Department of Orthopaedic Surgery, School of Medicine, Toho University, Tokyo, Japan.
Department of Environmental and Occupational Health, School of Medicine, Toho University, 5-21-16 Omori-nishi, Otaku, Tokyo, 143-8540, Japan.
Arch Osteoporos. 2017 Nov 22;12(1):105. doi: 10.1007/s11657-017-0401-9.
We investigated the longitudinal association of noninvasively evaluated kyphotic posture with future dependence in activities of daily living and death in a community-dwelling older Japanese. We found that the association with outcomes varied according to the types of kyphotic posture.
We have previously found an association between severe kyphosis and future dependence in activities of daily living (ADL) in people who manifest the condition in the supine position (structural curvature). However, because some people show severe kyphosis only in the standing position (postural curvature), we combined our noninvasively obtained kyphosis measurements from participants in the supine position (block method) with those obtained from participants in the standing position (kyphosis index) to determine whether not only structural curvature but also postural curvature is associated with ADL dependence and death.
Between 2005 and 2006, we carried out health evaluations of adults aged 65 years or older in Kurabuchi Town, Japan: 792 participants (337 males, 455 females) who were independent in ADL at baseline and underwent evaluation of kyphotic posture were followed up until March 2014 (mean follow-up: 7.5 years). Participants who experienced one or more admissions to a nursing home, certification of a need for long-term care/support, or a decline in the Katz ADL Index during the follow-up period were defined as being dependent in ADL.
A flat back (straight spine in a standing position) and structural curvature were associated with future ADL dependence, but postural curvature was not. The multivariate-adjusted odds ratios (95% confidence interval) compared with physiological curvature (physiological curvature in a standing position) as the reference were 1.72 (1.04-2.86) for a flat back and 2.76 (1.59-4.79) for structural curvature. A weak association with death was observed in those with structural curvature.
Our results suggest that the prognoses of people with kyphosis differ according to the type of kyphotic posture.
我们研究了社区居住的日本老年人中，非侵袭性评估的后凸姿势与未来日常生活活动（ADL）依赖和死亡之间的纵向关联。我们发现，与结局的关联因后凸姿势的类型而异。
我们之前发现，在仰卧位（结构性弯曲）出现该情况的人群中，严重后凸与未来 ADL 依赖有关。然而，由于有些人仅在站立位（姿势弯曲）表现出严重后凸，我们将参与者仰卧位（块方法）的非侵袭性后凸测量值与站立位（后凸指数）的测量值相结合，以确定不仅结构性弯曲，而且姿势弯曲是否与 ADL 依赖和死亡相关。
在 2005 年至 2006 年间，我们对日本仓敷市的 65 岁或以上成年人进行了健康评估：792 名参与者（337 名男性，455 名女性）在基线时 ADL 独立，并接受了后凸姿势评估，随访至 2014 年 3 月（平均随访时间：7.5 年）。在随访期间经历过一次或多次入住疗养院、需要长期护理/支持的认证或 Katz ADL 指数下降的参与者被定义为 ADL 依赖。
直背（站立位脊柱正常）和结构性弯曲与未来 ADL 依赖相关，但姿势弯曲不相关。与生理弯曲（站立位生理弯曲）作为参考相比，多变量调整后的优势比（95%置信区间）为直背 1.72（1.04-2.86），结构性弯曲 2.76（1.59-4.79）。观察到结构性弯曲与死亡有微弱关联。
我们的结果表明，后凸患者的预后因后凸姿势的类型而异。
