School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei City, Taiwan (R.O.C).
Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand.
Physiother Theory Pract. 2023 Sep 2;39(9):1816-1831. doi: 10.1080/09593985.2022.2060885. Epub 2022 Apr 11.
Upper quadrant geometrical changes in individuals with chronic obstructive pulmonary disease (COPD) appear to have negative influences on geometrical arrangements of the thorax and scapula.
The purpose of this systematic review was to assess the impairment of scapular control in individuals with COPD as compared with healthy controls.
We systematically searched seven electronic databases from inception to June 2021 and updated the searches again in December 2021. Eligible studies included the participants with COPD and compared scapular control outcomes (scapular/shoulder kinematic or related muscle activity) with a control group. Two researchers independently searched for, screened, extracted data from, and evaluated the quality of all articles.
Seven studies met the inclusion criteria and only five studies with 190 subjects were included in the meta-analyses. Subgroup analyses showed that the control group exhibited more scapular anterior tilt (SMD: 0.46; 95% CI: 0.01 to 0.90) and shoulder flexion (SMD: -1.02; 95% CI: -1.79 to -0.26) as compared with the COPD group. Conversely, the COPD group exhibited more scapular elevation (SMD: -1.03; 95% CI: -1.69 to -0.37), internal rotation (SMD: -1.65; 95% CI: -3.19 to -0.10), and protraction (SMD: -0.75; 95% CI: -1.18 to -0.32) compared with the control group. All other outcomes revealed non-significant findings.
This review demonstrated scapular control impairments, such as scapular elevation, internal rotation, protraction, and anterior tilt in a static position in patients with COPD. To validate these findings, high-quality randomized control trials with large sample sizes and reliable outcome measures should be conducted.
慢性阻塞性肺疾病（COPD）患者的上象限几何形状变化似乎对胸廓和肩胛骨的几何排列有负面影响。
本系统评价的目的是评估 COPD 患者与健康对照组相比，肩胛骨控制的受损情况。
我们系统地检索了七个电子数据库，从建库开始检索到 2021 年 6 月，并在 2021 年 12 月再次更新检索。纳入的研究包括 COPD 患者，并比较了肩胛骨控制结果（肩胛骨/肩部运动学或相关肌肉活动）与对照组。两名研究人员独立搜索、筛选、提取所有文章的数据，并评估其质量。
有 7 项研究符合纳入标准，只有 5 项研究的 190 名受试者纳入荟萃分析。亚组分析显示，与 COPD 组相比，对照组的肩胛骨前倾斜（SMD：0.46；95%CI：0.01 至 0.90）和肩前屈（SMD：-1.02；95%CI：-1.79 至-0.26）更大。相反，与对照组相比，COPD 组的肩胛骨抬高（SMD：-1.03；95%CI：-1.69 至-0.37）、内旋（SMD：-1.65；95%CI：-3.19 至-0.10）和前伸（SMD：-0.75；95%CI：-1.18 至-0.32）更大。所有其他结果均无显著发现。
本综述表明 COPD 患者在静态位置存在肩胛骨控制受损，如肩胛骨抬高、内旋、前伸和前倾斜。为了验证这些发现，应该进行高质量的随机对照试验，样本量大，结果测量可靠。
