentiation by directly targeting Runx2, and therapeutic inhibition of miR-103a may be an efficient anabolic strategy for skeletal disorders caused by pathological mechanical loading.
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Affiliation(s)
- Bin Zuo
- Department of Orthopedic Surgery, Xinhua Hospital, Shanghai JiaoTong University School of Medicine (SJTUSM), Shanghai, China
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Katzman WB, Harrison SL, Fink HA, Marshall LM, Orwoll E, Barrett-Connor E, Cawthon PM, Kado DM. Physical function in older men with hyperkyphosis. J Gerontol A Biol Sci Med Sci 2014; 70:635-40. [PMID: 25431353 DOI: 10.1093/gerona/glu213] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 10/18/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Age-related hyperkyphosis has been associated with poor physical function and is a well-established predictor of adverse health outcomes in older women, but its impact on health in older men is less well understood. METHODS We conducted a cross-sectional study to evaluate the association of hyperkyphosis and physical function in 2,363 men, aged 71-98 (M = 79) from the Osteoporotic Fractures in Men Study. Kyphosis was measured using the Rancho Bernardo Study block method. Measurements of grip strength and lower extremity function, including gait speed over 6 m, narrow walk (measure of dynamic balance), repeated chair stands ability and time, and lower extremity power (Nottingham Power Rig) were included separately as primary outcomes. We investigated associations of kyphosis and each outcome in age-adjusted and multivariable linear or logistic regression models, controlling for age, clinic, education, race, bone mineral density, height, weight, diabetes, and physical activity. RESULTS In multivariate linear regression, we observed a dose-related response of worse scores on each lower extremity physical function test as number of blocks increased, p for trend ≤.001. Using a cutoff of ≥4 blocks, 20% (N = 469) of men were characterized with hyperkyphosis. In multivariate logistic regression, men with hyperkyphosis had increased odds (range 1.5-1.8) of being in the worst quartile of performing lower extremity physical function tasks (p < .001 for each outcome). Kyphosis was not associated with grip strength in any multivariate analysis. CONCLUSIONS Hyperkyphosis is associated with impaired lower extremity physical function in older men. Further studies are needed to determine the direction of causality.
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Affiliation(s)
- Wendy B Katzman
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco.
| | | | - Howard A Fink
- Geriatric Research Education & Clinical Center, VA Medical Center, Minneapolis, Minnesota
| | - Lynn M Marshall
- Orthopaedics & Rehabilitation Department, Oregon Health and Science University, School of Medicine, Portland
| | - Eric Orwoll
- Orthopaedics & Rehabilitation Department, Oregon Health and Science University, School of Medicine, Portland
| | - Elizabeth Barrett-Connor
- Departments of Family and Preventive Medicine and Internal Medicine, University of California, San Diego
| | - Peggy M Cawthon
- California Pacific Medical Center Research Institute, San Francisco
| | - Deborah M Kado
- Departments of Family and Preventive Medicine and Internal Medicine, University of California, San Diego
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34
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Blain H, Rolland Y, Beauchet O, Annweiler C, Benhamou CL, Benetos A, Berrut G, Audran M, Bendavid S, Bousson V, Briot K, Brazier M, Breuil V, Chapuis L, Chapurlat R, Cohen-Solal M, Cortet B, Dargent P, Fardellone P, Feron JM, Gauvain JB, Guggenbuhl P, Hanon O, Laroche M, Kolta S, Lespessailles É, Letombe B, Mallet É, Marcelli C, Orcel P, Puisieux F, Seret P, Souberbielle JC, Sutter B, Trémollières F, Weryha G, Roux C, Thomas T. Usefulness of bone density measurement in fallers. Joint Bone Spine 2014; 81:403-8. [DOI: 10.1016/j.jbspin.2014.01.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2014] [Indexed: 10/25/2022]
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35
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Valentin G, Maribo T. Hand-held dynamometry fixated with a tripod is reliable for assessment of back extensor strength in women with osteoporosis. Osteoporos Int 2014; 25:2143-9. [PMID: 24866393 DOI: 10.1007/s00198-014-2743-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 05/06/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED An appropriate method to assess back extensor strength in clinical practice has not yet been described. Our results showed that a hand-held dynamometry fixated with a tripod is reliable for assessing back extensor strength in women with osteoporosis. INTRODUCTION Back strengthening exercises play an important role in the rehabilitation of patients with osteoporotic vertebral fractures. Evaluation of the effect of back strengthening exercises requires a method suitable for use in clinical practice to measure back extensor strength. A hand-held dynamometer (HHD) is quick and easy to handle in clinical practice. Currently, there is a lack of evidence whether a HHD is reliable for assessment of back extensor strength in people with osteoporosis. When using a HHD, it may be difficult for the tester to provide a counter pressure corresponding to the effort of the patient. In order to accommodate this, we have developed a tripod and a belt system, which was used to fixate the HHD. This study examined the intra-tester reliability of back extensor strength assessment in women with osteoporosis using a HHD. METHODS Back extensor strength of the participants was measured on two events with 7-day intervals. Test procedures were standardized, and all tests were performed by the same tester. RESULTS Forty-eight women with osteoporosis and vertebral fractures were included in the analysis. The coefficient of variation was 22% using a HHD fixated by the tester and 17% using a HHD fixated with the tripod. ICC was 0.75 (95% confidence interval (CI), 0.63 and 0.88) when using a HHD with fixated by the tester and 0.90 (95% CI, 0.84 and 0.95) when using a HHD fixated with the tripod. CONCLUSION A HHD fixated with a tripod is reliable for the assessment of back extensor strength in women with osteoporosis and vertebral fractures.
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Affiliation(s)
- G Valentin
- Public Health and Quality Improvement, Central Denmark Region, Olof Palmes allé 15, 8200, Aarhus N, Denmark,
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Valentin GH, Pedersen LN, Maribo T. Wearing an active spinal orthosis improves back extensor strength in women with osteoporotic vertebral fractures. Prosthet Orthot Int 2014; 38:232-8. [PMID: 23986468 DOI: 10.1177/0309364613497393] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Accepted: 06/19/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND Vertebral fractures are the most common clinical manifestations of osteoporosis. Vertebral fractures and reduced back extensor strength can result in hyperkyphosis. Hyperkyphosis is associated with diminished daily functioning and an increased risk of falling. Improvements in back extensor strength can result in decreased kyphosis and thus a decreased risk of falls and fractures. OBJECTIVES The aim was to examine the effects of an active spinal orthosis - Spinomed III - on back extensor strength, back pain and physical functioning in women with osteoporotic vertebral fractures. STUDY DESIGN Experimental follow-up. METHODS The women used the active spinal orthosis for 3 months. Outcomes were changes in isometric back extensor strength, changes in back pain and changes in physical functioning. RESULTS A total of 13 women were included in the trial. Wearing the orthosis during a 3-month period was associated with an increase in back extensor strength of 50% (p = 0.01). The study demonstrated a 33% reduction in back pain and a 6.5-point improvement in physical functioning. The differences in pain and physical functioning were borderline significant. CONCLUSION The women demonstrated a clinically relevant improvement in the back extensor strength. The differences in pain and physical functioning were clinically relevant and borderline significant. CLINICAL RELEVANCE The results imply that Spinomed III could be recommended for women with vertebral fractures as a supplement to traditional back strengthening exercises. It is essential that the orthosis is adjusted correctly and that there is an individual programme concerning the amount of time the orthosis has to be worn every day.
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Affiliation(s)
| | | | - Thomas Maribo
- Department of Physiotherapy, Aarhus University Hospital, Aarhus, Denmark
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Suetterlin KJ, Sayer AA. Proprioception: where are we now? A commentary on clinical assessment, changes across the life course, functional implications and future interventions. Age Ageing 2014; 43:313-8. [PMID: 24231586 DOI: 10.1093/ageing/aft174] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Proprioception, the sense of where one is in space, is essential for effective interaction with the environment. A lack of or reduction in proprioceptive acuity has been directly correlated with falls and with reduced functional independence in older people. Proprioceptive losses have also been shown to negatively correlate with functional recovery post stroke and play a significant role in other conditions such as Parkinson's disease. However, despite its central importance to many geriatric syndromes, the clinical assessment of proprioception has remained remarkably static. We look at approaches to the clinical assessment of proprioception, changes in proprioception across the life course, functional implications of proprioception in health and disease and the potential for targeted interventions in the future such as joint taping, and proprioception-specific rehabilitation and footwear.
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Effect of Posture Training with Weighted Kypho-Orthosis (WKO) on Improving Balance in Women with Osteoporosis. J Aging Res 2014; 2014:427903. [PMID: 24734180 PMCID: PMC3964740 DOI: 10.1155/2014/427903] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 01/02/2014] [Indexed: 11/23/2022] Open
Abstract
Objectives. To determine the effect of weighted kypho-orthosis (WKO) on improving balance in women with osteoporosis. In this nonrandomized controlled clinical trial, 31 patients with osteoporosis were included. The patients were assigned to two groups: (1) control group who received 4-week home-based daily exercise program including weight bearing, back strengthening, and balance exercises and (2) intervention group (WKO) who performed aforementioned exercises and wore WKO for one hour twice a day. Patients were assessed using clinical balance tests (timed up and go test, functional reach test, and unilateral balance test) before and 4 weeks after start of treatment. Results. Functional reach and timed up and go test were improved significantly in both groups compared to baseline. The improvement in intervention group was more significant in comparison to control group (P < 0.05). Discussion. Posture training with WKO together with exercise program improved two clinical balance tests in women with osteoporosis. Conclusion. Posture training support (PTS) applied as WKO together with back extension exercises can be prescribed as an intervention in elderly women in order to reduce the risk of falling.
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Barker KL, Javaid MK, Newman M, Minns Lowe C, Stallard N, Campbell H, Gandhi V, Lamb S. Physiotherapy Rehabilitation for Osteoporotic Vertebral Fracture (PROVE): study protocol for a randomised controlled trial. Trials 2014; 15:22. [PMID: 24422876 PMCID: PMC3904404 DOI: 10.1186/1745-6215-15-22] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 12/24/2013] [Indexed: 11/10/2022] Open
Abstract
Background Osteoporosis and vertebral fracture can have a considerable impact on an individual’s quality of life. There is increasing evidence that physiotherapy including manual techniques and exercise interventions may have an important treatment role. This pragmatic randomised controlled trial will investigate the clinical and cost-effectiveness of two different physiotherapy approaches for people with osteoporosis and vertebral fracture, in comparison to usual care. Methods/Design Six hundred people with osteoporosis and a clinically diagnosed vertebral fracture will be recruited and randomly allocated to one of three management strategies, usual care (control - A), an exercise-based physiotherapy intervention (B) or a manual therapy-based physiotherapy intervention (C). Those in the usual care arm will receive a single session of education and advice, those in the active treatment arms (B + C) will be offered seven individual physiotherapy sessions over 12 weeks. The trial is designed as a prospective, adaptive single-blinded randomised controlled trial. An interim analysis will be completed and if one intervention is clearly superior the trial will be adapted at this point to continue with just one intervention and the control. The primary outcomes are quality of life measured by the disease specific QUALLEFO 41 and the Timed Loaded Standing test measured at 1 year. Discussion There are a variety of different physiotherapy packages used to treat patients with osteoporotic vertebral fracture. At present, the indication for each different therapy is not well defined, and the effectiveness of different modalities is unknown. Trial registration Reference number ISRCTN49117867.
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Affiliation(s)
- Karen L Barker
- NIHR - BRU, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK.
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Abstract
OBJECTIVE The aim of this study was to determine the association of increased kyphosis with declines in mobility, balance, and disability among community-living older adults. DESIGN The 18-mo follow-up visit data from 2006 to 2009 for 620 participants from the population-based Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly Boston Study of older adults was used. Cross-sectional multivariable regression analyses were performed to assess the relationship between kyphosis (measured using the kyphosis index) and measures of mobility performance (Short Physical Performance Battery), balance (Berg Balance Scale score), and disability (self-reported difficulty walking a quarter of a mile or climbing a flight of stairs). The authors then evaluated the men and the women separately. Adjustment variables included demographic factors (age, sex, race, and education), body mass index, self-rated health, comorbidities (heart disease, diabetes, stroke, and depressive symptoms), back pain, knee pain, and falls self-efficacy. RESULTS After full adjustment, greater kyphosis index was associated with lower Short Physical Performance Battery scores (adjusted β = -0.08, P = 0.01) but not with lower Berg Balance Scale (adjusted β = -0.09, P = 0.23) or self-reported disability (adjusted β = 1.00; 95% confidence interval, 0.93-1.06) scores. In sex-specific analyses, kyphosis index was associated with only the Short Physical Performance Battery in the women. CONCLUSIONS Greater kyphosis is associated with poorer mobility performance but not with poorer balance or self-reported disability. This association with the Short Physical Performance Battery was observed only among the women. Mechanisms by which increased kyphosis influences physical performance should be explored prospectively.
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Drzał-Grabiec J, Snela S, Rykała J, Podgórska J, Banaś A. Changes in the body posture of women occurring with age. BMC Geriatr 2013; 13:108. [PMID: 24119004 PMCID: PMC3852784 DOI: 10.1186/1471-2318-13-108] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 10/04/2013] [Indexed: 01/06/2023] Open
Abstract
Background A current topic in the field of geriatrics still needing a great deal of study is the changes in body posture occurring with age. Symptoms of these changes can be observed starting between the ages of 40–50 years with a slow progression that increases after 60 years of age. The aims of this study were to evaluate parameters characterizing the posture of women over the age of 60 years compared with a control group and to determine the dynamics of body posture changes in the following decades. Methods The study included 260 randomly selected women. The study group consisted of 130 women between the ages of 60–90 years (Older Women). The control group (Younger Women) consisted of 130 women between the ages of 20–25 years (posture stabilization period). The photogrammetric method was used to evaluate body posture using the phenomenon of the projection chamber. The study was conducted according to generally accepted principles. Results In the analysis of parameters characterizing individual slope curves, results were varied among different age groups. The lumbar spine slope did not show significant differences between different age groups (p = 0.6952), while statistically significant differences (p = 0.0000) were found in the thoracic-lumbar spine slope (p = 0.0033) and upper thoracic spine slope. Body angle was shown to increase with age (p = 0.0000). Thoracic kyphosis depth significantly deepened with age (p = 0.0002), however, the thoracic kyphosis angle decreased with age (p = 0.0000). An increase in asymmetries was noticed, provided by a significantly higher angle of the shoulder line (p = 0.0199) and the difference in height of the lower shoulder blade angle (p = 0.0007) measurements in the group of older women. Conclusions Changes in the parameters describing body posture throughout consecutive decades were observed. Therapy for women over the age of 60 years should involve strengthening of the erector spinae muscles and controlling body posture with the aim of reducing trunk inclination and deepening of thoracic kyphosis. Moreover, exercises shaping lumbar lordosis should be performed to prevent its flattening.
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Azadinia F, Kamyab M, Behtash H, Maroufi N, Larijani B. The effects of two spinal orthoses on balance in elderly people with thoracic kyphosis. Prosthet Orthot Int 2013; 37:404-10. [PMID: 23401294 DOI: 10.1177/0309364612474487] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Hyperkyphosis increases the risk of falls for elderly people by reducing postural balance. Spinomed orthosis and the posture-training support are two available options for improving postural balance but have never been compared. OBJECTIVES To compare the effect of the Spinomed orthosis and the posture-training support on balance in elderly people with thoracic hyperkyphosis. STUDY DESIGN This study is a clinical trial on an accessible sample of elderly people with thoracic kyphosis. METHOD Eighteen participants (16 women and 2 men), aged 60-80 years, with thoracic kyphosis greater than 50°, completed the study procedure. Subjects were randomly allocated to two groups, namely, Spinomed orthosis and the posture-training support groups. Sensory organization test and limits of stability were assessed using the EquiTest system and the Balance Master system, respectively. Balance score, directional control, and reaction time were measured to evaluate balance with and without orthosis in a random order. RESULTS In the posture-training support group, significant changes were observed in the studied balance parameters: balance score (p < 0.001), directional control (p = 0.027), and reaction time (p = 0.047). There was a significant change in balance score (p < 0.001) and directional control (p = 0.032) in the Spinomed group. However, there were no significant differences in the effect of the two orthoses, the Spinomed orthosis and posture-training support, on balance factors. CONCLUSION Both Spinomed orthosis and posture-training support may improve balance in the elderly with thoracic hyperkyphosis in a similar manner.
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Affiliation(s)
- Fatemeh Azadinia
- Department of Orthotics and Prosthetics, Faculty of Rehabilitation Sciences, Tehran University of Medical Sciences, Tehran, Iran
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Wong CC, McGirt MJ. Vertebral compression fractures: a review of current management and multimodal therapy. J Multidiscip Healthc 2013; 6:205-14. [PMID: 23818797 PMCID: PMC3693826 DOI: 10.2147/jmdh.s31659] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Vertebral compression fractures are a prevalent disease affecting osteoporotic patients. When symptomatic, they cause significant pain and loss of function and have a high public health impact. In this paper we outline the diagnosis and management of these patients, with evidence-based review of treatment outcomes for the various therapeutic options. Diagnosis involves a clinical history focusing on the nature of the patient’s pain as well as various imaging studies. Management is multimodal in nature and starts with conservative therapy consisting of analgesic medication, medication for osteoporosis, physical therapy, and bracing. Patients who are refractory to conservative management may be candidates for vertebral augmentation through either vertebroplasty or kyphoplasty.
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Affiliation(s)
- Cyrus C Wong
- Vanderbilt University Medical Center, Nashville, TN, USA
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Granacher U, Gollhofer A, Hortobágyi T, Kressig RW, Muehlbauer T. The Importance of Trunk Muscle Strength for Balance, Functional Performance, and Fall Prevention in Seniors: A Systematic Review. Sports Med 2013; 43:627-41. [DOI: 10.1007/s40279-013-0041-1] [Citation(s) in RCA: 266] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Der Rücken nach osteoporosebedingten Wirbeleinbrüchen. MANUELLE MEDIZIN 2013. [DOI: 10.1007/s00337-012-1003-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Miyazaki J, Murata S, Horie J, Uematsu A, Hortobágyi T, Suzuki S. Lumbar lordosis angle (LLA) and leg strength predict walking ability in elderly males. Arch Gerontol Geriatr 2013; 56:141-7. [DOI: 10.1016/j.archger.2012.09.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Revised: 09/17/2012] [Accepted: 09/18/2012] [Indexed: 11/25/2022]
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Sinaki M. Exercise for Patients With Osteoporosis: Management of Vertebral Compression Fractures and Trunk Strengthening for Fall Prevention. PM R 2012; 4:882-8. [DOI: 10.1016/j.pmrj.2012.10.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 10/10/2012] [Indexed: 02/07/2023]
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Palacios S, Christiansen C, Sánchez Borrego R, Gambacciani M, Hadji P, Karsdal M, Lambrinoudaki I, Lello S, O'Beirne B, Romao F, Rozenberg S, Stevenson JC, Ben-Rafael Z. Recommendations on the management of fragility fracture risk in women younger than 70 years. Gynecol Endocrinol 2012; 28:770-86. [PMID: 22558997 DOI: 10.3109/09513590.2012.679062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The risk for fragility fracture represents a problem of enormous magnitude. It is estimated that only a small fraction of women with this risk take the benefit of preventive measures. The relationship between estrogen and bone mass is well known as they are the other factors related to the risk for fracture. There are precise diagnostic methods, including a tool to diagnose the risk for fracture. Yet there continues to be an under-diagnosis, with the unrecoverable delay in instituting preventive measures. Women under the age of 70 years, being much more numerous than those older, and having risk factors, are a group in which it is essential to avoid that first fragility fracture. Today it is usual not to differentiate between the treatment and the prevention of osteoporosis since the common aim is to prevent fragility fractures. Included in this are women with osteoporosis or with low bone mass and increased risk for fracture, for whom risk factors play a primary role. There is clearly controversy over the type of treatment and its duration, especially given the possible adverse effects of long-term use. This justifies the concept of sequential treatment, even more so in women under the age of 70, since they presumably will need treatment for many years. Bone metabolism is age-dependent. In postmenopausal women under 70 years of age, the increase in bone resorption is clearly predominant, related to a sharp drop in estrogens. Thus a logical treatment is the prevention of fragility fractures by hormone replacement therapy (HRT) and, in asymptomatic women, selective estradiol receptor modulators (SERMs). Afterwards, there is a period of greater resorption, albeit less intense but continuous, when one could utilise anti-resorptive treatments such as bisphosphonates or denosumab or a dual agent like strontium ranelate. Bone formation treatment, such as parathyroid hormone (PTH), in women under 70 years will be uncommon. That is because it should be used in cases where the formation is greatly diminished and there is a high risk for fracture, something found in much older women.
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Affiliation(s)
- Santiago Palacios
- Instituto Palacios, Salud y Medicina de la Mujer, C/ Antonio Acuña, Madrid, Spain
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Dalagiorgou G, Piperi C, Georgopoulou U, Adamopoulos C, Basdra EK, Papavassiliou AG. Mechanical stimulation of polycystin-1 induces human osteoblastic gene expression via potentiation of the calcineurin/NFAT signaling axis. Cell Mol Life Sci 2012; 70:167-180. [PMID: 23014991 DOI: 10.1007/s00018-012-1164-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 09/03/2012] [Accepted: 09/06/2012] [Indexed: 01/12/2023]
Abstract
Mechanical forces trigger biological responses in bone cells that ultimately control osteoblastogenesis and bone program. Although several mechanosensors have been postulated, the precise mechanotransduction pathway remains obscure as the initial mechanosensing event has not yet been identified. Studies in kidney cells have shown that polycystin-1 (PC1), via its extracellular N-terminal part, may function as an "antenna-like" protein providing a linkage between environmental cues and their conversion into biochemical responses that regulate various cellular processes via the calcineurin/NFAT pathway. Here we explored the involvement of PC1 in mechanical load (stretching)-induced signaling cascades that control osteoblastogenesis/bone formation. FACS and TransAM Transcription Factor ELISA analyses employing extracts from primary human osteoblast-like, PC1 expressing cells subjected to mechanical stretching (0-6 h) revealed that unphosphorylated/DNA-binding competent NFATc1 increased at 0.5-1 h and returned to normal at 6 h. In accordance with the activation mechanism of NFATc1, stretching of cultured cells pre-treated with cyclosporin A (CsA, a specific inhibitor of the calcineurin/NFAT pathway) abrogated the observed decrease in the abundance of the cytoplasmic pNFATc1 (phosphorylated/inactive) species. Furthermore, stretching of osteoblastic cells pre-treated with an antibody against the mechanosensing N-terminal part of PC1 also abrogated the observed decrease in the cytoplasmic levels of the inactive pNFATc1 species. Importantly, under similar conditions (pre-incubation of stretched cells with the inhibitory anti-PC1 antibody), the expression of the key osteoblastic, NFATc1-target gene runx2 decreased compared to untreated cells. Therefore, PC1 acts as chief mechanosensing molecule that modulates osteoblastic gene transcription and hence bone-cell differentiation through the calcineurin/NFAT signaling cascade.
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Affiliation(s)
- Georgia Dalagiorgou
- Department of Biological Chemistry, University of Athens Medical School, 11527 Athens, Greece
| | - Christina Piperi
- Department of Biological Chemistry, University of Athens Medical School, 11527 Athens, Greece
| | - Urania Georgopoulou
- Molecular Virology Laboratory, Hellenic Pasteur Institute, 11527 Athens, Greece
| | - Christos Adamopoulos
- Department of Biological Chemistry, University of Athens Medical School, 11527 Athens, Greece
| | - Efthimia K Basdra
- Department of Biological Chemistry, University of Athens Medical School, 11527 Athens, Greece
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Abstract
There are now a great many domains where information is recorded by sensors over a limited time period or on a permanent basis. This data flow leads to sequences of data known as time series. In many domains, like seismography or medicine, time series analysis focuses on particular regions of interest, known as events, whereas the remainder of the time series contains hardly any useful information. In these domains, there is a need for mechanisms to identify and locate such events. In this paper, we propose an events definition language that is general enough to be used to easily and naturally define events in time series recorded by sensors in any domain. The proposed language has been applied to the definition of time series events generated within the branch of medicine dealing with balance-related functions in human beings. A device, called posturograph, is used to study balance-related functions. The platform has four sensors that record the pressure intensity being exerted on the platform, generating four interrelated time series. As opposed to the existing ad hoc proposals, the results confirm that the proposed language is valid, that is generally applicable and accurate, for identifying the events contained in the time series.
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