Brink Yolandi, Louw Quinette, Grimmer Karen
Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, P O Box 19063, Tygerberg 7505, South Africa.
International Centre for Allied Health Evidence (iCAHE), University of South Australia, GPO Box 2471, Adelaide, SA 5000, Australia.
J Bodyw Mov Ther. 2018 Jul;22(3):608-617. doi: 10.1016/j.jbmt.2017.10.002. Epub 2017 Oct 6.
Improved techniques of measuring sitting posture have not led to a more comprehensive understanding of poor posture, nor its association with pain. There is also an evidence gap regarding critical thresholds of sitting postural change over time related to pain production. This paper describes postural angle changes over a 12-month period, and describes the process of placing defensible cut-points in the angle change data, to better understand associations between posture change over time, and onset of upper quadrant musculoskeletal pain (UQMP).
This paper reports on data captured at baseline and 12-month follow-up, in adolescents in school using computers. Four sitting postural angles, head flexion (HF), neck flexion (NF), craniocervical angle (CCA) and trunk flexion (TF), and self-reported seated UQMP in the previous month were captured at each time-point. Research questions were: 1) What is the magnitude and direction of change in each postural angle over 12 months? 2) What are best cut-points in the continuous posture change distribution to most sensitively test the association between posture change and UQMP? 3) Is gender-specific cut-points required? The 12-month posture angle change data was divided into quintiles (0-20th%; 21-40%, 41-60%, 61-80%, >80%), and the odds of UQMP occurring in each posture change quintile were calculated using logistic regression models.
Two hundred and eleven students participated at baseline, of which 153 were followed-up at one year. Both males and females with postural change into extension (which represents lesser flexion range) were more at risk for the development of UQMP, than any other group. The best cut-point for HF was 40% (≤-3.9°), NF was 20th% (≤-2.9°) and TF was 40% (≤-1.1°). For CCA however, change at or beyond 40 % for extension or beyond 60% for flexion was associated with UQMP.
Identification of critical postural angle change cut-points assists in considering the pain-producing mechanisms for adolescents using desk top computers.
测量坐姿的技术有所改进，但尚未使人们对不良姿势及其与疼痛的关联有更全面的理解。关于随着时间推移坐姿变化与疼痛产生相关的关键阈值，也存在证据空白。本文描述了12个月期间的姿势角度变化，并描述了在角度变化数据中设定合理切点的过程，以更好地理解随时间的姿势变化与上象限肌肉骨骼疼痛（UQMP）发作之间的关联。
本文报告了在学校使用电脑的青少年在基线和12个月随访时收集的数据。在每个时间点记录四个坐姿角度，即头部前屈（HF）、颈部前屈（NF）、颅颈角（CCA）和躯干前屈（TF），以及前一个月自我报告的坐位UQMP。研究问题为：1）12个月内每个姿势角度的变化幅度和方向是怎样的？2）在连续的姿势变化分布中，最能敏感地测试姿势变化与UQMP之间关联的最佳切点是什么？3）是否需要特定性别的切点？将12个月的姿势角度变化数据分为五分位数（0 - 20%；21 - 40%，41 - 60%，61 - 80%，>80%），并使用逻辑回归模型计算每个姿势变化五分位数中发生UQMP的几率。
211名学生参与了基线测试，其中153名在一年后接受了随访。与姿势变为伸展（代表较小的前屈范围）的男性和女性相比，其他任何组发生UQMP的风险都更高。HF的最佳切点为40%（≤ - 3.9°），NF为第20百分位数（≤ - 2.9°），TF为40%（≤ - 1.1°）。然而，对于CCA，伸展达到或超过40%或屈曲超过60%的变化与UQMP相关。
确定关键的姿势角度变化切点有助于考虑使用台式电脑的青少年的疼痛产生机制。
