Thoracic kyphosis increases with age. The resultant increase in compression forces on the anterior vertebral bodies leads to further kyphotic deformity and, an increased likelihood of vertebral collapse. This study aimed to determine the relative efficacy of two therapeutic strategies commonly used to treat hyperkyphosis. 69 subjects (26 male: 43 female) were randomised into 4 groups: strengthening, postural re-education (PEd), both and control. The strengthening group attended a gym 3 times a week for 12 weeks to perform seated extension exercises. The PEd group had 3 physiotherapy sessions within a 12 week period in which they received postural assessment and a home exercise programme. The combined group received both interventions while the control group received neither. Outcome measurements were assessed at baseline and 12 weeks. They included static (inclinometer) and 6-hour angular measurements (using flexible electrogoniometer (FEG)) and physical function tests. There were no significant differences between the marginal means of the angular measurements for any of the intervention groups. However, the group which received both interventions demonstrated reduced kyphosis as measured by the FEG angles (apex of the curve between T3 and T11), while the strengthening group showed reduced inclinometer angles (between T1 and T12). The strengthening group showed improvement in back extensor strength (BES) (0.6 +/− 0.2 N/kg, p < 0.01), time to walk 10 metres (−0.3 +/− 0.6 s, p < 0.05), and time to stand and sit 5 times (−0.9 +/− 0.6 s, p < 0.05). However, there was no relationship between change in BES and change in kyphotic angle. The PEd group showed the greatest improvement in the timed up and go test but this was not significant. Improvement in inclinometer angle over the 12 weeks was associated with degree of kyphosis at baseline (upright inclinometer r = −0.47, p=0.0001) but this relationship was not apparent in the FEG measurements. Both the FEG and inclinometer angles showed a marked decrease in degree of improvement in subjects aged >70. (50/50). A combination of strengthening and PEd was most effective at reducing hyperkyphosis. BES was improved with resisted strengthening but not with home-based postural exercises. However, increased BES was not associated with decreased kyphosis. Larger baseline kyphosis was associated with greater angular improvement. Subjects aged >70 were less likely to improve.
The Biometrics Flexible Electrogoniometer (FEG) is a lightweight device which when attached over joints can record angular displacements for periods of up to 10 hours. The aim of this study was to examine the validity of the FEG for measuring the thoracic spine using the Cobb angle and functional activities. 12 subjects (6 F, 71±11years; 6 M, 65±11) were X-rayed in upright and “slumped” standing with the FEG attached to their thoracic spine. Three Cobb angles were obtained from the vertebrae underlying the FEG at the outer margins (OEB); the inner margins (IEB), and the mid points (MEB), of the FEG end blocks. Comparisons of FEG and Cobb angles were derived with intraclass correlation coefficients (ICC). In a separate experiment, 12 subjects (8F, 43±13; 4M, 35±17) performed 7 functional activities one week apart in order to assess day-to-day reliability of the FEG. Time 1 and time 2 angles were compared with an ICC. The mean FEG angles for upright and “slumped standing” were 31±7° and 39±8° (mean ± SD) respectively. The corresponding mean OEB Cobb angles were 48±13° and 52±12°; the mean IEB Cobb angles were 24±11° and 29±10°; and the MEB Cobb angles were 36±13° and 41±10°. The correlation between the FEG and OEB Cobb was ICC(2,1)=0.85; between FEG and IEB Cobb was ICC(2,1)=0.77 and between FEG and MEB Cobb was ICC(2,1)=0.87. The second experiment compared day-to day reliability of the FEG when used over the thoracic spine. For the 7 activities performed: standing erect, standing slumped, reaching up, reaching down, and walking on-the-spot, the mean correlation between the measures on day 1 and day 2 was ICC(2,1)=0.96 (range 0.94 to 0.98). This study has shown that the FEG demonstrates excellent internal and external validity in the thoracic spine. Further, it has demonstrated that the FEG measures the segment of the spine between the mid-endblocks. Future studies are planned which will use the FEG to evaluate interventions aimed at treating thoracic kyphosis
