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Chokshi SN, Mudiganty S, Clement RC, Accousti W. Vitamin D deficiency in Scheuermann's disease is associated with increased adverse outcomes. SICOT J 2024; 10:13. [PMID: 38568088 PMCID: PMC10989516 DOI: 10.1051/sicotj/2024010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/20/2024] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION Scheuermann's disease is a diagnosis of hyperkyphosis commonly encountered in pediatric patients. Studies in animal models suggest an association with vitamin D deficiency, however, extensive studies have not been performed in humans. This study analyzes the role of vitamin D deficiency on unfavorable results in patients with Scheuermann's disease. METHODS The TriNetX database was utilized to perform a retrospective analysis. Patients in the United States aged 0-18 years with Scheuermann's disease were identified using International Classification of Diseases, Tenth Revision (ICD-10) codes and categorized into those with and without a diagnosis of vitamin D deficiency. Comparison of patient groups depending on age, sex, ethnic origin, prior diagnosis of fibromyalgia, anxiety disorder, myositis, and major depressive disorder. Statistical analysis was conducted to identify the association between vitamin D levels and unfavorable results including pain, depression, suicide attempt, emergency department (ED) consult, hospitalization, and procedures on the spine or spinal cord. RESULTS In total, 11,277 patients were identified, 39% of whom had a concurrent diagnosis of scoliosis. A total of 1,024 (9.08%) were deficient in vitamin D. Patients with vitamin D deficiency had greater odds of pain (P < 0.0001), depression (P < 0.0001), suicide attempt (P = 0.0021), ED visits (P = 0.0246), and hospital admission (P < 0.0015). Conversely, patients with vitamin D deficiency had decreased odds of surgery on the spine or spinal cord (P = 0.0009). CONCLUSION Vitamin D deficiency is associated with an elevated risk of pain, depression, suicide attempts, ED visits, and hospitalization. Our analysis highlights the need for more research to study the effect of vitamin D on Scheuermann's disease. LEVEL OF EVIDENCE Level III, Prognostic.
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Affiliation(s)
- Shivan N. Chokshi
- John Sealy School of Medicine 301 University Blvd, The University of Texas Medical Branch Galveston TX 77555 USA
| | - Srikanth Mudiganty
- Department of Orthopaedic Surgery, Louisiana State University New Orleans LA 70112 USA
| | | | - William Accousti
- Department of Orthopaedic Surgery, Louisiana State University New Orleans LA 70112 USA
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Xu H, Zhou J, Ling C, Xu Y, Tang Z, Cai Y, Li J, Hu Z, Qiu Y, Zhu Z, Liu Z. Potential impairment of spinal cord around the apical vertebral level in hyperkyphotic patients: findings from diffusion tensor imaging. Eur Spine J 2024; 33:1256-1264. [PMID: 38340177 DOI: 10.1007/s00586-024-08144-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/31/2023] [Accepted: 01/13/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE To evaluate the neuronal metrics/microstructure of the spinal cord around apical region in patients with hyperkyphosis using diffusion tensor imaging (DTI). METHODS Thirty-seven patients with hyperkyphosis aged 45.5 ± 19.6 years old who underwent 3.0 T magnetic resonance imaging (MRI) examination with DTI sequence were prospectively enrolled from July 2022 to July 2023. Patients were divided into three groups according to spinal cord/ cerebrospinal fluid (CSF) architecture on sagittal-T2 MRI of the thoracic apex (the axial spinal cord classification): Group A-circular cord with visible CSF, Group B-circular cord without visible CSF at apical dorsal, and Group C-spinal cord deformed without intervening CSF. The fractional anisotropy (FA) values acquired from DTI were compared among different groups. Correlations between DTI parameters and global kyphosis (GK)/sagittal deformity angular ratio (sagittal DAR) were evaluated using Pearson correlation coefficients. RESULTS In all patients, FA values were significantly lower at apical level as compared with those at one level above or below the apex (0.548 ± 0.070 vs. 0.627 ± 0.056 versus 0.624 ± 0.039, P < 0.001). At the apical level, FA values were significantly lower in Group C than those in Group B (0.501 ± 0.052 vs. 0.598 ± 0.061, P < 0.001) and Group A (0.501 ± 0.052 vs. 0.597 ± 0.019, P < 0.001). Moreover, FA values were significantly lower in symptomatic group than those in non-symptomatic group (0.498 ± 0.049 v. 0.578 ± 0.065, P < 0.001). Pearson correlation analysis showed that GK (r2 = 0.3945, P < 0.001) and sagittal DAR (r2 = 0.3079, P < 0.001) were significantly correlation with FA values at apical level. CONCLUSION In patients with hyperkyphosis, the FA of spinal cord at apical level was associated with the neuronal metrics/microstructure of the spinal cord. Furthermore, the DTI parameter of FA at apical level was associated with GK and sagittal DAR. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Hui Xu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jin Zhou
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Chen Ling
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Yanjie Xu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Ziyang Tang
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Yinqi Cai
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Jie Li
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zongshan Hu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Zezhang Zhu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Zhen Liu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.
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Reyes J, Katiyar P, Greisberg G, Coury JR, Dionne A, Lombardi JM, Sardar ZM. Preoperative nutritional optimization for adult spinal deformity: Review. Spine Deform 2024; 12:257-262. [PMID: 38055123 DOI: 10.1007/s43390-023-00792-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/04/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE The main objective of this review article is to examine the role that nutrition has on adult spinal deformity. The information presented in this review aims to provide spine surgeons with a broad overview of screening, assessment, and interventional strategies that may be used for presurgical nutritional optimization. METHODS A comprehensive literature review utilizing three biomedical databases was performed to generate articles of interest. Published articles related to nutrition, adult spinal deformity, spine surgery and orthopaedics were reviewed for the composition of this article. Nutrition may play a role in optimizing postoperative outcomes following adult spinal deformity surgeries, such as limiting delirium, length of stay, blood transfusion, and other medical complications. The use of screening tools, such as the PNI and CONUT score can assess preoperative nutritional status and may provide some utility in evaluating nutrition status in patients undergoing deformity surgery. Balancing both macronutrients and micronutrients, notably, carbohydrates, protein, albumin, and vitamin D can play a role in preoperative optimization. CONCLUSION Adult spinal deformity patients are at an increased risk for malnutrition. These patients should be assessed for nutrition status to prime them for surgery, minimize complications, and maximize their outcomes. However, further studies are needed to determine how nutrition ultimately affects adult spinal deformity patients in the postoperative period and to establish specific nutritional recommendations for this unique population.
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Affiliation(s)
- Justin Reyes
- The Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, Broadway, 3 Field West, 5141, New York, NY, USA.
| | - Prerana Katiyar
- The Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, Broadway, 3 Field West, 5141, New York, NY, USA
| | - Gabriella Greisberg
- The Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, Broadway, 3 Field West, 5141, New York, NY, USA
| | - Josephine R Coury
- The Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, Broadway, 3 Field West, 5141, New York, NY, USA
| | - Alexandra Dionne
- The Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, Broadway, 3 Field West, 5141, New York, NY, USA
| | - Joseph M Lombardi
- The Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, Broadway, 3 Field West, 5141, New York, NY, USA
| | - Zeeshan M Sardar
- The Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, Broadway, 3 Field West, 5141, New York, NY, USA
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O’Donnell JM, Wu W, Youn A, Mann A, Swarup I. Scheuermann Kyphosis: Current Concepts and Management. Curr Rev Musculoskelet Med 2023; 16:521-530. [PMID: 37615931 PMCID: PMC10587050 DOI: 10.1007/s12178-023-09861-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE OF REVIEW Scheuermann's kyphosis (SK) is a developmental deformity of the spine that affects up to 8% of children in the US. Although, the natural progression of SK is noted to be gradual over years, severe deformity can be associated with significant morbidity. Thorough clinical examination and interpretation of relevant imaging help differentiate and confirm this diagnosis. Treatment includes both operative and nonoperative approaches. The purpose of this article is to provide an updated overview of the current theories of its pathogenesis, as well as the principles of diagnosis and treatment of SK. RECENT FINDINGS Although a definitive, unified theory continues to be elusive, numerous reports in the past decade provide insight into the pathophysiology of SK. These include alterations in mechanical stress and/or hormonal disturbances. Candidate genes have also been identified to be linked to the inheritance of SK. Updates to nonoperative treatment include the effectiveness of dedicated exercise programs, as well as the types and duration of orthotic treatment. Advances in surgical technique can be observed with a trend toward a posterior-only approach, with supporting evidence for careful evaluation of both the sagittal and coronal planes to determine fusion levels in order to avoid postoperative junctional pathologies. SK is an important cause of structural or rigid kyphosis. It can lead to significant morbidity in severe cases. Treatment is based on curve magnitude and symptoms. Nonoperative treatment consists of physical therapy in symptomatic patients, and bracing can be added for skeletally mature patients. Operative management can be considered in patients with large, progressive, and symptomatic deformity. Future studies can benefit from a focused investigation into patient-reported outcomes after undergoing appropriate treatment.
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Affiliation(s)
| | - Wei Wu
- Department of Orthopedic Surgery, UCSF Benioff Children’s Hospital, 747 52nd Street, OPC 1st Floor, Oakland, CA 94609 USA
| | - Alex Youn
- San Francisco School of Medicine, University of California, San Francisco, CA USA
| | - Angad Mann
- California Health Sciences University College of Medicine, Clovis, CA USA
| | - Ishaan Swarup
- Department of Orthopedic Surgery, UCSF Benioff Children’s Hospital, 747 52nd Street, OPC 1st Floor, Oakland, CA 94609 USA
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Withers RA, Plesh CR, Skelton DA. Does stretching of anterior structures alone, or in combination with strengthening of posterior structures, decrease hyperkyphosis and improve posture in adults? A Systematic Review and Meta-analysis. J Frailty Sarcopenia Falls 2023; 8:174-187. [PMID: 37663159 PMCID: PMC10472040 DOI: 10.22540/jfsf-08-174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 09/05/2023] Open
Abstract
Kyphosis can lead to back pain, poor posture, and increased falls risk. This systematic review aimed to synthesize research on stretching alone, or in combination with strengthening, as a management for hyperkyphosis in the adult population (≥18 years old). An electronic database search was conducted from February to March 2022. The author and an independent reviewer screened titles and abstracts for inclusion criteria - those whose intervention involved stretching alone or with strengthening exercises. The author appraised and extracted data from included articles and performed a meta-analysis where appropriate. The database and citation search yielded 327 articles, 18 of which met inclusion criteria. One study included performed stretching as a standalone intervention; the remainder used a combination of stretching and strengthening. The meta-analysis (n=3, with 5 exercise groups) found a statistically significant difference (MD = -6.97 (95% CI -9.84, -4.10), p<0.00001) in post-intervention measures of hyperkyphosis favouring the exercise group. The narrative review of studies agrees with this finding, demonstrating statistically significant improvement in hyperkyphosis following various exercise programs. This review suggests that stretching and strengthening exercises improve hyperkyphosis in the short and long term. Low-quality evidence supports stretching as a standalone intervention. Further, more robust research is required to recommend procedures and determine if stretching alone is effective for treating hyperkyphosis in adults.
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Affiliation(s)
- Rebecca A. Withers
- Research Centre for Health (ReaCH), Department of Physiotherapy and Paramedicine, School of Health & Life Sciences, Glasgow Caledonian University, UK
| | - C. Ryanne Plesh
- Research Centre for Health (ReaCH), Department of Physiotherapy and Paramedicine, School of Health & Life Sciences, Glasgow Caledonian University, UK
| | - Dawn A. Skelton
- Research Centre for Health (ReaCH), Department of Physiotherapy and Paramedicine, School of Health & Life Sciences, Glasgow Caledonian University, UK
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Zhang Z, Wang L, Li JC, Liu LM, Song YM, Yang X. Characteristics of Sagittal Alignment in Patients with Severe and Rigid Scoliosis. Orthop Surg 2023. [PMID: 37154161 DOI: 10.1111/os.13749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/01/2023] [Accepted: 04/04/2023] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVE There has been increasing concern about the importance of sagittal alignment in the evaluation and treatment of spinal scoliosis. However, recent studies have only focused on patients with mild to moderate scoliosis. To date, little is known about the sagittal alignment in patients with severe and rigid scoliosis (SRS). This study was performed to evaluate the sagittal alignment in patients with SRS, and to analyze how it was altered after corrective surgery. METHODS In this retrospective cohort study, we included 58 patients with SRS who underwent surgery from January 2015 to April 2020. Preoperative and postoperative radiographs were reviewed, and the sagittal parameters mainly included thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacrum slope (SS), and sagittal vertical axis (SVA). The sagittal balance state was evaluated according to whether the PI minus the LL (PI-LL) was less than 9°, and the patients were divided into thoracic hyperkyphosis and normal groups based on whether the TK exceeded 40°. The Student's t test, Pearson's test, and Receiver operating characteristic (ROC) curve analysis were used to compare related parameters between the different groups. RESULTS The mean follow-up duration was 2.8 years. Preoperatively, the mean PI was 43.6 ± 9.4°, and the mean LL was 65.2 ± 13.9°. Sixty-nine percent of patients showed sagittal imbalance, and they showed larger TK and LL values and smaller PI and SVA values than those with sagittal balance. Additionally, most patients (44/58) presented with thoracic hyperkyphosis; this group had smaller PI and SVA values than the normal patients. Patients with syringomyelia-associated scoliosis were more likely to present with thoracic hyperkyphosis. The TK and LL values were significantly decreased, and 45% of patients with preoperative sagittal imbalance recovered after surgery. These patients had a larger PI (46.4 ± 9.0° vs 38.3 ± 8.8°, P = 0.003) and a smaller TK (25.5 ± 5.2° vs 36.3 ± 8.0°, P = 0.000) at the final follow-up. CONCLUSION Preoperative sagittal imbalance appears in the majority of SRS patients, accounting for approximately 69% of our cohort. Patients with small PI values or syringomyelia-associated scoliosis were more likely to present with thoracic hyperkyphosis. Sagittal imbalance can generally be corrected by surgery, except in patients with a PI less than 39°. To achieve good postoperative sagittal alignment, we recommend controlling the TK to within 31°.
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Affiliation(s)
- Zhuang Zhang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Liang Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Jing-Chi Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Li-Min Liu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yue-Ming Song
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Xi Yang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
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Yağcı G, Kırdı E, Erel S, Aksoy T, Demirkıran G, Yazıcı M. Reliability and validity of the Turkish version of the Kyphosis specific spinal appearance questionnaire in adolescents with moderate hyperkyphosis. Spine Deform 2023; 11:289-296. [PMID: 36217000 DOI: 10.1007/s43390-022-00584-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 09/10/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Hyperkyphosis cause poor posture, self-image, clinical or cosmetic deformity and well-being. Therefore, it is important to evaluate patients' perception of appearance in the rehabilitation process of individuals with hyperkyphosis. Recently Kyphosis Specific Spinal Appearance Questionnaire (KSAQ) has been developed for the assessment of appearance in hyperkyphosis patients. OBJECTIVE To test validity and reliability of the Turkish version of the KSAQ. METHODS Sixty-two patients with hyperkyphosis (curve above 50º), ranging in age between 12 and 22 years, was included in this study. Turkish translation/back-translation of the KSAQ was done by an expert committee. Internal consistency was analyzed using Cronbach's alpha. Validity was assessed by correlating the KSAQ with the Scoliosis Research Society-22 (SRS-22) Questionnaire. Its reliability was assessed using the test-retest method with two-week interval (Pearson's correlation coefficient) on 44 of these patients. RESULTS Mean kyphosis angle was 60º ± 8.9º. KSAQ total scores showed excellent internal consistency (Cronbach's α = 0.944) and test-retest reliability (ICC = 0.890). Moderate to strong associations were found between KSAQ total score, each item scores and self-image domain of SRS-22 (r -0.299 to -0.730, p < 0.05). KSAQ total score had moderate correlation with SRS-22 total score (r 0.423, p 0.001). Overall, the KSAQ scale showed good validity. CONCLUSION The Turkish version of the KSAQ is a reliable and valid patient reported outcome measure of kyphosis-specific aspects of appearance in patients with moderate hyperkyphosis.
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Affiliation(s)
- Gözde Yağcı
- Department of Physiotherapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey.
| | - Elif Kırdı
- Vocational School of Health Services, Hacettepe University, Ankara, Turkey
| | - Suat Erel
- Faculty of Physiotherapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Taha Aksoy
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gökhan Demirkıran
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Muharrem Yazıcı
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Tsekoura M, Katsoulaki M, Kastrinis A, Nomikou E, Fousekis K, Tsepis E, Billis E. The Effects of Exercise in Older Adults with Hyperkyphotic Posture. Adv Exp Med Biol 2023; 1425:501-506. [PMID: 37581824 DOI: 10.1007/978-3-031-31986-0_49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
The objective of this review was to investigate the effects of exercise in older adults with hyperkyphosis. Medline and Google Scholar databases were searched from June to August 2022 for studies related to exercise interventions in older adults above 60 years of age. All types of exercise interventions (such as strengthening, stretching, Yoga, and/or any other exercise with a focus on treatment or prevention of postural malalignment) were included. The keywords used were "hyperkyphosis," "exercise," and "older adults." Ten studies were included involving 625 older adults with hyperkyphotic posture. The exercise interventions included spine strengthening (strengthening of back and abdominal muscles), poses of Yoga and postural alignment, and flexibility and respiratory muscle exercises. Duration of exercise programs varied from 6 weeks (1 study) to 8 weeks (3 studies), 12 weeks (4 studies), and 6 months (3 studies). Exercise adherence was generally good in studies. In summary, low to moderate evidence suggest that exercises in age-related hyperkyphosis have a role in the management of this group of patients. It can be beneficial in order to improve postural control, spinal stability, and kyphosis outcomes. The adherence reported across studies suggests that exercise is an acceptable treatment option for people with age-related hyperkyphosis. Types of exercise and dose-response parameters of exercise eliciting improvement warrant further investigation. Due to heterogeneity in clinical trials, future research is needed with the goal of improving the health of our growing geriatric population.
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Affiliation(s)
- M Tsekoura
- Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Rio, Greece.
| | - M Katsoulaki
- "Physiodrasis," Physio and Rehab Clinic, Athens, Greece
| | - A Kastrinis
- Department of Physiotherapy, Health Assessment and Quality of Life Research Laboratory, University of Thessaly, Volos, Greece
| | - E Nomikou
- "The House" Physio and Rehab Clinic, Athens, Greece
| | - K Fousekis
- Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Rio, Greece
| | - E Tsepis
- Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Rio, Greece
| | - E Billis
- Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Rio, Greece
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Legister CS, Harding DC, Morgan SJ, Guillaume TJ. Pitfalls and management of corrective spinal surgery in trisomy 9 mosaicism: a report of three cases. Spine Deform 2022. [PMID: 36547810 DOI: 10.1007/s43390-022-00624-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/19/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of this case series is to present the outcomes of surgical correction of hyperkyphosis, and subsequent management of complications for three patients with a rare chromosomopathy, Trisomy 9 Mosaicism (T9M). METHODS Case series with 2 year outcomes following index surgery. RESULTS Case 1 presented at 9 years of age with 103° of kyphosis (T3-T10), which progressed to 118° despite bracing. Case 2 presented at 7 years of age with 113° of kyphosis (T3-T11). Case 3 presented at 4 years of age with 103° of kyphosis (T1-T11). Cases 1 and 2 underwent T2-L2 posterior instrumented spinal fusion (PISF). Upon follow up, radiographs for Cases 1 and 2 revealed severe, symptomatic proximal junctional kyphosis (PJK) of 71° and 50°, respectively, requiring surgical revision proximally to the C4 level. Case 3 underwent placement of magnetically controlled growing rods given young age and growth potential. Surgical levels for Case 3 were extended from C4-pelvis in an attempt to prevent development of symptomatic PJK. Most recent radiographs for Case 3 taken 21 months postoperatively demonstrate a stable 50° of kyphosis. PJK above C4 was noted but is stable and asymptomatic. CONCLUSION T9M often presents with progressive hyperkyphosis. Despite instrumentation above the upper end vertebra (UEV), PJK may be a common complication in this small patient population. This novel report on spine deformity correction in the T9M population may provide preliminary guidance for the treatment of hyperkyphosis in patients with T9M and help surgeons avoid common pitfalls. LEVEL OF EVIDENCE IV.
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10
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Roessinger O, Hügle T, Walker UA, Geurts J. Polg mtDNA mutator mice reveal limited involvement of vertebral bone loss in premature aging-related thoracolumbar hyperkyphosis. Bone Rep 2022; 17:101618. [PMID: 36120646 PMCID: PMC9479024 DOI: 10.1016/j.bonr.2022.101618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/25/2022] [Accepted: 08/29/2022] [Indexed: 11/30/2022] Open
Abstract
Background Age-related hyperkyphosis is multifactorial and involves alterations of vertebral bone, intervertebral discs (IVD) and paraspinal muscles. The relative contribution of these tissues remains unclear. Here, we compared differences in vertebral bone microarchitecture and IVD thickness between prematurely aging mice with spinal hyperkyphosis and wild type littermates. Methods Thoracolumbar vertebral columns were dissected from homozygous Polg D257A and age-matched wild type littermates. Micro-computed tomography was performed to quantify cortical and trabecular bone parameters at anterior and posterior portions of T8-L4 vertebrae. In addition, vertebral shape, transaxial facet joint orientation and IVD thickness were quantified. Differences in anterior/posterior ratios between genotypes were compared by Student's t-test and association between vertebral bone and IVD parameters was investigated using Pearson correlation analysis. Results Hyperkyphotic homozygous mice displayed generalized osteopenia that was more pronounced at the posterior compared with anterior portion of thoracolumbar vertebrae. An increase in the anterior/posterior ratio of trabecular bone parameters was revealed at the thoracolumbar junction (T13-L1). Polg D257A displayed diffuse loss of cortical bone thickness, yet anterior/posterior ratios were unchanged. Despite generalized and regional bone loss, vertebral shape was unaffected. PolG D257A mice showed a 10-20 % reduction of IVD thickness at both thoracic and lumbar levels, with only minimal histopathological changes. IVD thickness was negatively correlated with anterior/posterior ratios of trabecular bone parameters, as well as with more coronally oriented facet joints, but negatively correlated with the anterior/posterior ratio of cortical bone thickness. Conclusions Aging-induced regional changes of vertebral trabecular and cortical bone did not lead to altered vertebral shape in Polg D257A mice but may indirectly cause hyperkyphosis through reduction of IVD thickness. These findings suggest a limited role for aging-induced bone loss in spinal hyperkyphosis and warrants further research on the involvement of paraspinal muscle degeneration.
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Affiliation(s)
- Olivier Roessinger
- Department of Rheumatology, Lausanne University Hospital, Avenue Pierre Decker 4, 1005 Lausanne, Switzerland
| | - Thomas Hügle
- Department of Rheumatology, Lausanne University Hospital, Avenue Pierre Decker 4, 1005 Lausanne, Switzerland
| | - Ulrich A Walker
- Department of Rheumatology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Jeroen Geurts
- Department of Rheumatology, Lausanne University Hospital, Avenue Pierre Decker 4, 1005 Lausanne, Switzerland
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11
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Chankavee N, Amatachaya S, Hunsawong T, Thaweewannakij T, Mato L. The 7th cervical vertebra wall distance (C7WD) identifies balance control, functional mobility and the risk of multiple falls in elderly community-dwelling women with thoracic hyperkyphosis. J Back Musculoskelet Rehabil 2022; 36:485-492. [PMID: 36155501 DOI: 10.3233/bmr-220105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Thoracic hyperkyphosis is common in the elderly, especially in women, and results in impaired balance control, impaired functional mobility and an increased risk of multiple falls. The 7th cervical vertebra wall distance (C7WD) is a practical method for evaluating thoracic hyperkyphosis. OBJECTIVE This study calculated C7WD cut-off scores that may identify impaired balance control, impaired functional mobility and an increased risk of multiple falls in elderly community-dwelling women with thoracic hyperkyphosis. This study also explored the correlation between C7WD, balance control and functional mobility. METHODS Sixty participants were assessed for thoracic hyperkyphosis using the C7WD, balance control using the functional reach test (FRT), functional mobility using the timed up-and-go test (TUG) and a history of falls using their personal information. RESULTS The data indicated that a C7WD of at least 7.95 cm, 8.1 cm and 8.8 cm had a good to excellent capability of identifying impaired balance control, impaired functional mobility and an increased risk of multiple falls, respectively. The C7WD results were significant and correlated with balance control (rs=-0.68) and functional mobility (rs= 0.41). CONCLUSIONS The C7WD may be utilised as a screening tool for these three impairments in this population.
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Affiliation(s)
- Nanniphada Chankavee
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand.,Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Sugalya Amatachaya
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand.,Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Torkamol Hunsawong
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand.,Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Thiwabhorn Thaweewannakij
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand.,Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Lugkana Mato
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand.,Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand
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12
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Veiskarami M, Aminian G, Bahramizadeh M, Gholami M, Ebrahimzadeh F, Arazpour M. The Efficacy of "Anatomical Posture Control Orthosis" on the Activity of Erector spinae Muscle, Risk of Falling, Balance Confidence, and Walking Speed in Osteoporotic Hyperkyphotic Subjects. Arch Bone Jt Surg 2022; 10:798-805. [PMID: 36246024 PMCID: PMC9527421 DOI: 10.22038/abjs.2021.53771.2678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 09/25/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Osteoporosis is a silent and asymptomatic disease that leads to thoracic hyperkyphosis, which can interfere with the normal function of the paraspinal musculature and balance control. There is no evidence regarding the effect of the anatomical posture control (APC) orthosis in older people with osteoporotic thoracic hyperkyphosis. This study aimed to examine the effects of this novel orthosis on the electromyography (EMG) of the erector spinae (ES) and balance control in this group of patients. METHODS In total, 22 elderly osteoporotic subjects with thoracic hyperkyphosis were enrolled in this study. The participants used the orthosis for 4 weeks. The clinical balance assessment scales assessing fall risk and surface EMG (sEMG) signals were recorded from the erector spinae muscles bilaterally before and after the use of orthosis. The marginal model was used with the generalized estimating equation analysis for investigating the effect of this orthosis on the sEMG of the paraspinal muscles and the balance control in this longitudinal study. RESULTS The normalized root mean square of sEMG of the lumbar and thoracic ES muscles reduced significantly (P<0.05), and significant improvement was observed (P<0.05) in the balance control test when the participants used this new-designed orthosis (P<0.05). CONCLUSION APC orthosis can decrease the activity of ES muscles during static standing and improve the static and dynamic balance in the hyperkyphotic osteoporotic subjects.
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Affiliation(s)
- Masoumeh Veiskarami
- Lorestan University of Medical Sciences, School of Alleid Medichal Sciences, Lorestan, Iran
| | - Gholamreza Aminian
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mahmood Bahramizadeh
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mehrdad Gholami
- Lorestan University of Medical Sciences, School of Alleid Medichal Sciences, Lorestan, Iran
| | - Farzad Ebrahimzadeh
- Department of Biostatistics and Epidemiology, University of Medical Sciences, Lorestan, Iran
| | - Mokhtar Arazpour
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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13
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Fukuoka Y, Katzman WB, Gladin A, Lane NE, Yoo JO. Factors associated with the 6-minute walk test performance in older adults with hyperkyphosis. Geriatr Nurs 2022; 47:95-99. [PMID: 35901578 DOI: 10.1016/j.gerinurse.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/01/2022] [Accepted: 07/05/2022] [Indexed: 11/20/2022]
Abstract
Age-related hyperkyphosis is associated with adverse health outcomes, such as falls, fractures, and mortality. However, few studies investigated the relationship between the severity of hyperkyphosis and physical endurance in older adults. This study examined whether a degree of hyperkyphosis curvature was independently associated with the 6-minute walk test (6MWT) distance. We analyzed the baseline data of 112 older adults aged 60-92 enrolled in the Specialized Center of Research (SCOR) Kyphosis trial. The majority of the sample had at least a college degree and were white. On average, participants walked 503.9 (SD 82.3) meters in 6 minutes. Multivariate regression results showed that the degree of hyperkyphosis curvature was not independently associated with the 6MWT distance, but taller height, lighter weight, and less prescription medication were significant predictors of better performance on the 6MWT distance. Validation of the study findings in a large, diverse older adult population is warranted.
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Affiliation(s)
- Yoshimi Fukuoka
- Department of Physiological Nursing, University of California, San Francisco, CA, USA.
| | - Wendy B Katzman
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, CA, USA
| | - Amy Gladin
- Department of Pain Medicine, Kaiser Permanente Northern California, San Francisco Medical Center, San Francisco, CA, USA
| | - Nancy E Lane
- Department of Medicine, Division of Rheumatology and Immunology, School of Medicine, University of California, Davis, CA, USA
| | - Jung Oh Yoo
- Department of Communication, University of California, Davis, CA, USA
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14
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Jung SH, Hwang UJ, Kim JH, Gwak GT, Kwon OY. Effect of improved thoracic kyphosis on forward shoulder posture after mobilization in individuals with thoracic hyperkyphosis. Clin Biomech (Bristol, Avon) 2022; 97:105707. [PMID: 35763888 DOI: 10.1016/j.clinbiomech.2022.105707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/21/2022] [Accepted: 06/14/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Thoracic hyperkyphosis structurally alters the position of the scapula to cause forward shoulder posture. However, the effect of improved thoracic hyperkyphosis on forward shoulder posture is unclear. The objective of this study was to determine the effect of eight weeks of thoracic mobilization on improving thoracic hyperkyphosis and forward shoulder posture and determine the cutoff change ratio in kyphosis for improving forward shoulder posture using the decision tree method. METHOD This study included 19 participants with thoracic hyperkyphosis who underwent thoracic mobilization for eight weeks. Forward shoulder posture (acromion-to-the-wall index) and thoracic kyphosis were measured before and after thoracic mobilization. FINDINGS The intervention significantly improved thoracic kyphosis and forward shoulder posture. The cutoff change ratio in kyphosis for improving forward shoulder posture was >13.79%. In the subgroup analysis of participants with a change ratio of kyphosis >13.79% (seven cases), all patients showed improved forward shoulder posture. In contrast, in the subgroup with a change ratio of kyphosis ≤13.79% (12 cases), eight cases showed improved forward shoulder posture, while four cases showed no improvement. INTERPRETATION Thoracic mobilization can be recommended in shoulder rehabilitation programs to improve forward shoulder posture to manage and prevent scapular malalignment in individuals with thoracic hyperkyphosis. We suggest that a high probability of improvement in forward shoulder posture can be expected when kyphosis is improved by >13.79%.
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Affiliation(s)
- Sung-Hoon Jung
- Department of Physical Therapy, Kinetic Ergocise Based on Movement Analysis Laboratory, College of Health Science, Yonsei University, Wonju, South Korea
| | - Ui-Jae Hwang
- Department of Physical Therapy, Kinetic Ergocise Based on Movement Analysis Laboratory, College of Health Science, Yonsei University, Wonju, South Korea
| | - Jun-Hee Kim
- Department of Physical Therapy, Kinetic Ergocise Based on Movement Analysis Laboratory, College of Health Science, Yonsei University, Wonju, South Korea
| | - Gyeong-Tae Gwak
- Department of Physical Therapy, Kinetic Ergocise Based on Movement Analysis Laboratory, College of Health Science, Yonsei University, Wonju, South Korea
| | - Oh-Yun Kwon
- Department of Physical Therapy, Kinetic Ergocise Based on Movement Analysis Laboratory, College of Health Science, Yonsei University, Wonju, South Korea.
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15
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Fukuoka Y, Katzman WB, Gladin A, Lane NE, Kado DM, Oh YJ. Slower upper extremity function in older adults with hyperkyphosis negatively impacts the 6-min walk test. BMC Musculoskelet Disord 2022; 23:505. [PMID: 35624469 PMCID: PMC9145457 DOI: 10.1186/s12891-022-05455-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/16/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Approximately 30% to 40% of older adults have hyperkyphosis, defined as excessive curvature of the thoracic spine. Hyperkyphosis is associated with increased morbidity and mortality. This study aimed to determine whether hyperkyphosis (Cobb's angle) and upper extremity tasks were independently associated with the 6-min walk test (6MWT) in community-dwelling older adults with hyperkyphosis. METHODS In this cross-sectional study, we studied 71 women and 28 men aged 60-87 from the study of hyperkyphosis, exercise, and function trial (SHEAF) who had kyphosis, 3 timed upper extremity tasks and the 6MWT assessed at their baseline visit. We used standing lateral spine radiographs and a standardized protocol for thoracic kyphosis (T4-T12) to measure Cobb angle of kyphosis. In addition, 3 activity of daily living (ADL) extremity tests (putting on and removing a laboratory coat, picking up a penny from the floor, and lifting a 7-lb. book to a shelf) were used. RESULTS The mean ± SD age was 70.1 ± 6.1 years. The mean ± SD Cobb angle of kyphosis was 57.4 ± 12.5 degrees. On average ± SD, the participants walked 504.8 ± 84.2 m in 6 min and took 2.4 ± 2.2 prescription medications. The mean ± SD height was 164.7 ± 8.5 cm, weight was 68.7 ± 13.1 kg, and BMI was 25.2 ± 4.0 kg/m2. Multivariate regression revealed that age, height, upper extremity book lift task, and the number of prescribed medications were significant predictors of performance on the 6MWT (p < 0.05). CONCLUSIONS While kyphosis was not associated with the 6MWT, timed tests of upper extremity function indicated that upper body dynamics can affect walking performance. In addition, sociodemographic factors and the number of prescribed medications were significant contributing factors to the 6MWT in older adults with mild to moderate hyperkyphosis. These results illustrate multifactorial influences on physical performance and the need for an integrated and targeted approach in helping older hyperkyphotic adults maintain healthy physical functioning as they age.
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Affiliation(s)
- Yoshimi Fukuoka
- Department of Physiological Nursing, University of California, San Francisco, 2 Koret Way, N631, San Francisco, CA 94143 USA
| | - Wendy B. Katzman
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, San Francisco, CA 94158 USA
| | - Amy Gladin
- San Francisco Medical Center, Kaiser Permanente Northern California, San Francisco, CA 94118 USA
| | - Nancy E. Lane
- Center for Musculoskeletal Health, School of Medicine, University of California at Davis, Davis, CA 95616 USA
| | - Deborah M. Kado
- Department of Medicine, Stanford University School of Medicine, Stanford, CA and Geriatric Research Education and Clinical Center (GRECC), Veterans Health Administration, Palo Alto, CA 94304 USA
| | - Yoo Jung Oh
- Department of Communication, University of California Davis, Davis, CA 95616 USA
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16
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Patel R, Shen J, Nichols JF, Schousboe JT, Woods GN, Katzman WB, Kado DM. Trabecular bone score and its association with Cobb angle kyphosis in older men: a cross-sectional study for the Osteoporotic Fractures in Men (MrOS) Study. Osteoporos Int 2022; 33:1171-1176. [PMID: 35031808 PMCID: PMC9010364 DOI: 10.1007/s00198-021-06267-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 12/08/2021] [Indexed: 11/26/2022]
Abstract
UNLABELLED Hyperkyphosis (HK), or accentuated forward spinal curvature, commonly affects older people, although its causes are not completely understood. We tested whether a measure of bone quality, trabecular bone score (TBS), is associated with HK in 1997 older men, and determined that men with degraded TBS were more likely to have HK. INTRODUCTION While vertebral fractures and low bone mineral density (BMD) contribute to kyphosis progression, it is unknown whether the trabecular bone score (TBS) may provide additional information on bone quality that could influence the degree of kyphosis. We hypothesized that degraded TBS would be associated with hyperkyphosis (HK) defined as a Cobb angle > 50°. METHODS Using data from 1997 participants of the Osteoporotic Fractures in Men (MrOS) Study who had baseline TBS and Cobb angle kyphosis measured, we investigated whether men with degraded TBS were more likely to be hyperkyphotic, even after adjustment for BMD and prevalent vertebral fractures. RESULTS Men were an average age of 74 ± 6 (mean ± SD) years with a mean kyphosis angle of 38.6 ± 11.5°, 295 (15%) were classified as hyperkyphotic, and 416 (21%) had degraded TBS. Compared with men with TBS > 1.2, men with degraded TBS were more likely to have HK (OR: 1.47, 95% CI: 1.06-2.06, p = 0.02) after adjusting for age, clinic, race, BMI, hip BMD, and prevalent vertebral fracture. If spine instead of hip BMD was included in the model, the odds ratio decreased to 1.35 (95% CI: 0.97-1.89, p = 0.08). CONCLUSIONS Older men with degraded TBS are more likely to have HK not explained by underlying vertebral fractures.
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Affiliation(s)
- R Patel
- Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - J Shen
- Herbert Wertheim School of Public Health and Human Longevity Sciences, University of California San Diego, La Jolla, CA, USA
| | - J F Nichols
- Herbert Wertheim School of Public Health and Human Longevity Sciences, University of California San Diego, La Jolla, CA, USA
| | - J T Schousboe
- Park Nicollet Clinic and Health Partners Institute and University of Minnesota, Minneapolis, MN, USA
| | - G N Woods
- Department of Medicine, University of California San Diego and VA San Diego Health Care System, La Jolla, CA, USA
| | - W B Katzman
- University of California, San Francisco, San Francisco, CA, USA
| | - D M Kado
- Department of Medicine, Stanford University, Stanford, California and VA Palo Alto, Palo Alto, CA, USA.
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17
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Keshavarzi F, Azadinia F, Talebian S, Khalkhali Zavieh M, Rasouli O. Effect of a semi-rigid backpack type thoracolumbar orthosis on thoracic kyphosis angle and muscle performance in older adults with hyperkyphosis: a randomized controlled trial. Disabil Rehabil 2022; 45:1488-1497. [PMID: 35452347 DOI: 10.1080/09638288.2022.2065541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To investigate the effect of a semi-rigid backpack type thoracolumbar orthosis (TLO) on thoracic kyphosis angle (TKA) and potentially contributing factors of hyperkyphosis, including position sense and back muscle strength and endurance. METHOD This randomized, controlled trial was conducted on 48 older adults with hyperkyphosis, randomly allocated to an experimental or control group. The experimental group wore a semi-rigid TLO for 3 consecutive months. The control group received no external support or exercise. Thoracic kyphosis angle (TKA), joint position sense, back muscle strength and endurance were evaluated at the baseline and at the end of week 6 and week 12. RESULTS The two-way (group × time) interactions were significant in terms of TKA (F = 37.88, p ≤ 0.001, ηp2 = 0.45), muscle strength (F = 26.005, p ≤ 0.001, ηp2 = 0.36), muscle endurance measured via load cell (F = 3.417, p = 0.039, ηp2 = 0.06), and endurance holding time of Ito test (F = 3.629, p = 0.045, ηp2 = 0.07). A further analysis using one-way repeated measures of ANOVA showed that TKA, muscle strength and endurance were significantly improved in the experimental group. Also, two-way interactions were significant for absolute error and variable error of trunk neutral repositioning test from a trunk flexed and/or extended position for global components and horizontal components trunk repositioning test. CONCLUSION Wearing a semi-rigid backpack type TLO even from an unknown brand for short periods during the day (e.g., 2-4 h) over 3 months not only modifies kyphotic posture but also can enhance back muscle performance in older adults with hyperkyphosis. IMPLICATIONS FOR REHABILITATIONPrescription of a semi-rigid backpack type thoracolumbar orthosis for older adults has no adverse effects such as muscle weakness if it is applied for short periods during the day.A semi-rigid backpack thoracolumbar orthosis can prevent position sense degradation in older adults with hyperkyphosis.A semi-rigid backpack type thoracolumbar orthosis may counteract trunk flexion and kyphotic posture by applying the biomechanical principles of the three-point pressure system.Improvement in spinal alignment resulting from wearing thoracolumbar orthosis should not occur in exchange for muscle deconditioning.
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Affiliation(s)
- Fatemeh Keshavarzi
- Rehabilitation Research Center, Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Azadinia
- Rehabilitation Research Center, Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Talebian
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences and Health Services, Tehran, Iran
| | - Minoo Khalkhali Zavieh
- Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Omid Rasouli
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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18
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Keshavarzi F, Azadinia F, Talebian S, Rasouli O. Test-retest reliability of a load cell setup, Ito, and timed loaded standing tests for measuring muscle strength and endurance in older adults with and without hyperkyphosis. Musculoskelet Sci Pract 2022; 58:102475. [PMID: 34801467 DOI: 10.1016/j.msksp.2021.102475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/29/2021] [Accepted: 11/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The association of back muscle weakness with greater thoracic kyphosis has been widely documented. Reliable and easy-to-use techniques are needed to monitor changes in muscle function over time and assess the effectiveness of therapeutic interventions. Therefore, the present study aimed to evaluate the test-retest reliability of a designed load-cell setup and two clinical tests, namely Ito and Timed loaded standing (TLS) tests for measuring back muscle function (i.e., strength and endurance) in older adults with and without hyperkyphosis. METHOD Fifty-three older people (28 with thoracic hyperkyphosis and 25 normal age-matched controls) completed the present test-retest reliability study. A two-way random model of the Intraclass Correlation Coefficient (ICC2,3) was used to estimate relative reliability. Absolute reliability was assessed by calculating Standard Error of the Measurements (SEM) and Minimal Detectable Change (MDC). RESULTS The findings showed excellent test-retest reliability in all performed tests for this population (ICC = 0.95-0.99). In addition, the MDC values for measuring endurance time via load cell, Ito, and TLS tests in the hyperkyphosis group, were 16.5, 28.2, and 35.1 s, respectively. These values ranged from 36 to 39 s for the control group. CONCLUSION The present study suggests high test-retest reliability of the designed load-cell setup, Ito, and TLS for assessing back extensor muscle strength and endurance in older adults with and or without hyperkyphosis.
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Affiliation(s)
- Fatemeh Keshavarzi
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Fatemeh Azadinia
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran; Rehabilitation Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Saeed Talebian
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences and Health Services, Tehran, Iran.
| | - Omid Rasouli
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
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19
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Diaremes P, Braun S, Meurer A. [Scheuermann's disease]. Orthopade 2022; 51:339-348. [PMID: 35290495 DOI: 10.1007/s00132-022-04239-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/18/2022] [Indexed: 10/18/2022]
Abstract
Scheuermann's disease represents the second most common deformity of the growing spine after the various forms of scoliosis. In cases of early diagnosis and mild kyphotic deformity conservative treatment with a brace and physiotherapy shows very good results; however, in cases of neurologic deficits, curve progression despite conservative treatment and increasing pain symptoms with a Stagnara angle of more than 70-75°, surgical treatment is meaningful. The surgical strategy can include posterior spondylodesis with prior anterior release or posterior instrumentation with posterior column osteotomy depending on the surgeon's experience. The choice of the extent of the operation with the vertebrae to be instrumented and including the straightening method should be oriented to the avoidance of complications, such as proximal or distal junctional kyphosis.
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Affiliation(s)
- Panagiotis Diaremes
- Klinik für Orthopädie (Friedrichsheim), Universitätsklinikum Frankfurt, Marienburgstr. 2, 60528, Frankfurt am Main, Deutschland.
| | - Sebastian Braun
- Klinik für Orthopädie (Friedrichsheim), Universitätsklinikum Frankfurt, Marienburgstr. 2, 60528, Frankfurt am Main, Deutschland
| | - Andrea Meurer
- Klinik für Orthopädie (Friedrichsheim), Universitätsklinikum Frankfurt, Marienburgstr. 2, 60528, Frankfurt am Main, Deutschland
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20
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Souza RBD, Kawahara EI, Farinha-Arcieri LE, Gyuricza IG, Neofiti-Papi B, Miranda-Rodrigues M, Teixeira MBCG, Fernandes GR, Lemes RB, Reinhardt DP, Gouveia CH, Pereira LV. Hyperkyphosis is not dependent on bone mass and quality in the mouse model of Marfan syndrome. Bone 2021; 152:116073. [PMID: 34171513 DOI: 10.1016/j.bone.2021.116073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/10/2021] [Accepted: 06/20/2021] [Indexed: 11/24/2022]
Abstract
Marfan syndrome (MFS) is an autosomal dominant disease affecting cardiovascular, ocular and skeletal systems. It is caused by mutations in the fibrillin-1 (FBN1) gene, leading to structural defects of connective tissue and increased activation of TGF-β. Angiotensin II (ang-II) is involved in TGF-β activity and in bone mass regulation. Inhibition of TGF-β signaling by blockage of the ang-II receptor 1 (AT1R) via losartan administration leads to improvement of cardiovascular and pulmonary phenotypes, but has no effect on skeletal phenotype in the haploinsufficient mouse model of MFS mgR, suggesting a distinct mechanism of pathogenesis in the skeletal system. Here we characterized the skeletal phenotypes of the dominant-negative model for MFS mgΔlpn and tested the effect of inhibition of ang-II signaling in improving those phenotypes. As previously shown, heterozygous mice present hyperkyphosis, however we now show that only males also present osteopenia. Inhibition of ang-II production by ramipril minimized the kyphotic deformity, but had no effect on bone microstructure in male mutant animals. Histological analysis revealed increased thickness of the anterior longitudinal ligament (ALL) of the spine in mutant animals (25.8 ± 6.3 vs. 29.7 ± 7.7 μm), coupled with a reduction in type I (164.1 ± 8.7 vs. 139.0 ± 4.4) and increase in type III (86.5 ± 10.2 vs. 140.4 ± 5.6) collagen in the extracellular matrix of this ligament. In addition, we identified in the MFS mice alterations in the erector spinae muscles which presented thinner muscle fibers (1035.0 ± 420.6 vs. 655.6 ± 239.5 μm2) surrounded by increased area of connective tissue (58.17 ± 6.52 vs. 105.0 ± 44.54 μm2). Interestingly, these phenotypes were ameliorated by ramipril treatment. Our results reveal a sex-dependency of bone phenotype in MFS, where females do not present alterations in bone microstructure. More importantly, they indicate that hyperkyphosis is not a result of osteopenia in the MFS mouse model, and suggest that incompetent spine ligaments and muscles are responsible for the development of that phenotype.
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Affiliation(s)
- Rodrigo Barbosa de Souza
- Department of Genetics and Evolutionary Biology, Institute of Biosciences, University of São Paulo, São Paulo, SP 05508-090, Brazil
| | - Elisa Ito Kawahara
- Department of Genetics and Evolutionary Biology, Institute of Biosciences, University of São Paulo, São Paulo, SP 05508-090, Brazil
| | - Luis Ernesto Farinha-Arcieri
- Department of Genetics and Evolutionary Biology, Institute of Biosciences, University of São Paulo, São Paulo, SP 05508-090, Brazil
| | - Isabela Gerdes Gyuricza
- Department of Genetics and Evolutionary Biology, Institute of Biosciences, University of São Paulo, São Paulo, SP 05508-090, Brazil
| | - Bianca Neofiti-Papi
- Department of Anatomy, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP 05508-000, Brazil
| | - Manuela Miranda-Rodrigues
- Department of Anatomy, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP 05508-000, Brazil
| | | | - Gustavo Ribeiro Fernandes
- Department of Genetics and Evolutionary Biology, Institute of Biosciences, University of São Paulo, São Paulo, SP 05508-090, Brazil
| | - Renan Barbosa Lemes
- Department of Genetics and Evolutionary Biology, Institute of Biosciences, University of São Paulo, São Paulo, SP 05508-090, Brazil
| | - Dieter P Reinhardt
- Faculty of Medicine and Health Sciences and Faculty of Dentistry, McGill University, Montreal, Canada
| | - Cecília Helena Gouveia
- Department of Anatomy, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP 05508-000, Brazil
| | - Lygia V Pereira
- Department of Genetics and Evolutionary Biology, Institute of Biosciences, University of São Paulo, São Paulo, SP 05508-090, Brazil.
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Chokphukiao P, Wiyanad A, Suwannarat P, Amatachaya S, Mato L, Wattanapan P, Gaogasigam C, Thaweewannakij T. Validity and reliability of the block method for measuring thoracic hyperkyphosis. Physiother Theory Pract 2021; 38:3037-3044. [PMID: 34493160 DOI: 10.1080/09593985.2021.1975335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aimed to investigate the concurrent validity of the block method as compared with the gold standard (Cobb's method). An additional aim was to examine the intra- and inter-rater reliability of expert and novice assessors using the block method. METHODS In a cross-sectional study, we enrolled 62 participants with hyperkyphosis aged ≥10 years, with hyperkyphosis defined as one or more blocks. The participants were stratified by age (<60 years and ≥60 years). To determine concurrent validity, and kyphosis was assessed in all the participants using the block method and Cobb's method. Finally, 15 participants were included in a reliability study. To determine intra- and inter-rater reliability, each participant was assessed twice, 7 days apart, by one expert and one novice using the block method. RESULTS The concurrent validity of the block method and gold standard method showed moderate correlation (rs = 0.53, P < .001). However, after stratifying the participants by age (<60 years and ≥60 years), there was small to moderate correlation (rs = 0.42, P = .006, and rs = 0.64, P = .002, respectively). The intra- and inter-rater reliability of the expert and novice assessors was excellent (ICC3,1 = 0.82-0.97, P < .001). CONCLUSIONS The findings showed small correlation in those <60 and moderate correlation in those ≥60 years, and reported excellent reliability. The block method can be used by novices with strong reliability. This method is a practical technique for early screening hyperkyphosis in the elderly.
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Affiliation(s)
- Pakwipa Chokphukiao
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand.,Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Arpassanan Wiyanad
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand.,Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Patcharawan Suwannarat
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand.,Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Sugalya Amatachaya
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand.,Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Lugkana Mato
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand.,Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Pattra Wattanapan
- Department of Rehabilitation Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chitanongk Gaogasigam
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Pathumwan, Bangkok, Thailand
| | - Thiwabhorn Thaweewannakij
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand.,Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand
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22
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Zappalá M, Lightbourne S, Heneghan NR. The relationship between thoracic kyphosis and age, and normative values across age groups: a systematic review of healthy adults. J Orthop Surg Res 2021; 16:447. [PMID: 34243795 PMCID: PMC8268398 DOI: 10.1186/s13018-021-02592-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/28/2021] [Indexed: 01/22/2023] Open
Abstract
Background Thoracic kyphosis is reported to increase with ageing. However, this relationship has not been systematically investigated. Peoples’ kyphosis often exceeds 40°, but 40° is the widely accepted cut-off and threshold for normality. Consequently, patients may be misclassified. Accurate restoration of kyphosis is important to avoid complications following spinal surgery. Therefore, specific reference values are needed. The objective of the review is to explore the relationship between thoracic kyphosis and age, provide normative values of kyphosis for different age groups and investigate the influence of gender and ethnicity. Methods Two reviewers independently conducted a literature search, including seven databases and the Spine Journal, from inception to April 2020. Quantitative observational studies on healthy adults (18 years of age or older) with no known pathologies, and measuring kyphosis with Cobb’s method, a flexicurve, or a kyphometer, were included. Study selection, data extraction, and study quality assessment (AQUA tool) were performed independently by two reviewers. The authors were contacted if clarifications were necessary. Correlation analysis and inferential statistics were performed (Microsoft Excel). The results are presented narratively. A modified GRADE was used for evidence quality assessment. Results Thirty-four studies (24 moderate-quality, 10 high-quality) were included (n = 7633). A positive moderate correlation between kyphosis and age was found (Spearman 0.52, p < 0.05, T5-T12). Peoples’ kyphosis resulted greater than 40° in 65% of the cases, and it was significantly smaller in individuals younger than 40 years old (x < 40) than in those older than 60 years old (x > 60) 75% of the time (p < 0.05). No differences between genders were found, although a greater kyphosis angle was observed in North Americans and Europeans. Conclusion Kyphosis increases with ageing, varying significantly between x < 40 and x > 60. Furthermore, kyphosis appears to be influenced by ethnicity, but not gender. Peoples’ thoracic sagittal curvature frequently exceeds 40°. Trial registration The review protocol was devised following the PRISMA-P Guidelines, and it was registered on PROSPERO (CRD42020175058) before study commencement. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02592-2.
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Affiliation(s)
- Mattia Zappalá
- Physiotherapy Department, St John & St Elizabeth Hospital, 60 Grove End Rd., St John's Wood, London, UK. .,Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK.
| | - Stephen Lightbourne
- Bermuda Hospitals Board, King Edward Memorial Hospital, 7 Point Finger Road, Paget, DV 04, Bermuda
| | - Nicola R Heneghan
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
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23
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Betsch M, Kalbhen K, Michalik R, Schenker H, Gatz M, Quack V, Siebers H, Wild M, Migliorini F. The influence of smartphone use on spinal posture - A laboratory study. Gait Posture 2021; 85:298-303. [PMID: 33640863 DOI: 10.1016/j.gaitpost.2021.02.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Smartphones have become increasingly more popular and complicated tasks can be performed with these devices. However, the increasing use is associated with shoulder and neck pain, as well as with psychological addiction. RESEARCH QUESTION Do different smartphone tasks lead to changes in spinal posture and pelvic position? Is there a relationship between smartphone addiction and changes in posture? METHODS A cross-sectional study including 50 participants was performed. Test subjects completed the Smartphone Addiction Scale and the SF-36 health questionnaire. Subjects spinal posture and pelvic position during different smartphone tasks were measured through a surface topography system. The different tasks were: standing in an upright position, simulating a phone call, texting with one or two hands during standing or while walking on a treadmill. Paired T-tests and ANOVA tests were performed to evaluate differences. The Kendall rank test was used to investigate the association between clinical scores and changes in spinal posture. RESULTS All smartphone tasks lead to a significant increase in thoracic kyphosis and trunk inclination during standing and while walking. A significant increased lumbar lordosis was also found. Texting with one or two hands correlated with increased surface rotation. No associations between smartphone addiction and changes of the spinal posture were reported. SIGNIFICANCE This represents the first surface topography study that investigated the influence of different smartphone tasks on the spinal posture and pelvic position during standing and while walking. With the results of this study we demonstrated that smartphone use leads to significant changes of sagittal and frontal spine parameters. Further research should focus on the evaluation of possible detrimental effects of long-term smartphone use on the spinal posture and on the development of preventive measures.
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Affiliation(s)
- Marcel Betsch
- University of Toronto Orthopaedic Sports Medicine Program (UTOSM), Women's College Hospital, Toronto, ON, Canada; Department of Orthopaedics and Trauma Surgery, University Hospital Mannheim, Medical Faculty University Heidelberg, Mannheim, Germany.
| | - Kyra Kalbhen
- Department of Orthopaedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Roman Michalik
- Department of Orthopaedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Hanno Schenker
- Department of Orthopaedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Mattias Gatz
- Department of Orthopaedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Valentin Quack
- Department of Orthopaedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Hannah Siebers
- Department of Orthopaedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Michael Wild
- Department of Orthopaedics, Trauma and Hand Surgery, Klinikum Darmstadt, Darmstadt, Germany
| | - Filippo Migliorini
- Department of Orthopaedics, University Hospital RWTH Aachen, Aachen, Germany
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24
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Gladin A, Katzman WB, Fukuoka Y, Parimi N, Wong S, Lane NE. Secondary analysis of change in physical function after exercise intervention in older adults with hyperkyphosis and low physical function. BMC Geriatr 2021; 21:133. [PMID: 33618669 PMCID: PMC7901174 DOI: 10.1186/s12877-021-02062-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/29/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Hyperkyphosis is common in older adults and associated with low physical function and reduced health related quality of life (HrQol). Improved kyphosis has been previously established in kyphosis-targeted interventions in randomized controlled trials in older adults with hyperkyphosis; however, evidence for improved physical function is conflicting. Few studies have investigated change in physical function after a targeted kyphosis intervention in older adults with low physical function. The primary aim in this descriptive study was to explore change in physical function after a progressive high-intensity 3-month targeted kyphosis exercise and posture training intervention in older adults with low physical function and hyperkyphosis. Secondary aims were to explore change in HrQol, spinal strength and spinal curvature, and adherence and safety of the intervention. METHODS In this secondary analysis of the Specialized Center of Research (SCOR) Kyphosis randomized trial, 101 community dwelling older men and women with hyperkyphosis who completed the intervention were divided into a low function group (LFG) and high function group (HFG). Baseline characteristics were compared between LFG and HFG. Physical function, HrQol, spinal strength and spinal curvature (kyphosis and lordosis) pre/post intervention change scores were explored within and between groups. Adherence and adverse events were examined in the LFG and HFG. RESULTS Twenty-six (26%) older adults were LFG, mean Short Phyiscal Performance Battery (SPPB) 9.62 (SD = 1.17) points. At baseline, the LFG was older than HFG (p = 0.005), experienced more pain, (p = 0.060), had worse physical function and HrQol (p ≤ 0.001), and comparable kyphosis (p = 0.640). SPPB changed 0.62 (95% CI: - 0.20 to 1.44) points in the LFG and - 0.04 (95%CI: - 0.28 to 0.19) points in the HFG, p = 0.020. Gait speed changed 0.04 (95% CI: - 0.02 to 0.10) m/s in the LFG. Kyphosis improved equally in both groups. Adherence to the intervention was 83% in the LFG and 79% in the HFG. There were no adverse events in either group. CONCLUSIONS Older adults with low physical function and hyperkyphosis may improve physical function after a kyphosis targeted intervention. Older adults with low physical function may safely participate in targeted high-intensity kyphosis exercise and posture training. This observation needs to be confirmed in larger adequately powered studies. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT01766674 .
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Affiliation(s)
- Amy Gladin
- Chronic Pain Management, San Francisco Kaiser Permanente Medical Center, 4141 Geary Blvd, Suite 212, San Francisco, CA, 94118, USA
| | - Wendy B Katzman
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, 1500 Owens Street, Suite 400, San Francisco, CA, 94143, USA.
| | - Yoshimi Fukuoka
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, 2 Koret Way, San Francisco, CA, 94143, USA
| | - Neeta Parimi
- California Pacific Medical Center, Research Institute, San Francisco, CA, USA
| | - Shirley Wong
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, 1500 Owens Street, Suite 400, San Francisco, CA, 94143, USA
| | - Nancy E Lane
- Center for Musculoskeletal Health, University of California at Davis School of Medicine, 4625 2nd Ave, Suite 200, Davis, CA, 95817, USA
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25
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McDaniels-Davidson C, Nichols JF, Vaida F, Marshall LM, Kado DM. Kyphosis and 3-year fall risk in community-dwelling older men. Osteoporos Int 2020; 31:1097-1104. [PMID: 32040599 PMCID: PMC7444683 DOI: 10.1007/s00198-019-05155-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 09/02/2019] [Indexed: 10/25/2022]
Abstract
Hyperkyhosis is thought to be a fall risk factor in older adults. This large study of older men found that fall risk increased with greater kyphosis measured with the blocks method, but did not find an association between kyphosis and falls when measured by the commonly used the Cobb angle method. INTRODUCTION Research suggests an association between hyperkyphosis and falls in community-dwelling older adults, though this has not been investigated within large, population-based studies. This study sought to determine whether two measures of kyphosis prospectively predict fall risk over 3 years among older men. METHODS Within the Osteoporotic Fractures in Men Study (MrOS), we conducted two 3-year prospective studies of 2346 and 2928 men. The first group had kyphosis measured by the Cobb angle at visit 1, while the second group had kyphosis assessed with the blocks method at visit 3; both groups then self-reported falls tri-annually for 3 years. Poisson regression with GEE was used to obtain relative risks (RR) of falls. RESULTS The fall rates over 3 years were 651/1000 person-years among the visit 1 sample (mean age 74 ± 6 years) and 839/1000 person-years among the visit 3 sample (mean age 79 ± 5 years). In adjusted models of the visit 3 sample, the risk of falls was increased by 12% for each standard deviation increase (1.4 blocks) in the number of blocks required to achieve a neutral head and neck position (RR = 1.12, 95% CI = 1.06, 1.18). The Cobb angle was not associated with falls in the visit 1 sample. CONCLUSIONS Although the Cobb angle did not predict falls in community-dwelling older men over 3 years, the blocks method of measuring kyphosis was predictive of falls in this population. This difference could be due to the Cobb angle's focus on thoracic kyphosis, whereas the blocks method may additionally capture abnormal cervical spine curvature.
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Affiliation(s)
- C McDaniels-Davidson
- Joint Doctoral Program in Public Health (Epidemiology), San Diego State University/University of California, San Diego, San Diego, CA, USA.
| | - J F Nichols
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - F Vaida
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - L M Marshall
- Department of Orthopaedics & Rehabilitation, Oregon Health and Science University, Portland, OR, USA
| | - D M Kado
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
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26
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Affiliation(s)
- Michiel Bronswijk
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Belgium.
| | - Jan Tack
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Belgium; Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Belgium
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27
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Goto NA, Koelé MC, van Loon IN, Boereboom FTJ, Verhaar MC, Emmelot-Vonk MH, Hamaker ME, Willems HC. Thoracic vertebral fractures and hyperkyphosis in elderly patients with end-stage kidney disease; do these patients have different clinical outcomes? Bone 2019; 127:181-187. [PMID: 31200077 DOI: 10.1016/j.bone.2019.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/29/2019] [Accepted: 06/07/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Elderly patients with end-stage kidney disease (ESKD) are at high risk for fractures. However, the prevalence of vertebral fractures and hyperkyphosis is not studied well. This is relevant, because in the general population, both vertebral fractures and hyperkyphosis are associated with poor outcome. Therefore, the primary aim of our study was to assess the prevalence of vertebral fractures and hyperkyphosis in the ESKD population. The secondary aim was to assess if patients with vertebral fractures and/or hyperkyphosis more often have poor outcome after starting dialysis, such as accidental falling, functional decline and mortality compared to the patients without vertebral fractures and/or hyperkyphosis. DESIGN, SETTING, PARTICIPANTS & MEASUREMENTS This study included patients ≥65 years with ESKD who were enrolled in the Geriatric assessment in Older patients starting Dialysis (GOLD) study of whom a lateral chest radiograph was available. Chest radiographs were scored independently by two observers for vertebral fractures (Genant ≥1) and hyperkyphosis (≥50 degrees). The relation between vertebral fractures and hyperkyphosis with clinical outcomes (falls, decline in ADL and IADL, mortality) was studied using the Chi-square test. RESULTS Of the 196 enrolled patients, chest radiographs were available for 160 patients. Mean age was 75.3 (SD ±6.9), and 35% were female. The prevalence of vertebral fractures was 43% and of hyperkyphosis 22%. Patients with hyperkyphosis had a higher one-year mortality compared to patients without hyperkyphosis (20% vs. 8%, p = 0.04). No differences were observed between patients with and without hyperkyphosis, vertebral fractures and the remaining outcomes after six months of follow-up. CONCLUSIONS In patients ≥65 years old with ESKD starting dialysis, vertebral fractures are highly prevalent. In contrast to the general population, patients with vertebral fractures did experience poor outcome as often as patients without vertebral fractures. Remarkably, patients with hyperkyphosis did have a higher one-year mortality. However, these patients did not experience more functional decline or accidental falls.
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Affiliation(s)
- N A Goto
- Dianet Dialysis Center, Utrecht, the Netherlands; Department of Geriatrics, University Medical Center Utrecht, Utrecht University, the Netherlands.
| | - M C Koelé
- Department of Internal Medicine, Division of Geriatrics, Amsterdam UMC, Academic Medical Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - I N van Loon
- Dianet Dialysis Center, Utrecht, the Netherlands; Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - F T J Boereboom
- Dianet Dialysis Center, Utrecht, the Netherlands; Department of Internal Medicine, Diakonessenhuis Utrecht, Utrecht, the Netherlands
| | - M C Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - M H Emmelot-Vonk
- Department of Geriatrics, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - M E Hamaker
- Department of Geriatrics, Diakonessenhuis Utrecht, Utrecht, the Netherlands
| | - H C Willems
- Department of Internal Medicine, Division of Geriatrics, Amsterdam UMC, Academic Medical Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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Sharifi P, Kamyab M, Babaee T, Ganjavian MS. Objective Monitoring of Brace Wearing Time in Adolescents with Scheuermann's Kyphosis. Asian Spine J 2019; 13:942-948. [PMID: 31434464 PMCID: PMC6894974 DOI: 10.31616/asj.2019.0008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 04/09/2019] [Indexed: 11/29/2022] Open
Abstract
Study Design This was a prospective cohort study. Purpose This study aimed to evaluate the potential differences between the objective and subjective bracing compliances of adolescents with Scheuermann’s kyphosis. Overview of Literature Bracing is a well-documented intervention for managing adolescents with progressive thoracic Scheuermann’s kyphosis, and the brace should be worn 23 hours every day. Most research studies that have investigated the efficacy of bracing have assumed that the patients wore the braces as advised or that the bracing time was measured subjectively. This may be one of the reasons for the conflicting reports regarding the efficacy of bracing. Methods Nineteen volunteers (11 girls and 7 boys, 12.89±1.77 years) who were prescribed Milwaukee braces for Scheuermann’s kyphosis were enrolled. Each brace was equipped with a miniature temperature logger to record the actual brace wearing time over a period of 3 weeks. The patients and their families were unaware of the mounted sensor. Each participants and/or parent was provided with a questionnaire to record the number of hours for which the brace was worn each day. In addition, the therapist asked each patient and/or his/her parent about the average number of hours that the brace was worn. Results The compliance rates measured using the temperature logger (16.00±4.90 hours daily) were significantly lower than those reported in the questionnaires (19.52±6.04 hours daily, p<0.001) and the verbal responses (20.21±6.05 hours daily, p<0.001). Moreover, there was no correlation of age, sex, and body mass index with brace compliance. Conclusions The braces were worn less often than reported by the patients and/or their parents. Therefore, objective compliance assessments of adolescents with Scheuermann’s kyphosis in a brace are recommended for future studies.
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Affiliation(s)
- Pouya Sharifi
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Kamyab
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Taher Babaee
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Saleh Ganjavian
- Department of Orthopaedic Surgery, Shafa Yahyaiian Hospital, Iran University of Medical Sciences, Tehran, Iran
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Karimian R, Rahnama N, Ghasemi G, Lenjannejadian S. Photogrammetric Analysis of Upper Cross Syndrome among Teachers and the Effects of National Academy of Sports Medicine Exercises with Ergonomic Intervention on the Syndrome. J Res Health Sci 2019; 19:e00450. [PMID: 31586371 PMCID: PMC7183553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/26/2019] [Accepted: 06/15/2019] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND Hyperkyphosis is often accompanied by forward head and shoulder postures. Together, these three disorders are called "Upper Cross Syndrome (UCS)". We aimed to perform a photogrammetric analysis of UCS among teachers and to determine the effects of National Academy of Sports Medicine (NASM) exercises with ergonomic training interventions on the syndrome. STUDY DESIGN A semi-experimental study. METHODS Photogrammetric analysis was performed using the UCS software among teachers in order to determine the angles of forward head, rounded shoulders, and hyperkyphosis. Twenty-three teachers were selected purposefully and enrolled in Fasa City in 2018. They were randomly divided into experimental (n=12) and control (n=11) groups. Experimental group attended 12 wk of NASM exercises with ergonomic intervention but the control group did not participate in any regular exercise. The data were analyzed using paired t-test and differential independent t-test (P<0.05). RESULTS The results indicated a significant decrease in forward head (P=0.001), shoulder angles (P=0.000) and hyperkyphosis (P=0.003). The applied intervention had a 90% positive effect in reducing the forward head angle, an 88% positive effect in reducing the rounded shoulder angle and a 90% positive effect in reducing the kyphosis angle. However, the results for the control group did not show a significant difference for forward head, rounded shoulders, and hyperkyphosis angles. CONCLUSION The UCS software application can be used as an accurate instrument for measuring the extent of the UCS. Moreover, using NASM exercises can lead to a reduction in the UCS among teachers.
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Affiliation(s)
- Razieh Karimian
- 1Department of Sports Injuries and Corrective Exercises, School of Sport Sciences, University of Isfahan, Isfahan, Iran
| | - Nader Rahnama
- 1Department of Sports Injuries and Corrective Exercises, School of Sport Sciences, University of Isfahan, Isfahan, Iran,Correspondence : Nader Rahnama (PhD) Tel: +98 81746 73441 Fax: +98 81746 73441 E-mail:
| | - Gholamali Ghasemi
- 1Department of Sports Injuries and Corrective Exercises, School of Sport Sciences, University of Isfahan, Isfahan, Iran
| | - Shahram Lenjannejadian
- 1Department of Sports Injuries and Corrective Exercises, School of Sport Sciences, University of Isfahan, Isfahan, Iran
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Demarteau J, Jansen B, Van Keymolen B, Mets T, Bautmans I. Trunk inclination and hip extension mobility, but not thoracic kyphosis angle, are related to 3D-accelerometry based gait alterations and increased fall-risk in older persons. Gait Posture 2019; 72:89-95. [PMID: 31176286 DOI: 10.1016/j.gaitpost.2019.05.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 05/18/2019] [Accepted: 05/24/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Only a portion of the increased variability in gait parameters observed in ageing can be explained by age and gait speed alone. Other factors, like musculoskeletal changes of the spine, might contribute to higher variability of gait parameters, slower walking speed and subsequently increased fall-risk in ageing. RESEARCH QUESTION Are spinal posture and mobility related to 3D-accelerometry based gait analysis, functional performance and fall-risk in ageing? METHODS Forty elderly presenting increased fall-risk (OFR, 80.6 ± 5.4yrs), 41 old controls (OC, 79.1 ± 4.9yrs), and 40 young controls (YC, 21.6 ± 1.4yrs) were assessed for spinal posture and mobility (SpinalMouse®), gait analysis (DynaPort MiniMod), and functional performance (grip strength, grip work, timed-get-up-and-go-test, performance-oriented mobility assessment). RESULTS Compared to OC, OFR showed significantly (p < .05) larger trunk inclination angle (INC), smaller sacral extension mobility, slower walking speed, and lower medio-lateral step and stride regularity. Thoracic kyphosis angle (TKA) was similar in all groups. INC and sacral extension mobility showed the highest correlation with walking speed, gait parameters, functional performance and fall-risk. INC (OR = 1.14) and sacral extension mobility (OR = 1.12) can moderately explain fall-risk in elderly participants and showed fair capacity to discriminate OFR from OC, the diagnostic value on fall-risk is however low (best probabilistic cut-off value, INC: -0.83° [sensitivity = 70%, specificity = 61%, PPV = 64%, NPV = 68%, LR+ = 1.79, LR- = 0.49, AUC = 0.71]; sacral extension mobility: 8.5° [sensitivity = 70%, specificity = 73%, PPV = 72%, NPV = 71%, LR+ = 2.61, LR -= 0.41, AUC = 0.71]). SIGNIFICANCE Larger trunk inclination and smaller sacral extension mobility (i.e. hip extension mobility) are moderately related to increased fall-risk, gait alterations, lower muscle performance and worse functional mobility in ageing. Contrary to our hypothesis, TKA showed no relation with parameters of gait and/or fall-risk. INC and sacral extension mobility have fair discriminative power to distinguish older persons with increased fall-risk from those without and might be considered as therapeutic targets.
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Affiliation(s)
- Jeroen Demarteau
- Gerontology, Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090, Brussels, Belgium; Frailty in Ageing research department, Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090, Brussels, Belgium; SOMT University of Physiotherapy, Softwareweg 5, 3821 BN, Amersfoort, the Netherlands
| | - Bart Jansen
- Electronics and Informatics department, ETRO, Vrije Universiteit Brussel, Pleinlaan 2, B-1050, Brussels, Belgium; imec, Kapeldreef 75, B-3001, Leuven, Belgium
| | - Bart Van Keymolen
- Gerontology, Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090, Brussels, Belgium; Frailty in Ageing research department, Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090, Brussels, Belgium; SOMT University of Physiotherapy, Softwareweg 5, 3821 BN, Amersfoort, the Netherlands
| | - Tony Mets
- Gerontology, Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090, Brussels, Belgium; Frailty in Ageing research department, Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090, Brussels, Belgium; Department of Geriatric Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, B-1090, Brussels, Belgium
| | - Ivan Bautmans
- Gerontology, Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090, Brussels, Belgium; Frailty in Ageing research department, Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090, Brussels, Belgium; SOMT University of Physiotherapy, Softwareweg 5, 3821 BN, Amersfoort, the Netherlands; Department of Geriatric Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, B-1090, Brussels, Belgium.
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Ziebart C, Gibbs JC, McArthur C, Papaioannou A, Mittmann N, Laprade J, Kim S, Khan A, Kendler DL, Wark JD, Thabane L, Scherer SC, Prasad S, Hill KD, Cheung AM, Bleakney RR, Ashe MC, Adachi JD, Giangregorio LM. Are osteoporotic vertebral fractures or forward head posture associated with performance-based measures of balance and mobility? Arch Osteoporos 2019; 14:67. [PMID: 31243557 DOI: 10.1007/s11657-019-0626-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/17/2019] [Indexed: 05/05/2023]
Abstract
UNLABELLED The main objective of this study was to explore whether vertebral fracture characteristics or posture is independently associated with physical performance. Posture was significantly associated with physical performance but fracture characteristics were not, suggesting posture should be the focus of physical performance variance. PURPOSE The main objective of this study was to explore whether vertebral fracture characteristics (number, severity, location) or occiput-to-wall distance (OWD) is independently associated with physical performance. METHODS This was a secondary data analysis using baseline data from a randomized controlled trial, of community-dwelling women aged 65 years and older with a suspected vertebral fragility fracture. Lateral thoracic and lumbar spine radiographs were used to determine the number, location, and severity of fracture. The dependent variables were timed up and go (TUG), five times sit-to-stand, four-meter walk, and step test. The independent variables were number, severity, location of fracture, and OWD. Pain during movement and age were covariates. Multivariable regression analyses determined the association between each of the dependent and independent variables. RESULTS Participants' (n = 158) mean (standard deviation [SD]) age was 75.9 (6.5) years. They had a mean (SD) BMI, OWD, and number of fractures of 26.7 (5.3) kg/m2, 5.7 (4.6) cm, and 2.2 (1.8), respectively. OWD was independently associated with TUG (estimated coefficient [B] = 0.29, 95% confidence interval [CI] = 0.16, 0.42), five times sit-to-stand (B = 0.33, 95% CI = 0.12, 0.55), four-meter walk (B = 0.09, 95% CI = 0.05, 0.13), and step test (B = - 0.36, 95% CI = - 0.50, - 0.23) in the unadjusted model. OWD was independently associated with TUG (B = 0.25, 95% CI = 0.12, 0.38), five times sit-to-stand (B = 0.29, 95% CI = 0.07, 0.50), four-meter walk (B = 0.08, 95% CI = 0.03, 0.12), and step test (B = - 0.22, 95% CI = - 0.47, - 0.19) in the adjusted model. CONCLUSION OWD was significantly associated with physical performance but fracture characteristics were not. These analyses were exploratory and require replication in future studies.
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Affiliation(s)
- Christina Ziebart
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.,University of Western Ontario, London, ON, Canada
| | - Jenna C Gibbs
- Department of Kinesology and Physical Education, McGill University, Quebec, Canada
| | - Caitlin McArthur
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.,McMaster University, Hamilton, ON, Canada.,GERAS Centre for Aging Research, Hamilton, ON, Canada
| | - Alexandra Papaioannou
- McMaster University, Hamilton, ON, Canada.,GERAS Centre for Aging Research, Hamilton, ON, Canada
| | | | | | - Sandra Kim
- University of Toronto, Toronto, ON, Canada.,Women's College Hospital, Toronto, ON, Canada
| | - Aliya Khan
- McMaster University, Hamilton, ON, Canada
| | - David L Kendler
- University of British Columbia, Vancouver, British Columbia, Canada
| | - John D Wark
- University of Melbourne, Melbourne, Australia.,Royal Melbourne Hospital, Melbourne, Australia
| | - Lehana Thabane
- McMaster University, Hamilton, ON, Canada.,St Joseph's Healthcare-Hamilton, Hamilton, ON, Canada
| | - Samuel C Scherer
- University of Melbourne, Melbourne, Australia.,Broadmeadows Health Service, Melbourne, Australia
| | | | - Keith D Hill
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia
| | | | | | - Maureen C Ashe
- University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada
| | - Jonathan D Adachi
- McMaster University, Hamilton, ON, Canada.,St Joseph's Healthcare-Hamilton, Hamilton, ON, Canada
| | - Lora M Giangregorio
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada. .,University Health Network, Toronto, ON, Canada. .,Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada.
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Ziebart C, Adachi JD, Ashe MC, Bleakney RR, Cheung AM, Gibbs JC, Hill KD, Kendler DL, Khan AA, Kim S, McArthur C, Mittmann N, Papaioannou A, Prasad S, Scherer SC, Thabane L, Wark JD, Giangregorio LM. Exploring the association between number, severity, location of fracture, and occiput-to-wall distance. Arch Osteoporos 2019; 14:27. [PMID: 30820733 DOI: 10.1007/s11657-019-0582-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 02/19/2019] [Indexed: 02/03/2023]
Abstract
UNLABELLED This study of women with a suspected vertebral fracture determined the association between vertebral fracture characteristics and posture. The number of fractures was associated with posture. Severity of fracture was associated with posture when adjusting for pain. Fracture characteristics explain some variability in posture in women with a suspected vertebral fracture. PURPOSE Osteoporotic vertebral fractures are associated with increased morbidity and mortality. An accumulation of vertebral fractures may lead to forward head posture, which has been independently associated with mortality. It is unclear how fracture characteristics, including the number, severity, and location of fracture, contribute to occiput-to-wall distance (OWD). METHODS This was a cross-sectional secondary data analysis using baseline data from a randomized controlled trial, in community-dwelling women aged 65 years and older with a suspected vertebral fragility fracture. Lateral thoracic and lumbar spine radiographs were used to determine the number, location, and severity of fracture. Occiput-to-wall distance (OWD) was used to assess forward head posture. Pain during movement (0-10 scale) and age were considered as confounding variables. Multivariable regression models were used to evaluate relationships between fracture variables and OWD. RESULTS Participants (n = 158) were of mean age 75.9 (SD 6.5) years with a mean (SD) BMI = 26.7 (5.3) kg/m2, OWD = 5.7 (4.6) cm, and number of fractures = 2.4 (2.4). In unadjusted analyses, the number of fractures (B = 0.82, 95% CI = 0.04, 1.59) was associated with OWD. When adjusting for pain, severity of fractures (B = 1.08, 95% CI = 0.001, 2.15) was independently associated with OWD. Location was not associated with OWD in any of the models. CONCLUSIONS The number of fractures was significantly associated with OWD in the unadjusted model, explaining more of the variability in OWD than other fracture characteristics. Severity of fracture was associated with OWD in the adjusted model. However, pain may confound the relationship between OWD and fracture characteristics.
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Affiliation(s)
- Christina Ziebart
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
- University of Western Ontario, London, Canada
| | - Jonathan D Adachi
- McMaster University, Hamilton, Canada
- St Joseph's Healthcare-Hamilton, Hamilton, Canada
| | - Maureen C Ashe
- University of British Columbia, Vancouver, Canada
- Centre for Hip Health and Mobility, Vancouver, Canada
| | | | - Angela M Cheung
- Department of Medicine, University of Toronto, Toronto, Canada
- University Health Network, Toronto, Canada
| | - Jenna C Gibbs
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Keith D Hill
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia
| | | | | | - Sandra Kim
- Department of Medicine, University of Toronto, Toronto, Canada
- Women's College Hospital, Toronto, Canada
| | - Caitlin McArthur
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
- McMaster University, Hamilton, Canada
- Geriatric Education and Research in Aging Sciences Centre, Hamilton, Canada
| | | | - Alexandra Papaioannou
- McMaster University, Hamilton, Canada
- Geriatric Education and Research in Aging Sciences Centre, Hamilton, Canada
| | | | - Samuel C Scherer
- Broadmeadows Health Service, Broadmeadows, Australia
- University of Melbourne, Melbourne, Australia
| | - Lehana Thabane
- McMaster University, Hamilton, Canada
- St Joseph's Healthcare-Hamilton, Hamilton, Canada
| | - John D Wark
- University of Melbourne, Melbourne, Australia
- Royal Melbourne Hospital, Parkville, Australia
| | - Lora M Giangregorio
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
- University Health Network, Toronto, Canada.
- Schlegel-UW Research Institute for Aging, Waterloo, Canada.
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Lorente A, Barrios C, Lorente R, Tamariz R, Burgos J. Severe hyperkyphosis reduces the aerobic capacity and maximal exercise tolerance in patients with Scheuermann disease. Spine J 2019; 19:330-8. [PMID: 30025996 DOI: 10.1016/j.spinee.2018.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 06/30/2018] [Accepted: 07/02/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The evaluation of ventilatory functional restrictions during a maximal exercise tolerance test in patients with Scheuermann disease has never been described. PURPOSE This study evaluated the respiratory functional capacity of patients with Scheuermann disease compared to healthy adolescents matched in age. STUDY DESIGN/SETTING Prospective comparative study. PATIENTS SAMPLE Forty-one consecutive adolescents with Scheuermann hyperkyphosis (SK) and 20 healthy controls matched in age were included in the study. OUTCOME MEASURES Basal spirometry and dynamic ventilatory parameters were measured during a maximal cardiopulmonary exercise tolerance test. Heart rate, oxygen saturation (SatO2), maximum oxygen uptake (VO2 max), quotient between ventilation and volume of exhaled carbon dioxide (VE/CO2), respiratory exchange rate (RER), ventilatory capacity at maximal exercise (VEmax), and test duration were recorded at initium and at maximal exercise. METHODS The exercise tolerance test (ETT) was completed to exhaustion using a standard Bruce protocol on a ramp treadmill. Comparisons of quantitative variables between SK and control group were analyzed by statistical nonparametric test. The correlations between the magnitude of the thoracic kyphosis and both the VO2 max/kg and VEmax of the SK group were also analyzed. No funds were required. The authors have no conflicts of interests. RESULTS Patients with SK started the test with a higher heart rate (p<.01) and reached exhaustion with a lower heart rate (p<.05) than healthy controls. At maximal exercise, the SatO2 was declined in Scheuermann patients compared to healthy subjects (p<.05). The maximal aerobic power (VO2max) was greater in healthy controls than in hyperkyphotic patients (50.0±6.7 vs. 43.4±11.3 mL/kg/min; p<.05). There was an inverse correlation between the increase in the magnitude of thoracic kyphosis and the deterioration of the maximal aerobic power. VO2max and VEmax were severely deteriorated in patients with more than 75° kyphosis. Patients with >75° thoracic kyphosis also showed an impairment in their cardiovascular efficiency as measured by the heart rate/VO2 quotient. The limited tolerance to the exercise in SK patients was reflected by a shorter duration of the exercise test and a lower energy cost measured in METS (metabolic equivalents) as compared to healthy controls. CONCLUSIONS Patients with severe hyperkyphosis (>75°) show significant respiratory inefficiency together with a lower ventilation capacity and lower VO2max. There is an inverse correlation between the increase in the magnitude of thoracic kyphosis and the deterioration of the maximal aerobic power.
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Katzman WB, Parimi N, Gladin A, Fan B, Wong SS, Mergenthaler J, Lane NE. Reliability of sagittal vertical axis measurement and association with measures of age-related hyperkyphosis. J Phys Ther Sci 2018; 30:1417-1423. [PMID: 30568327 PMCID: PMC6279700 DOI: 10.1589/jpts.30.1417] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 09/12/2018] [Indexed: 02/04/2023] Open
Abstract
[Purpose] Persons with age-related hyperkyphosis often have concomitant sagittal plane
imbalance of the spine. This study investigated the reliability of sagittal vertical axis
(SVA) measurement of sagittal balance, association between thoracic Cobb angle of kyphosis
and SVA measure of sagittal balance, and compared the degree of SVA in males and females
with age-related hyperkyphosis. [Participants and Methods] Measurements of SVA and Cobb
angle of kyphosis were obtained from baseline radiographs of 112 community-dwelling males
and females, mean age 70.0 (SD=5.7) years with kyphosis ≥40 degrees, recruited for a
randomized controlled trial. Spearman correlation coefficients were used to determine
associations between SVA and kyphosis, and Wilcoxon nonparametric tests to compare SVA
between genders. [Results] SVA was acquired with excellent intra-rater [0.95 (95% CI:
0.88, 0.98)] and inter-rater reliability [0.93 (95% CI: 0.83,0.97)]. There was no
significant correlation between Cobb angle of thoracic kyphosis and SVA, (r=−0.05). More
males than females had sagittal imbalance (SVA≥5 cm). [Conclusion] In older adults with
hyperkyphosis, SVA was a reliable measure of sagittal balance, and more extreme in males.
SVA was not associated with Cobb angle of thoracic kyphosis, and could be considered an
independent phenotype of age-related hyperkyphosis to be targeted in future intervention
trials.
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Affiliation(s)
- Wendy B Katzman
- Department of Physical Therapy and Rehabilitation Science, University of California, San Fransisco: 1500 Owens St., Ste 400, San Francisco, CA 94158, USA
| | | | | | - Bo Fan
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA
| | - Shirley S Wong
- Department of Physical Therapy and Rehabilitation Science, University of California, San Fransisco: 1500 Owens St., Ste 400, San Francisco, CA 94158, USA
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McMaster ME, Ashley-Sing C, Dos Santos Tavares AA, Corral CA, McGill K, McNeil D, Jansen MA, Simpson AHRW. The inhalation effects of by-products from chlorination of heated indoor swimming pools on spinal development in pup mice. Environ Res 2018; 166:668-676. [PMID: 30015251 DOI: 10.1016/j.envres.2018.06.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/22/2018] [Accepted: 06/24/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION It has been postulated that swimming in heated indoor swimming pools in the first year of life is associated with the development of spinal deformity in children. We explored in pup mice whether exposure to certain disinfection by-products resulting from chlorination of heated pools would affect the future development of the spinal column. METHODS Mice, from birth and for 28 consecutive days, were exposed to chemicals known to be created by disinfection by-products of indoor heated swimming pools. The study made use of a body fluid analogue and a chlorine source to recreate the conditions found in municipal pools. A cohort of 51 wild-type C57B6 mice, male and female, were divided into two groups: experimental (n = 29) and controls (n = 22). 24 mice were observed for 8 months (32 weeks), with 27 culled at 4 months (16 weeks). Serial CT scanning was used to assess the spines. RESULTS Exposure to disinfection by-products resulted in an increase in the normal thoracic kyphotic spinal angle of the mice when compared with their controls at 10 weeks; experimental mice kyphosis range 35-82° versus 29-38° in controls. At 14 weeks the kyphosis of the experimental mice had reduced in size but never to that of the control group. CONCLUSION We have demonstrated the ability to influence spinal development in pup mice through environmental factors and shown that the developmental deformity became evident only after a significant latent period.
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Affiliation(s)
| | | | | | - Carlos Alcaide Corral
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
| | - Katie McGill
- Central Bioresearch Services, University of Edinburgh, Edinburgh, UK.
| | - Duncan McNeil
- Central Bioresearch Services, University of Edinburgh, Edinburgh, UK.
| | - Maurits A Jansen
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
| | - A H R W Simpson
- Department of Orthopaedic Surgery, University of Edinburgh, Edinburgh, UK.
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McDaniels-Davidson C, Davis A, Wing D, Macera C, Lindsay SP, Schousboe JT, Nichols JF, Kado DM. Kyphosis and incident falls among community-dwelling older adults. Osteoporos Int 2018; 29:163-169. [PMID: 29018904 DOI: 10.1007/s00198-017-4253-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 10/01/2017] [Indexed: 10/18/2022]
Abstract
UNLABELLED Hyperkyphosis commonly affects older persons and is associated with morbidity and mortality. Many have hypothesized that hyperkyphosis increases fall risk. Within this prospective study of older adults, kyphosis was significantly associated with incident falls over 1 year. Measures of hyperkyphosis could enhance falls risk assessments during primary care office visits. INTRODUCTION To determine the association between four measures of kyphosis and incident and injurious falls in older persons. METHODS Community-dwelling adults aged 65 and older (n = 72) residing in southern California were invited to participate in a prospective cohort study. Participants had kyphosis assessed four ways. Two standing measures included a flexicurve ruler placed against the back to derive a kyphotic index and the Debrunner kyphometer, a protractor used to measure the kyphotic angle in degrees. Two lying measures included the blocks method (number of 1.7 cm blocks needed to achieve a neutral head position while lying supine) and traditional Cobb angle calculation derived from DXA based lateral vertebral assessment. Baseline demographic, clinical, and other health information (including a timed up and go (TUG) test) were assessed at a clinic visit. Participants were followed monthly through email or postcard for 1 year, with falls outcomes confirmed through telephone interview. RESULTS Mean age was 77.8 (± 7.1) among the 52 women and 20 men. Over 12 months, 64% of participants experienced at least one incident fall and 35% experienced an injurious fall. Each standard deviation increase in kyphosis resulted in more than doubling the adjusted odds of an incident fall, even after adjusting for TUG. Odds of injurious falls were less consistent across measures; after adjusting for TUG, only the blocks method was associated with injurious falls. CONCLUSIONS Each kyphosis measure was independently associated with incident falls. Findings were inconsistent for injurious falls; the blocks measure suggested the strongest association. If these findings are replicated, the blocks measure could be incorporated into office visits as a quick and efficient tool to identify patients at increased fall risk.
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Affiliation(s)
- C McDaniels-Davidson
- San Diego State University/University of California, San Diego | Joint Doctoral Program in Public Health (Epidemiology), San Diego, CA, USA.
| | - A Davis
- San Diego State University/University of California, San Diego | Joint Doctoral Program in Public Health (Epidemiology), San Diego, CA, USA
| | - D Wing
- Department of Family Medicine and Public Health, University of California, San Diego, CA, USA
| | - C Macera
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - S P Lindsay
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - J T Schousboe
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
- Park Nicollet Osteoporosis Center and Institute for Research and Education, Minneapolis, MN, USA
| | - J F Nichols
- Department of Family Medicine and Public Health, University of California, San Diego, CA, USA
| | - D M Kado
- Department of Family Medicine and Public Health, University of California, San Diego, CA, USA
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Bettany-Saltikov J, Turnbull D, Ng SY, Webb R. Management of Spinal Deformities and Evidence of Treatment Effectiveness. Open Orthop J 2017; 11:1521-1547. [PMID: 29399227 PMCID: PMC5759105 DOI: 10.2174/1874325001711011521] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/02/2017] [Accepted: 09/11/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The review evaluates the up-to-date evidence for the treatment of spinal deformities, including scoliosis and hyperkyphosis in adolescents and adults. MATERIAL AND METHODS The PubMed database was searched for review articles, prospective controlled trials and randomized controlled trials related to the treatment of spinal deformities. Articles on syndromic scoliosis were excluded and so were the articles on hyperkyphosis of the spine with causes other than Scheuermann's disease and osteoporosis. Articles on conservative and surgical treatments of idiopathic scoliosis, adult scoliosis and hyperkyphosis were also included. For retrospective papers, only studies with a follow up period exceeding 10 years were included. RESULTS The review showed that early-onset idiopathic scoliosis has a worse outcome than late-onset idiopathic scoliosis, which is rather benign. Patients with AIS function well as adults; they have no more health problems when compared to patients without scoliosis, other than a slight increase in back pain and aesthetic concern. Conservative treatment of adolescent idiopathic scoliosis (AIS) using physiotherapeutic scoliosis-specific exercises (PSSE), specifically PSSR and rigid bracing was supported by level I evidence. Yet to date, there is no high quality evidence (RCT`s) demonstrating that surgical treatment is superior to conservative treatment for the management of AIS. For adult scoliosis, there are only a few studies on the effectiveness of PSSEs and a conclusion cannot as yet be drawn.For hyperkyphosis, there is no high-quality evidence for physiotherapy, bracing or surgery for the treatment of adolescents and adults. However, bracing has been found to reduce thoracic hyperkyphosis, ranging from 55 to 80° in adolescents. In patients over the age of 60, bracing improves the balance score, and reduces spinal deformity and pain. Surgery is indicated in adolescents and adults in the presence of progression of kyphosis, refractory pain and loss of balance. DISCUSSION The available evidence reviewed has suggested that different approaches are needed towards the management of different spinal deformities. Specific exercises should be prescribed in children and adolescents with a Cobb angle in excess of 15°. In progressive curves, they should be used in conjunction with bracing. Clarity regarding differences and similarities is given as to what makes PSSE and PSSR specific exercises. As AIS is relatively benign in nature, conservative treatment should be tried when the curve is at a surgical threshold, before surgery is considered. Similarly, bracing and exercises should be prescribed for patients with hyperkyphosis, particularly when the lumbar spine is afflicted. Surgery should be considered only when the symptoms cannot be managed conservatively. CONCLUSION There is at present high quality evidence in support of the conservative treatment of AIS. The current evidence supports the use of PSSE, especially those using PSSR, together with bracing in the treatment of AIS. In view of the lack of medical consequences in adults with AIS, conservative treatment should be considered for curves exceeding the formerly assumed range of conservative indications.There is, however a lack of evidence in support of any treatment of choice for hyperkyphosis in adolescents and spinal deformities in adults. Yet, conservative treatment should be considered first. Yet to date, there is no high quality evidence (RCT`s) demonstrating that surgical treatment is superior to conservative treatment for the management of AIS and hyperkyphosis. Additionally, surgery needs to be considered with caution, as it is associated with a number of long-term complications.
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Affiliation(s)
| | | | | | - Richard Webb
- Peacocks Medical Group, Newcastle-upon-Tyne, Newcastle, UK
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Katzman WB, Parimi N, Gladin A, Poltavskiy EA, Schafer AL, Long RK, Fan B, Wong SS, Lane NE. Sex differences in response to targeted kyphosis specific exercise and posture training in community-dwelling older adults: a randomized controlled trial. BMC Musculoskelet Disord 2017; 18:509. [PMID: 29202732 PMCID: PMC5715979 DOI: 10.1186/s12891-017-1862-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 11/20/2017] [Indexed: 12/13/2022] Open
Abstract
Background Hyperkyphosis, an excessive anterior curvature in the thoracic spine, is associated with reduced health status in older adults. Hyperkyphosis is highly prevalent, more common in older women than men. There is no standard intervention to reduce age-related hyperkyphosis. Sex differences in response to a kyphosis-specific exercise intervention are not known. Methods We conducted a randomized controlled trial of a targeted kyphosis-specific exercise and postural training program on the primary outcome Cobb angle of kyphosis, and investigated whether the magnitude of change differed between men and women. One hundred twelve participants aged ≥60 years with kyphosis ≥40° were enrolled and randomized to exercise or waitlist control, and 101 participants had analyzable baseline and follow-up radiographs for Cobb angle measurements. A group intervention including 10 participants per group was delivered by a physical therapist, 1-h, twice a week for 3-months. Controls were placed on a waitlist for 3 months before receiving a delayed intervention. Primary outcome was change from baseline to 3-months in Cobb angle measured from standing lateral spine radiographs. Secondary outcomes included change over 3-months in kyphometer-measured kyphosis, physical function and quality of life. Groups were combined for analysis after both received the intervention, and sex differences in response to the intervention were tested with ANOVA. Results Participants (60 women, 41 men) were 70.0 (SD = 5.7) years old with mean Cobb angle 55.9 (SD = 12.2) degrees at baseline. The active group had higher baseline modified Physical Performance Test scores than control, p = 0.03. Men had greater baseline kyphometer-measured kyphosis, p = 0.09, and higher bone mineral density (BMD), spine strength, more vertebral fractures and diffuse idiopathic skeletal hyperostosis (DISH) than women, p ≤ 0.01. There was no statistically significant difference between groups in change in Cobb at 3-months, p = 0.09, however change in kyphometer-measured kyphosis differed by 4.8 (95% CI:-6.8,-2.7) degrees, p < 0.001, favoring the active group. There were no differences between men and women in change in either kyphosis measurement after intervention, p > 0.1. Conclusions A 3-month targeted spine strengthening exercise and posture training program reduced kyphometer-measured, but not radiographic-measured kyphosis. Despite sex differences in baseline kyphosis, BMD, spine strength, fractures and DISH, sex did not affect treatment response. Trial registration ClinicalTrials.gov Identifier: NCT01766674.
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Affiliation(s)
- Wendy B Katzman
- University of California, 1500 Owens Street, Suite 400, San Francisco, CA, 94158, USA.
| | - Neeta Parimi
- San Francisco Coordinating Center, San Francisco, CA, USA
| | - Amy Gladin
- Kaiser Permanente Northern California, San Francisco, CA, USA
| | | | - Anne L Schafer
- University of California, 1500 Owens Street, Suite 400, San Francisco, CA, 94158, USA.,San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Roger K Long
- University of California, 1500 Owens Street, Suite 400, San Francisco, CA, 94158, USA
| | - Bo Fan
- University of California, 1500 Owens Street, Suite 400, San Francisco, CA, 94158, USA
| | - Shirley S Wong
- University of California, 1500 Owens Street, Suite 400, San Francisco, CA, 94158, USA
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Abstract
BACKGROUND Age-related hyperkyphosis causes deleterious effects on health, physical function, and quality of life. Recently, health care providers recognized it as a major health concern. OBJECTIVE To identify the effect of corrective exercise strategy on hyperkyphosis and compare it with that of conventional exercise. METHODS Subjects were randomly categorized into two groups. Each group comprised 30 subjects. Group A received the corrective exercise strategy, and group B received conventional exercises for 8 weeks of the study duration (15 repetitions of each exercise for three sessions/day for a total duration of 45 min and 4 days/week. Pre- and post-interventional hyperkyphosis were analyzed according to posture number using the Posture Pro 8 postural analysis software. In addition, pectoralis minor flexibility was assessed using the ruler scale method in centimeters. RESULTS Both groups showed highly significant postural alteration and changes in pectoralis minor muscle length (p< 0.001)CONCLUSIONS:The corrective exercise strategy seems to promote scapular stability and produce a more upright posture of the upper thoracic spine.
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Affiliation(s)
- P Senthil
- School of Physiotherapy, Vels University, Chennai, Tamilnadu, India.,Department of Musculoskeletal, Mohamed Sathak A.J. College of Physiotherapy, Chennai, Tamilnadu, India
| | - S Sudhakar
- Faculty of Physiotherapy, ACS Medical College and Hospitals, Dr MGR University Educational and Research Institute, Chennai, Tamilnadu, India
| | - R Radhakrishnan
- Department of Musculoskeletal, Mohamed Sathak A.J. College of Physiotherapy, Chennai, Tamilnadu, India
| | - S Jeyakumar
- Department of Physiotherapy, Saveetha University, Chennai, Tamilnadu, India
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Fortner MO, Oakley PA, Harrison DE. Treating 'slouchy' ( hyperkyphosis) posture with chiropractic biophysics ®: a case report utilizing a multimodal mirror image ® rehabilitation program. J Phys Ther Sci 2017; 29:1475-1480. [PMID: 28878486 PMCID: PMC5574330 DOI: 10.1589/jpts.29.1475] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 05/24/2017] [Indexed: 12/19/2022] Open
Abstract
[Purpose] To present a case of the non-surgical reduction of ‘slouchy’ hyperkyphosis
posture utilizing the multimodal Chiropractic BioPhysics® rehabilitation
program emphasizing the mirror image® concept. [Subject and Methods] A
27-year-old female presented suffering from neck and back pains, headaches and gait
dysfunction. The patient was treated 30 times over a period of 6-months. Treatment
consisted of anterior thoracic translation, thoracic extension, and head retraction
exercises as well as spinal traction and spinal manipulation. [Results] After 6-months of
treatment the patient displayed a total correction of the posterior thoracic translation
with a significant reduction in thoracic hyperkyphosis. The dramatic correction of her
overall posture and spine alignment corresponded to the significant relief of neck and
back pains, headaches and improvement of various other health issues as demonstrated by
self-report and SF-36. [Conclusion] Poor postures corresponding to poor health can be
changed for the better with multimodal rehabilitation programs that are now showing
consistent postural improvements corresponding with improvements in various health
conditions. We suggest that the postural correction of those with various pain symptoms be
considered as a first line non-pharmalogical, non-surgical rehabilitation approach for
those presenting with poor posture.
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Roghani T, Zavieh MK, Manshadi FD, King N, Katzman W. Age-related hyperkyphosis: update of its potential causes and clinical impacts-narrative review. Aging Clin Exp Res 2017; 29:567-77. [PMID: 27538834 DOI: 10.1007/s40520-016-0617-3] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 07/28/2016] [Indexed: 01/11/2023]
Abstract
The present study aims to qualitatively review the contributing factors and health implications of age-related hyperkyphosis. We conducted a narrative review of observational and cohort studies describing the risk factors and epidemiology of hyperkyphosis from 1955 to 2016 using the following key words: kyphosis, hyperkyphosis, posture, age-related hyperkyphosis, kyphotic posture, aetiology and causes. This review included 77 studies. Approximately 60-70 % of the most severe hyperkyphosis cases have no evidence of underlying vertebral compression fractures. Other proposed factors contributing to hyperkyphosis are degenerative disc disease, weakness of back extensor muscles and genetic predisposition. Strength and endurance of back extensor muscles are very important for maintaining normal postural alignment. Recent evidence suggests that age-related hyperkyphosis is not equivalent to spinal osteoporosis. Due to the negative impact of hyperkyphosis on physical function, quality of life and mortality rates, physicians should focus not only on osteoporosis, but also on age-related postural changes. More research about the relationship between spinal morphology and modifiable factors, especially the structural and functional parameters of trunk muscles, could further illuminate our understanding and treatment options for hyperkyphosis.
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Miller JE, Oakley PA, Levin SB, Harrison DE. Reversing thoracic hyperkyphosis: a case report featuring mirror image ® thoracic extension rehabilitation. J Phys Ther Sci 2017; 29:1264-1267. [PMID: 28744061 PMCID: PMC5509605 DOI: 10.1589/jpts.29.1264] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 04/05/2017] [Indexed: 01/30/2023] Open
Abstract
[Purpose] To present a case of non-surgical reduction of thoracic hyperkyphosis utilizing
a multimodal rehabilitation program emphasizing the mirror image® concept.
[Subject and Methods] A 15-year-old female presented to a rehabilitation office suffering
from back and neck pains and headaches. The patient was treated sporadically over a period
of 13-months. Treatment consisted of anterior thoracic translation and thoracic extension
exercises, spinal traction and spinal manipulation. [Results] After 13-months of treatment
the patient displayed a significant reduction in hyperkyphosis and a dramatic correction
of her overall posture and spine alignment corresponding to the reduction in back/neck
pains, headaches and the simultaneous improvement of various other health issues.
[Conclusion] Thoracic hyperkyphosis can be reduced through a multimodal rehabilitation
program emphasizing mirror image thoracic extension procedures.
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Senthil P, Sudhakar S, Radhakrishnan R. Effect of Thoracic Correction Exercises in Upper Body Dysfunction of 94-Year-old Male Participant - A Case Report. J Clin Diagn Res 2017; 10:YD01-YD02. [PMID: 28208991 DOI: 10.7860/jcdr/2016/22016.9029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/24/2016] [Indexed: 11/24/2022]
Abstract
The case report has been presented to show the effects of thoracic correction exercises on flexed posture in older men with upper body dysfunction using posture analysis software and pectoralis minor muscle length test. The present case is that of a 94-year-old male. He was guided for a specific thoracic correction exercises for 12 weeks. The program included breathing correction, thorax mobility, scapular stability and passive stretching of Pectoralis major and minor, performed thrice a week, 30 min each session, for 12 weeks. Outcome measures included the upper body dysfunction changes by posture analysis software and pectoralis minor muscle length test. The Pre and Post-test of the patient demonstrated significantly greater improvements in hyperkyphosis (forward head posture) and pectoralis minor muscle length. This case study provides a promising exercise intervention that may improve flexed posture in older men with age-related upper body dysfunction.
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Affiliation(s)
- P Senthil
- Professor, Department of Physiotherapy, Mohamed Sathak A J College of Physiotherapy , Chennai, Tamilnadu, India
| | - S Sudhakar
- Assistant Professor, Department of Arthroscopy and Sports Medicine, Sri Ramachandra University , Chennai, Tamilnadu, India
| | - R Radhakrishnan
- Professor, Department of Physiotherapy, Mohamed Sathak A J College of Physiotherapy , Chennai, Tamilnadu, India
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McDaniels-Davidson CR, Kritz-Silverstein D, Huang MH, Laughlin GA, Johnson S, Haapalahti J, Schneider DL, Barrett-Connor E, Kado DM. The association between bone turnover markers and kyphosis in community-dwelling older adults. Bone Rep 2016; 5:57-61. [PMID: 27868084 PMCID: PMC4926834 DOI: 10.1016/j.bonr.2016.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 03/05/2016] [Accepted: 04/03/2016] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Hyperkyphosis, accentuated curvature of the thoracic spine, is often attributed to osteoporosis, yet its underlying pathophysiology is not well understood. Bone turnover markers (BTM) reflect the dynamic process of bone formation and resorption. This study examined the association between serum BTM levels and kyphosis in community-dwelling older adults. METHODS Between 2003 and 2006, 760 men and women in the Rancho Bernardo Study age 60 and older had blood drawn and kyphosis measured. Fasting serum was assayed for N-telopeptide (NTX) and procollagen type 1 n-terminal propeptide (P1NP), markers of bone resorption and formation, respectively. Participants requiring two or more 1.7 cm blocks under their head to achieve a neutral supine position were classified as having accentuated kyphosis. Analyses were stratified by sex and use of estrogen therapy (ET). Odds of accentuated kyphosis were calculated for each standard deviation increase in log-transformed BTM. RESULTS Mean age was 75 years. Overall, 51% of 341 non-ET using women, 41% of 111 ET-using women, and 75% of 308 men had accentuated kyphosis. In adjusted models, higher P1NP and NTX were associated with decreased odds of accentuated kyphosis in non-ET using women (P1NP: OR = 0.78 [95% CI, 0.58-0.92]; NTX: OR = 0.68 [95% CI, 0.54-0.86]), but not in men or ET-using women (p > 0.05). CONCLUSIONS The selective association of higher bone turnover with reduced odds of accentuated kyphosis in non-ET using women suggests that elevated BTM were associated with a lower likelihood of hyperkyphosis only in the low estrogen/high BTM environment characteristic of postmenopausal women who are not using ET.
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Affiliation(s)
- Corinne R. McDaniels-Davidson
- San Diego State University/University of California, San Diego Joint Doctoral Program in Public Health (Epidemiology), 9500 Gilman Drive, MC 0725, La Jolla, CA 92093, United States
| | - Donna Kritz-Silverstein
- Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, San Diego, CA, United States
| | - Mei-Hua Huang
- Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, United States
| | - Gail A. Laughlin
- Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, San Diego, CA, United States
| | | | | | | | - Elizabeth Barrett-Connor
- Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, San Diego, CA, United States
| | - Deborah M. Kado
- Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, San Diego, CA, United States
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Abstract
BACKGROUND Hyperkyphosis with unknown reason is common in teenagers and can be corrected by orthotic management. OBJECTIVES Investigation of orthotic outcomes by Milwaukee brace. METHODS Sixty-one patients with idiopathic hyperkyphosis (> 45 degrees) were given Milwaukee brace before skeletal maturity. Hyperkyphosis was measured during the first visit without brace, in-brace, at the end of full-time and part time duration of treatment. After treatment completion, participants were categorized in two groups: with hyperkyphosis of 45 degrees and less (Group I) and more than 45 degrees (Group II). These groups were compared to interpret the treatment outcomes. RESULTS The mean kyphotic curve was 60.1 (SD ± 7.7) and 71 (SD = 10.1) degrees in Group I and II, respectively. The mean kyphotic curve at the time of full time and part time duration of treatment showed no significant difference in patients successfully completed the treatment (P = 0.10) while there was a significant difference between mean kyphotic curve in full time and part time treatment duration for patients with hyperkyphosis of more than 45 degrees (P < 0.05). CONCLUSIONS Hyperkyphosis of less than 70 degrees can be treated if the in-brace correction is saved in part-time duration.
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Affiliation(s)
- Mahboobeh Mehdikhani
- Rehabilitation Research Center, Iran University of Medical Sciences, Iran.,Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Hamid Behtash
- Department of Orthopaedic Surgery, Shafa Yahyaiian Hospital, Iran University of Medical Sciences, Iran
| | - Mohammad S Ganjavian
- Department of Orthopaedic Surgery, Shafa Yahyaiian Hospital, Iran University of Medical Sciences, Iran
| | - Nafiseh Khalaj
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
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Tran TH, Wing D, Davis A, Bergstrom J, Schousboe JT, Nichols JF, Kado DM. Correlations among four measures of thoracic kyphosis in older adults. Osteoporos Int 2016; 27:1255-1259. [PMID: 26475287 PMCID: PMC5332161 DOI: 10.1007/s00198-015-3368-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 10/06/2015] [Indexed: 02/02/2023]
Abstract
SUMMARY There are many ways to measure thoracic kyphosis ranging from simple clinical to more complex assessments. We evaluated the correlation among four commonly used kyphosis measures: Cobb angle, Debrunner kyphometer, kyphotic index, and the blocks method. Each measure was correlated with the others, confirming high clinical and research applicability. INTRODUCTION The purpose of this study was to assess the associations among four commonly used measures of thoracic kyphosis in older adults. METHODS Seventy two men and women aged 65-96 were recruited from the San Diego community. Four kyphosis measures were assessed in the same person during a baseline clinic visit. Two measures were done in the lying (L) and two in the standing (ST) position: (1) Cobb angle calculated from dual X-Ray absorptiometry (DXA) images (L), (2) Debrunner kyphometer (DK) angle measured by a protractor (ST), (3) kyphotic index (KI) calculated using an architect's flexicurve ruler (ST), and (4) the blocks method involving counting the number of 1.7 cm-thick blocks required to achieve a neutral head position while lying flat on the DXA table (L). Spearman rank correlation coefficients were used to determine the strength of the association between each kyphosis measure. RESULTS Using the Cobb angle as the gold standard, the blocks method demonstrated the lowest correlation (r(s) = 0.63, p < 0.0001), the Debrunner method had a moderate correlation (r(s) = 0.65, p < 0.0001), and the kyphotic index had the highest correlation (r(s) = 0.68, p < 0.0001). The correlation was strongest between the kyphotic index and the Debrunner kyphometer (r(s) = 0.76, p < 0.0001). CONCLUSION In older men and women, all four measures of thoracic kyphosis were significantly correlated with each other, whether assessed in the lying or standing position. Thus, any of these measures demonstrate both potential clinical and research utility.
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Affiliation(s)
- T H Tran
- Department of Family Medicine and Public Health, University of California at San Diego, 9500 Gilman Drive #0725, La Jolla, CA, 92093-0725, USA
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - D Wing
- Department of Family Medicine and Public Health, University of California at San Diego, 9500 Gilman Drive #0725, La Jolla, CA, 92093-0725, USA
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - A Davis
- Department of Family Medicine and Public Health, University of California at San Diego, 9500 Gilman Drive #0725, La Jolla, CA, 92093-0725, USA
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - J Bergstrom
- Department of Family Medicine and Public Health, University of California at San Diego, 9500 Gilman Drive #0725, La Jolla, CA, 92093-0725, USA
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - J T Schousboe
- Park Nicollet Osteoporosis Center and Institute for Research and Education, Minneapolis, MN, USA
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - J F Nichols
- Department of Family Medicine and Public Health, University of California at San Diego, 9500 Gilman Drive #0725, La Jolla, CA, 92093-0725, USA
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - D M Kado
- Department of Family Medicine and Public Health, University of California at San Diego, 9500 Gilman Drive #0725, La Jolla, CA, 92093-0725, USA.
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA.
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Jang HJ, Kim MJ, Kim SY. Effect of thorax correction exercises on flexed posture and chest function in older women with age-related hyperkyphosis. J Phys Ther Sci 2015; 27:1161-4. [PMID: 25995579 PMCID: PMC4434000 DOI: 10.1589/jpts.27.1161] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 12/11/2014] [Indexed: 11/28/2022] Open
Abstract
[Purpose] The purpose of this study was to determine the effects of thorax correction
exercises on flexed posture and chest function in older women with age-related
hyperkyphosis. [Subjects and Methods] The study participants included 41 elderly women who
were divided into a thorax correction exercise group (n = 20) and a control group (n =
21). Participants in the exercise group completed a specific exercise program that
included breathing correction, thorax mobility, thorax stability, and thorax alignment
training performed twice per week, 1 hour each session, for 8 weeks. Outcome measures
included the flexed posture (thoracic kyphosis angle, forward head posture) and chest
function (vital capacity, forced expiratory volume in a second, and chest expansion
length). [Results] Participants in the thorax correction exercise group demonstrated
significantly greater improvements in thoracic kyphosis angle, forward head, and chest
expansion than those in the control group. [Conclusion] This study provides a promising
exercise intervention that may improve flexed posture and chest function in older women
with age-related hyperkyphosis.
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Affiliation(s)
- Hyun-Jeong Jang
- Department of Physical Therapy, Daejeon University, Republic of Korea
| | - Myung-Jun Kim
- Department of Physical Therapy, Kyungdong University: Bongpo-ri, Toseong-myeon, Goseong-gun, Gangwon-do 216-705, Republic of Korea
| | - Suhn-Yeop Kim
- Department of Physical Therapy, Daejeon University, Republic of Korea
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
OBJECTIVE Hyperkyphosis (excess thoracic spine curvature) is associated with upper-extremity functional limitations and altered scapular posturing. The purpose of this study was to quantify the changes in upper-extremity function and scapular posturing following a 6-month yogaintervention in persons with hyperkyphosis. METHODS Twenty-one older adults with hyperkyphosis (75.5+7.4 yrs) enrolled in the UCLA Yoga for Kyphosis randomized controlled trial, elected to participate in this uncontrolled, prepost substudy of upper-extremity function. They were measured at baseline and after a 24-week yoga intervention. Maximum vertical reach and timed book tests were used to evaluate upper-extremity function. Scapular posturing was quantified using a motion analysis system and data was obtained under 4 conditions: 1) quiet-standing, 2) normal walking, 3) fast walking, and 4) seated. Paired t-tests were used to test for changes between baseline and 6-month follow-up measures and Cohen's d was calculated to examine effect sizes. RESULTS Following the 6-month yoga intervention, participants improved their book test performance by 26.4% (p < 0.001; d = 1.5). Scapular protraction decreased by 2.9% during the static-sitting condition (p < 0.001; d = 0.5) and the overall excursion of the scapulae decreased for both fast (25.0%, p < 0.05; d = 0.6) and self-selected walking (29.4%, p < 0.01; d = 0.9). There were no changes in maximum vertical reach. CONCLUSION Subjects demonstrated significant improvements with small to large effect sizes in the timed book test and scapular posturing to a less protracted position during both static and dynamic conditions after the intervention. These adaptations are likely to reduce the risk of scapular impingement and help preserve functional independence in older adults.
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Affiliation(s)
- Man-Ying Wang
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA 90089, USA
| | - Gail A Greendale
- Division of Geriatrics, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - Leslie Kazadi
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA 90089, USA
| | - George J Salem
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA 90089, USA
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