Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
Prosthet Orthot Int. 2020 Aug;44(4):234-244. doi: 10.1177/0309364620923816. Epub 2020 Jun 7.
Hyperkyphosis may cause balance impairment in elderly people. Although the effectiveness of orthoses for improving balance in hyperkyphotic elderly people has received much attention, the mechanisms by which devices affect balance remain unknown.
The objective of this study was to evaluate changes in balance performance, thoracic kyphosis angle, craniovertebral angle, back muscle endurance and joint position sense after 3 months of wearing a Spinomed orthosis. The study also included a secondary exploratory analysis to determine whether changes in any of the above-mentioned outcome measures can predict balance performance improvement in elderly people with hyperkyphosis.
Parallel group randomized controlled trial.
In total, 44 hyperkyphotic elderly people were randomly allocated to an experimental group, who wore a Spinomed orthosis and a control group, who did not. No other treatment or change in physical activity was permitted during the study. A blinded assessor evaluated thoracic kyphosis angle, joint position sense, craniovertebral angle, back muscle endurance, Timed Up and Go Test time and Berg Balance Scale score at baseline and after 5, 9 and 13 weeks. All dependent variables were measured without the orthosis and analyzed separately using a 2 × 4 (time × group) mixed model analysis of variance. Based on the results of correlation analysis, thoracic kyphosis angle, back muscle endurance and joint position sense were selected as independent variables in a stepwise multiple regression model.
The two-way (group × time) interactions were significant in terms of Berg Balance Scale ( = 11.6, ⩽ 0.001, ), Timed Up and Go Test ( = 3.74, = 0.013, ), thoracic kyphosis angle ( = 43.39, ⩽ 0.001, ), craniovertebral angle ( = 5.245, = 0.002, ) and joint position sense ( = 4.44, = 0.005, ). The two-way interaction was not significant in terms of back muscle endurance; however, the main effect of group was significant for this variable ( = 3.85, = 0.025). Stepwise multiple regression showed that thoracic kyphosis angle and joint position sense were significant determinants of Timed Up and Go Test time ( = 0.155, = 0.037 and = 0.292, = 0.012, respectively).
Wearing a Spinomed orthosis for 3 months improved the posture, position sense and muscle performance of hyperkyphotic elderly people. Orthoses may improve balance performance by correcting spinal alignment and increasing proprioceptive information.
脊柱后凸可能导致老年人平衡受损。尽管矫形器在改善脊柱后凸老年人平衡方面的有效性已得到广泛关注，但器械影响平衡的机制仍不清楚。
本研究旨在评估佩戴 Spinomed 矫形器 3 个月后平衡表现、胸椎后凸角、颅颈角、腰背肌耐力和关节位置觉的变化，并进行二次探索性分析，以确定上述任何指标的变化是否可以预测脊柱后凸老年人平衡表现的改善。
平行组随机对照试验。
共纳入 44 名脊柱后凸的老年人，随机分为实验组（佩戴 Spinomed 矫形器）和对照组（不佩戴矫形器）。研究期间不允许进行其他治疗或改变身体活动。盲法评估员在基线、第 5、9 和 13 周时评估胸椎后凸角、关节位置觉、颅颈角、腰背肌耐力、计时起立行走测试时间和 Berg 平衡量表评分。所有依赖变量均在不佩戴矫形器的情况下进行测量，并使用 2×4（时间×组）混合模型方差分析分别进行分析。基于相关性分析的结果，选择胸椎后凸角、腰背肌耐力和关节位置觉作为逐步多元回归模型的自变量。
在 Berg 平衡量表（ = 11.6， ⩽ 0.001，）、计时起立行走测试（ = 3.74， = 0.013，）、胸椎后凸角（ = 43.39， ⩽ 0.001，）、颅颈角（ = 5.245， = 0.002，）和关节位置觉（ = 4.44， = 0.005，）方面，组间×时间的双向交互作用均具有统计学意义。腰背肌耐力方面，组间×时间的双向交互作用不具有统计学意义，但组间的主要效应在该变量方面具有统计学意义（ = 3.85， = 0.025）。逐步多元回归显示，胸椎后凸角和关节位置觉是计时起立行走测试时间的显著决定因素（ = 0.155， = 0.037 和 = 0.292， = 0.012，）。
佩戴 Spinomed 矫形器 3 个月可改善脊柱后凸老年人的姿势、位置觉和肌肉性能。矫形器可能通过矫正脊柱排列和增加本体感觉信息来改善平衡表现。
