Department of Physical Therapy, School of Health Professions, University of Texas Medical Branch, Galveston.
J Geriatr Phys Ther. 2022;46(3):151-160. doi: 10.1519/JPT.0000000000000360. Epub 2022 Aug 5.
Thoracic hyperkyphosis is a common condition that progresses with aging and has been associated with impaired functional performance, increased risk of falls, and even mortality. Previous studies to improve posture primarily used exercise for durations of 3 months or longer. The purpose of this pilot study was to examine the feasibility of a manual therapy intervention in community-dwelling older adults over a 4-week time frame that is comparable to the typical clinical setting, to test the appropriateness and procedures for the measurement of posture and function in the older population with hyperkyphosis, and to collect preliminary data to describe change in posture and function measures.
Twenty-four participants with hyperkyphosis or forward head posture were recruited, and 22 participants completed this pilot study. Feasibility was measured based on attendance, tolerance, safety, and retention. Issues with measurement procedures were recorded. The intervention included manual therapy and exercise 3 times a week for 4 weeks to target spinal and peripheral joint stiffness, muscle lengthening, and muscle activation. Outcomes included height, kyphotic index (KI), Block Test, Acromion to Table (ATT), Timed Up and Go (TUG), 5 times sit-to-stand (5XSTS), Functional Reach (FR), 2-minute walk test (2MWT), and Patient-Specific Functional Scale (PSFS). Data collected at visits 1, 6, and 12 were analyzed using 1-way repeated-measures multivariate analysis of variance.
Measurement and intervention protocols were found to be feasible. A significant effect for the aggregate dependent variables change over time was found. Univariate analysis of each dependent variable showed significance except for FR. All postural measures (height, KI, Block Test, and ATT) significantly improved statistically. The KI and ATT exceed the minimal detectable change for clinical significance. Function showed statistical improvements in the TUG, 5XSTS, 2MWT, and PSFS. Clinical significance was reached with the PSFS. Seven of 9 measures showed a statistically significant change in just 2 weeks.
This pilot study suggests that manual therapy and exercise applied to older adults shows promise for improvement in measures of posture and functional performance in a clinically feasible 4-week time frame.
胸椎后凸是一种常见的随着年龄增长而逐渐加重的病症，它与功能表现受损、跌倒风险增加甚至死亡风险增加有关。既往改善姿势的研究主要采用时长为 3 个月或更长的运动疗法。本研究旨在探讨在与典型临床环境可比的 4 周时间内，对社区居住的老年患者实施手法治疗干预的可行性，检验针对胸椎后凸老年患者的姿势和功能测量的适宜性和程序，并收集初步数据以描述姿势和功能测量的变化。
共招募 24 名胸椎后凸或前屈头位患者，其中 22 名患者完成了本研究。以出席率、耐受性、安全性和保留率来衡量可行性。记录测量程序中的问题。干预措施包括每周 3 次、共 4 周的手法治疗和运动疗法，以治疗脊柱和外周关节僵硬、肌肉延长和肌肉激活。结局指标包括身高、后凸指数（kyphotic index，KI）、Block 测试、肩峰到桌面距离（acromion to table，ATT）、计时起立行走测试（Timed Up and Go，TUG）、5 次坐立站起（5 times sit-to-stand，5XSTS）、功能性伸手距离（functional reach，FR）、2 分钟步行测试（2-minute walk test，2MWT）和患者特异性功能量表（Patient-Specific Functional Scale，PSFS）。使用 1 因素重复测量多元方差分析对第 1、6 和 12 次就诊时采集的数据进行分析。
测量和干预方案被证明是可行的。发现综合因变量随时间的变化有显著效果。除 FR 外，各因变量的单变量分析均有显著性差异。所有姿势测量指标（身高、KI、Block 测试和 ATT）在统计学上均显著改善。KI 和 ATT 超过临床意义的最小可检测变化。TUG、5XSTS、2MWT 和 PSFS 的功能均显示出统计学上的改善。PSFS 达到临床意义。仅在 2 周内，9 项指标中的 7 项就显示出统计学上的显著变化。
本研究表明，应用于老年患者的手法治疗和运动疗法在 4 周的临床可行时间内有望改善姿势和功能表现测量。
