Methods of Postural Assessment used in Hyperkyphotic Elders: A Narrative Review
Main Article Content
Abstract
Background and objective: Aging is a natural process and associated changes in posture, mainly at the spine lead to complications in functional independence and quality of life. The aim of this review is to identify existing measuring tools used to measure hyperkyphotic posture in the elderly population.
Methods: Electronic databases were searched from January 2001 to December 2021, with different combinations of keywords, “thoracic kyphosis” or “hyperkyphosis” or “kyphotic posture” or hyperkyphotic posture” or “flexed posture” or “spinal curve” and “assessment”, “measurement” or “instrument” or “equipment” and “elderly” or “older adults” or “elders”. Studies were selected based on inclusion and exclusion criteria.
Results: Four thousand one hundred sixty-six studies were obtained from electronic databases. After the removal of 3227 duplicate studies, twenty-six relevant studies were selected from 939 unique studies. Radiographic measurement, Flexicurve ruler, Debrunner kyphometer, Gravity-dependent inclinometer, occiput to wall distance (OTW), tragus to wall distance (TWD), and spinal mouse were used for hyperkyphotic measurement. The radiographic method and Flexicurve showed very high reliability. The block method and flexicurve are widely used methods for assessing hyperkyphotic posture in older adults.
Conclusion: Postural assessment methods showed variability in defining criteria for hyperkyphosis in the elderly population. Flexicurve and block methods can be used as non-invasive methods for the early detection of hyperkyphosis. In the future, more measurement tools should be developed for the measurement of kyphosis, that are cost-effective, with excellent reliability and validity.
Keywords:
Kyphosis, Posture, Aged, Thorax, Spine
Article Details
How to Cite
KUMAR, Sunil; SINGLA, Deepika; CHHUGANI, Manju.
Methods of Postural Assessment used in Hyperkyphotic Elders: A Narrative Review.
Medical Research Archives, [S.l.], v. 11, n. 6, june 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/3896>. Date accessed: 22 dec. 2024.
doi: https://doi.org/10.18103/mra.v11i6.3896.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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8. Katzman WB, Wanek L, Shepherd JA, et al., Age-related hyperkyphosis: its causes, consequences, and management. J Orthop Sports Phys Ther. 2010;40(6):352-360. doi:10.2519/jospt.2010.3099
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10. Karimian MR, Yeowell G, Saberi S, et al. A comparison of the effectiveness of three types of trunk orthoses on the balance performance of older people with osteoporotic hyperkyphosis: A cross-over study. Musculoskelet Sci Pract. 2021;55:102430. doi:10.1016/j.msksp.2021.102430
11. Kaufmann CN, Shen J, Woods GN, et al. Hyperkyphosis and self-reported and objectively measured sleep quality in older men. PLoS One. 2020;15(2):e0228638. Published 2020 Feb 11. doi:10.1371/journal.pone.0228638
12. Roghani T, Khalkhali Zavieh M, Rahimi A, et al. The Reliability of Standing Sagittal Measurements of Spinal Curvature and Range of Motion in Older Women With and Without Hyperkyphosis Using a Skin-Surface Device. J Manipulative Physiol Ther. 2017;40(9):685-691. doi:10.1016/j.jmpt.2017.07.008
13. Katzman WB, Gladin A, Lane NE, et al. Feasibility and Acceptability of Technology-Based Exercise and Posture Training in Older Adults With Age-Related Hyperkyphosis: Pre-Post Study. JMIR Aging. 2019;2(1):e12199. doi:10.2196/12199
14. Jang HJ, Hughes LC, Oh DW, Kim SY. Effects of Corrective Exercise for Thoracic Hyperkyphosis on Posture, Balance, and Well-Being in Older Women: A Double-Blind, Group-Matched Design. J Geriatr Phys Ther. 2019;42(3):E17-E27. doi:10.1519/JPT.0000000000000146
15. Watson SL, Weeks BK, Weis LJ, et al. High-intensity exercise did not cause vertebral fractures and improves thoracic kyphosis in postmenopausal women with low to very low bone mass: the LIFTMOR trial. Osteoporos Int. 2019;30(5):957-964. doi:10.1007/s00198-018-04829-z
16. Sugai K, Michikawa T, Takebayashi T, et al. Association between muscle strength, mobility, and the progression of hyperkyphosis in the elderly: The Kurabuchi Cohort Study. J Gerontol A Biol Sci Med Sci. 2019;74(12):1987-1992. doi:10.1093/gerona/glz136
17. Naderi A, Rezvani MH, Shaabani F, et al. Effect of kyphosis exercises on physical function, postural control and quality of life in elderly men with hyperkyphosis. Iranian Journal of Ageing. 2019 Jan 10;13(4):464-79.
18. McDaniels-Davidson C, Davis A, Wing D, et al. Kyphosis and incident falls among community-dwelling older adults. Osteoporos Int. 2018;29(1):163-169. doi:10.1007/s00198-017-4253-3
19. Katzman WB, Parimi N, Gladin A, et al. Sex differences in response to targeted kyphosis specific exercise and posture training in community-dwelling older adults: a randomized controlled trial. BMC Musculoskelet Disord. 2017;18(1):509. Published 2017 Dec 4. doi:10.1186/s12891-017-1862-0
20. Katzman WB, Vittinghoff E, Lin F, et al. Targeted spine strengthening exercise and posture training program to reduce hyperkyphosis in older adults: results from the study of hyperkyphosis, exercise, and function (SHEAF) randomized controlled trial. Osteoporos Int. 2017;28(10):2831-2841. doi:10.1007/s00198-017-4109-x
21. Roghani T, Khalkhali Zavieh M, Talebian S, et al. Back muscle function in older women with age-related hyperkyphosis: A Comparative Study. J Manipulative Physiol Ther. 2019;42(4):284-294. doi:10.1016/j.jmpt.2018.11.012
22. Yokoyama Y, Nishiwaki Y, Michikawa T, et al. The association of kyphosis assessed in supine and standing positions with future activities of daily living dependence: the Kurabuchi Study. Arch Osteoporos. 2017;12(1):105. Published 2017 Nov 22. doi:10.1007/s11657-017-0401-9
23. Yamamoto J, Bergstrom J, Davis A, et al. Trunk lean mass and its association with 4 different measures of thoracic kyphosis in older community dwelling persons. PLoS One. 2017;12(4):e0174710. Published 2017 Apr 3. doi:10.1371/journal.pone.0174710
24. Tran TH, Wing D, Davis A, et al. Correlations among four measures of thoracic kyphosis in older adults. Osteoporos Int. 2016;27(3):1255-1259. doi:10.1007/s00198-015-3368-7
25. Jang HJ, Kim MJ, Kim SY. Effect of thorax correction exercises on flexed posture and chest function in older women with age-related hyperkyphosis. J Phys Ther Sci. 2015;27(4):1161-1164. doi:10.1589/jpts.27.1161
26. Katzman WB, Harrison SL, Fink HA, et al. Physical function in older men with hyperkyphosis. J Gerontol A Biol Sci Med Sci. 2015;70(5):635-640. doi:10.1093/gerona/glu213
27. van der Jagt-Willems, Hanna C et al. “Associations between vertebral fractures, increased thoracic kyphosis, a flexed posture and falls in older adults: a prospective cohort study.” BMC geriatrics vol. 15 34. 28 Mar. 2015, doi:10.1186/s12877-015-0018-z
28. Hojjati Zidashti, Zahra & Sheikhpour, Leila. (2013). Seated exercise therapy improves posture and balance in hyperkyphotic elderly females, a Randomized Control Trail. World Applied Sciences Journal. 24. 331-335, doi: 10.5829/idosi.wasj.2013.24.03.794
29. Quek J, Pua YH, Clark RA, et al. Effects of thoracic kyphosis and forward head posture on cervical range of motion in older adults. Man Ther. 2013;18(1):65-71. doi:10.1016/j.math.2012.07.005
30. Azadinia F, Kamyab M, Behtash H, et al. The effects of two spinal orthoses on balance in elderly people with thoracic kyphosis. Prosthet Orthot Int. 2013;37(5):404-410. doi:10.1177/0309364612474487
31. Katzman W, Cawthon P, Hicks GE, et al. Association of spinal muscle composition and prevalence of hyperkyphosis in healthy community-dwelling older men and women. J Gerontol A Biol Sci Med Sci. 2012;67(2):191-195. doi:10.1093/gerona/glr160
32. Bautmans I, Van Arken J, Van Mackelenberg M, et al. Rehabilitation using manual mobilization for thoracic kyphosis in elderly postmenopausal patients with osteoporosis. J Rehabil Med. 2010;42(2):129-135. doi:10.2340/16501977-0486
33. Regolin F, Carvalho GA. Relationship between thoracic kyphosis, bone mineral density, and postural control in elderly women. Brazilian Journal of Physical Therapy. 2010;14:464-9.
34. Greendale GA, Huang MH, Karlamangla AS, et al. Yoga decreases kyphosis in senior women and men with adult-onset hyperkyphosis: results of a randomized controlled trial. J Am Geriatr Soc. 2009;57(9):1569-1579. doi:10.1111/j.1532-5415.2009.02391.x
35. Hinman MR. Comparison of thoracic kyphosis and postural stiffness in younger and older women. Spine J. 2004;4(4):413-417. doi:10.1016/j.spinee.2004.01.002
36. Kado DM, Lui LY, Ensrud KE, et al. Hyperkyphosis predicts mortality independent of vertebral osteoporosis in older women. Ann Intern Med. 2009;150(10):681-687. doi:10.7326/0003-4819-150-10-200905190-00005
37. Ebrahim Mousavi M, Ahmadi Bani M, Aboutorabi A, et al. The effect of a semi-rigid thoracolumbosacral orthosis (TLSO) on foot pressure in elderly subjects presenting with spinal hyperkyphosis. Disabil Rehabil Assist Technol. 2020;15(2):205-210. doi:10.1080/17483107.2018.1555289
38. Mohebi S, Torkaman G, Bahrami F, et al. Postural instability and position of the center of pressure into the base of support in postmenopausal osteoporotic and nonosteoporotic women with and without hyperkyphosis. Arch Osteoporos. 2019;14(1):58. Published 2019 Jun 3. doi:10.1007/s11657-019-0581-6
39. Kado DM, Prenovost K, Crandall C. Narrative review: hyperkyphosis in older persons. Ann Intern Med. 2007;147(5):330-338. doi:10.7326/0003-4819-147-5-200709040-00008
40. González-Gálvez N, Gea-García GM, Marcos-Pardo PJ. Effects of exercise programs on kyphosis and lordosis angle: A systematic review and meta-analysis. PLoS One. 2019;14(4):e0216180. Published 2019 Apr 29. doi:10.1371/journal.pone.0216180
41. Chokphukiao, Pakwipa et al. “Validity and reliability of the block method for measuring thoracic hyperkyphosis.” Physiotherapy theory and practice, 1-8. 7 Sep. 2021, doi:10.1080/09593985.2021.1975335
2. Ailon T, Shaffrey CI, Lenke LG, et al., Progressive spinal kyphosis in the aging population. Neurosurgery. 2015;77 Suppl 4:S164-S172. doi:10.1227/NEU.0000000000000944
3. Bansal S, Katzman WB, Giangregorio LM. Exercise for improving age-related hyperkyphotic posture: a systematic review. Arch Phys Med Rehabil. 2014;95(1):129-140. doi:10.1016/j.apmr.2013.06.022
4. Roghani T, Zavieh MK, Manshadi FD, et al., Age-related hyperkyphosis: update of its potential causes and clinical impacts—narrative review. Aging clinical and experimental research. 2017 Aug;29(4):567-77. https://doi.org/10.1007/s40520-016-0617-3
5. Koelé MC, Lems WF, Willems HC. The Clinical Relevance of Hyperkyphosis: A Narrative Review. Front Endocrinol (Lausanne). 2020;11:5. Published 2020 Jan 24. doi:10.3389/fendo.2020.00005
6. Kado DM, Miller-Martinez D, Lui LY, et al. Hyperkyphosis, kyphosis progression, and risk of non-spine fractures in older community dwelling women: the study of osteoporotic fractures (SOF). J Bone Miner Res. 2014;29(10):2210-2216. doi:10.1002/jbmr.2251
7. Wang MY, Greendale GA, Kazadi L, Salem GJ. Yoga improves upper-extremity function and scapular posturing in persons with hyperkyphosis. Journal of yoga & physical therapy. 2012 Jun 6;2(3):117. doi:10.4172/2157-7595.1000117
8. Katzman WB, Wanek L, Shepherd JA, et al., Age-related hyperkyphosis: its causes, consequences, and management. J Orthop Sports Phys Ther. 2010;40(6):352-360. doi:10.2519/jospt.2010.3099
9. Roghani T, Zavieh MK, Talebian S, Baghban AA, Katzman W. Back muscle function in older women with age-related hyperkyphosis: A comparative study. Journal of Manipulative and Physiological Therapeutics. 2019 May 1;42(4):284-94. doi:10.1016/j.jmpt.2018.11.012
10. Karimian MR, Yeowell G, Saberi S, et al. A comparison of the effectiveness of three types of trunk orthoses on the balance performance of older people with osteoporotic hyperkyphosis: A cross-over study. Musculoskelet Sci Pract. 2021;55:102430. doi:10.1016/j.msksp.2021.102430
11. Kaufmann CN, Shen J, Woods GN, et al. Hyperkyphosis and self-reported and objectively measured sleep quality in older men. PLoS One. 2020;15(2):e0228638. Published 2020 Feb 11. doi:10.1371/journal.pone.0228638
12. Roghani T, Khalkhali Zavieh M, Rahimi A, et al. The Reliability of Standing Sagittal Measurements of Spinal Curvature and Range of Motion in Older Women With and Without Hyperkyphosis Using a Skin-Surface Device. J Manipulative Physiol Ther. 2017;40(9):685-691. doi:10.1016/j.jmpt.2017.07.008
13. Katzman WB, Gladin A, Lane NE, et al. Feasibility and Acceptability of Technology-Based Exercise and Posture Training in Older Adults With Age-Related Hyperkyphosis: Pre-Post Study. JMIR Aging. 2019;2(1):e12199. doi:10.2196/12199
14. Jang HJ, Hughes LC, Oh DW, Kim SY. Effects of Corrective Exercise for Thoracic Hyperkyphosis on Posture, Balance, and Well-Being in Older Women: A Double-Blind, Group-Matched Design. J Geriatr Phys Ther. 2019;42(3):E17-E27. doi:10.1519/JPT.0000000000000146
15. Watson SL, Weeks BK, Weis LJ, et al. High-intensity exercise did not cause vertebral fractures and improves thoracic kyphosis in postmenopausal women with low to very low bone mass: the LIFTMOR trial. Osteoporos Int. 2019;30(5):957-964. doi:10.1007/s00198-018-04829-z
16. Sugai K, Michikawa T, Takebayashi T, et al. Association between muscle strength, mobility, and the progression of hyperkyphosis in the elderly: The Kurabuchi Cohort Study. J Gerontol A Biol Sci Med Sci. 2019;74(12):1987-1992. doi:10.1093/gerona/glz136
17. Naderi A, Rezvani MH, Shaabani F, et al. Effect of kyphosis exercises on physical function, postural control and quality of life in elderly men with hyperkyphosis. Iranian Journal of Ageing. 2019 Jan 10;13(4):464-79.
18. McDaniels-Davidson C, Davis A, Wing D, et al. Kyphosis and incident falls among community-dwelling older adults. Osteoporos Int. 2018;29(1):163-169. doi:10.1007/s00198-017-4253-3
19. Katzman WB, Parimi N, Gladin A, et al. Sex differences in response to targeted kyphosis specific exercise and posture training in community-dwelling older adults: a randomized controlled trial. BMC Musculoskelet Disord. 2017;18(1):509. Published 2017 Dec 4. doi:10.1186/s12891-017-1862-0
20. Katzman WB, Vittinghoff E, Lin F, et al. Targeted spine strengthening exercise and posture training program to reduce hyperkyphosis in older adults: results from the study of hyperkyphosis, exercise, and function (SHEAF) randomized controlled trial. Osteoporos Int. 2017;28(10):2831-2841. doi:10.1007/s00198-017-4109-x
21. Roghani T, Khalkhali Zavieh M, Talebian S, et al. Back muscle function in older women with age-related hyperkyphosis: A Comparative Study. J Manipulative Physiol Ther. 2019;42(4):284-294. doi:10.1016/j.jmpt.2018.11.012
22. Yokoyama Y, Nishiwaki Y, Michikawa T, et al. The association of kyphosis assessed in supine and standing positions with future activities of daily living dependence: the Kurabuchi Study. Arch Osteoporos. 2017;12(1):105. Published 2017 Nov 22. doi:10.1007/s11657-017-0401-9
23. Yamamoto J, Bergstrom J, Davis A, et al. Trunk lean mass and its association with 4 different measures of thoracic kyphosis in older community dwelling persons. PLoS One. 2017;12(4):e0174710. Published 2017 Apr 3. doi:10.1371/journal.pone.0174710
24. Tran TH, Wing D, Davis A, et al. Correlations among four measures of thoracic kyphosis in older adults. Osteoporos Int. 2016;27(3):1255-1259. doi:10.1007/s00198-015-3368-7
25. Jang HJ, Kim MJ, Kim SY. Effect of thorax correction exercises on flexed posture and chest function in older women with age-related hyperkyphosis. J Phys Ther Sci. 2015;27(4):1161-1164. doi:10.1589/jpts.27.1161
26. Katzman WB, Harrison SL, Fink HA, et al. Physical function in older men with hyperkyphosis. J Gerontol A Biol Sci Med Sci. 2015;70(5):635-640. doi:10.1093/gerona/glu213
27. van der Jagt-Willems, Hanna C et al. “Associations between vertebral fractures, increased thoracic kyphosis, a flexed posture and falls in older adults: a prospective cohort study.” BMC geriatrics vol. 15 34. 28 Mar. 2015, doi:10.1186/s12877-015-0018-z
28. Hojjati Zidashti, Zahra & Sheikhpour, Leila. (2013). Seated exercise therapy improves posture and balance in hyperkyphotic elderly females, a Randomized Control Trail. World Applied Sciences Journal. 24. 331-335, doi: 10.5829/idosi.wasj.2013.24.03.794
29. Quek J, Pua YH, Clark RA, et al. Effects of thoracic kyphosis and forward head posture on cervical range of motion in older adults. Man Ther. 2013;18(1):65-71. doi:10.1016/j.math.2012.07.005
30. Azadinia F, Kamyab M, Behtash H, et al. The effects of two spinal orthoses on balance in elderly people with thoracic kyphosis. Prosthet Orthot Int. 2013;37(5):404-410. doi:10.1177/0309364612474487
31. Katzman W, Cawthon P, Hicks GE, et al. Association of spinal muscle composition and prevalence of hyperkyphosis in healthy community-dwelling older men and women. J Gerontol A Biol Sci Med Sci. 2012;67(2):191-195. doi:10.1093/gerona/glr160
32. Bautmans I, Van Arken J, Van Mackelenberg M, et al. Rehabilitation using manual mobilization for thoracic kyphosis in elderly postmenopausal patients with osteoporosis. J Rehabil Med. 2010;42(2):129-135. doi:10.2340/16501977-0486
33. Regolin F, Carvalho GA. Relationship between thoracic kyphosis, bone mineral density, and postural control in elderly women. Brazilian Journal of Physical Therapy. 2010;14:464-9.
34. Greendale GA, Huang MH, Karlamangla AS, et al. Yoga decreases kyphosis in senior women and men with adult-onset hyperkyphosis: results of a randomized controlled trial. J Am Geriatr Soc. 2009;57(9):1569-1579. doi:10.1111/j.1532-5415.2009.02391.x
35. Hinman MR. Comparison of thoracic kyphosis and postural stiffness in younger and older women. Spine J. 2004;4(4):413-417. doi:10.1016/j.spinee.2004.01.002
36. Kado DM, Lui LY, Ensrud KE, et al. Hyperkyphosis predicts mortality independent of vertebral osteoporosis in older women. Ann Intern Med. 2009;150(10):681-687. doi:10.7326/0003-4819-150-10-200905190-00005
37. Ebrahim Mousavi M, Ahmadi Bani M, Aboutorabi A, et al. The effect of a semi-rigid thoracolumbosacral orthosis (TLSO) on foot pressure in elderly subjects presenting with spinal hyperkyphosis. Disabil Rehabil Assist Technol. 2020;15(2):205-210. doi:10.1080/17483107.2018.1555289
38. Mohebi S, Torkaman G, Bahrami F, et al. Postural instability and position of the center of pressure into the base of support in postmenopausal osteoporotic and nonosteoporotic women with and without hyperkyphosis. Arch Osteoporos. 2019;14(1):58. Published 2019 Jun 3. doi:10.1007/s11657-019-0581-6
39. Kado DM, Prenovost K, Crandall C. Narrative review: hyperkyphosis in older persons. Ann Intern Med. 2007;147(5):330-338. doi:10.7326/0003-4819-147-5-200709040-00008
40. González-Gálvez N, Gea-García GM, Marcos-Pardo PJ. Effects of exercise programs on kyphosis and lordosis angle: A systematic review and meta-analysis. PLoS One. 2019;14(4):e0216180. Published 2019 Apr 29. doi:10.1371/journal.pone.0216180
41. Chokphukiao, Pakwipa et al. “Validity and reliability of the block method for measuring thoracic hyperkyphosis.” Physiotherapy theory and practice, 1-8. 7 Sep. 2021, doi:10.1080/09593985.2021.1975335