Katzman Wendy B, Gladin Amy, Lane Nancy E, Wong Shirley, Liu Felix, Jin Chengshi, Fukuoka Yoshimi
Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, CA, USA.
Rehabilitation Services, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA.
JMIR Aging. 2019 Jan-Jun;2(1):e12199. doi: 10.2196/12199. Epub 2019 Jan 21.
Hyperkyphosis is common among older adults, and is associated with multiple adverse health outcomes. A kyphosis-specific exercise and posture training program improves hyperkyphosis, but in-person programs are expensive to implement and maintain over longer-periods of time. It is unknown if a technology-based posture training program disseminated through a smartphone is a feasible or acceptable alternative to in-person training among older adults with hyperkyphosis.
The primary purpose of this study was to assess the feasibility of subject recruitment, short-term retention and adherence, and the acceptability of a technology-based exercise and postural training program disseminated as video clip links and text messaging prompts via a smartphone. The secondary purpose was to explore the potential efficacy of this program on kyphosis, physical function and health-related quality of life in older adults with hyperkyphosis.
This was a 6-week pre-post design pilot trial. We recruited community-dwelling adults ≥65 years with hyperkyphosis ≥40 (±5) degrees and access to a smartphone. The intervention had two parts: 1) exercise and posture training via video clips sent to participants daily via text messaging which included 6 weekly video clip links to be viewed on the participant's smartphone and 2) text messaging prompts to practice good posture. We determined subject recruitment, adherence, retention and acceptability of the intervention. Outcomes included change in kyphometer-measured kyphosis, occiput to wall (OTW), Short Physical Performance Battery (SPPB), Scoliosis Research Society SRS-30, Center for Epidemiological Studies Depression (CESD) and Physical Activity Scale for the Elderly (PASE).
64 potential participants were recruited, 17 participants were enrolled and 12 completed post-intervention testing at 6-weeks. Average age was 71.6 (SD=4.9) years and 50% were female. Median adherence to daily video viewing was 100%, (range 14 to 100) and to practicing good posture 3 times or more per day was 71%, (range 0 to 100). Qualitative evaluation of acceptability of the intervention revealed the smartphone screen was too small for participants to view the videos well and daily prompts to practice posture were too frequent. Kyphosis, OTW and physical activity significantly improved after the 6-week intervention. Kyphosis decreased by 8 (95% CI: 12, 5) degrees (p<0.001), OTW decreased 1.9 (95% CI: 3.3, 0.7) cm (p=0.007), and physical activity measured by PASE increased 29 (95% CI: 3, 54) points (p=0.03). The health-related quality of life SRS-30 score increased 0.11 (SD=0.19) points, but it was not statistically significant, p=0.09.
Technology-based exercise and posture training using video clip viewing and text messaging reminders is feasible and acceptable in a small cohort of older adults with hyperkyphosis. Technology-based exercise and posture training warrants further study as a potential self-management program for age-related hyperkyphosis that may be more easily disseminated than in-person training.
脊柱后凸在老年人中很常见，并与多种不良健康后果相关。特定于脊柱后凸的运动和姿势训练计划可改善脊柱后凸，但面对面的计划实施和长期维持成本很高。通过智能手机传播的基于技术的姿势训练计划对于患有脊柱后凸的老年人来说是否是面对面训练的可行或可接受的替代方案尚不清楚。
本研究的主要目的是评估招募受试者的可行性、短期保留率和依从性，以及通过智能手机以视频剪辑链接和短信提示形式传播的基于技术的运动和姿势训练计划的可接受性。次要目的是探讨该计划对患有脊柱后凸的老年人的脊柱后凸、身体功能和健康相关生活质量的潜在疗效。
这是一项为期6周的前后设计试点试验。我们招募了年龄≥65岁、脊柱后凸≥40（±5）度且能使用智能手机的社区居住成年人。干预包括两个部分：1）通过每天短信发送给参与者的视频剪辑进行运动和姿势训练，其中包括6个每周视频剪辑链接，供参与者在智能手机上观看；2）短信提示以练习良好姿势。我们确定了受试者招募、依从性、保留率和干预的可接受性。结果包括用脊柱后凸测量仪测量的脊柱后凸变化、枕骨到墙壁距离（OTW）、简短身体功能测试电池（SPPB）、脊柱侧弯研究学会SRS-30、流行病学研究中心抑郁量表（CESD）和老年人身体活动量表（PASE）。
招募了64名潜在参与者，17名参与者入组，12名在6周时完成了干预后测试。平均年龄为71.6（标准差=4.9）岁，50%为女性。每日视频观看的中位依从率为100%（范围14%至100%），每天练习良好姿势3次或更多次的依从率为71%（范围0至100%）。对干预可接受性的定性评估显示，智能手机屏幕太小，参与者无法很好地观看视频，且每天的姿势练习提示过于频繁。为期6周的干预后，脊柱后凸、OTW和身体活动显著改善。脊柱后凸减少了8（95%置信区间：12，5）度（p<0.001），OTW减少了1.9（95%置信区间：3.3，0.7）厘米（p=0.007），用PASE测量的身体活动增加了29（95%置信区间：3，54）分（p=0.03）。健康相关生活质量SRS-30评分增加了0.11（标准差=0.19）分，但无统计学意义，p=0.09。
在一小群患有脊柱后凸的老年人中，使用视频剪辑观看和短信提醒的基于技术的运动和姿势训练是可行且可接受的。基于技术的运动和姿势训练作为一种潜在的与年龄相关脊柱后凸的自我管理计划值得进一步研究，它可能比面对面训练更容易传播。
