Influence of thoracic spine postural disorders on cardiorespiratory parameters in children and adolescents with cystic fibrosis

Abstract

Objectives: To assess the impact of increased thoracic kyphosis on pulmonary function and functional capacity in children and adolescents with cystic fibrosis (CF) and to verify the influence of disease severity, age and nutritional status on this deformity.Method: This was a cross-sectional, analytical study conducted at a university hospital. It included CF patients with confirmed diagnosis and without pulmonary exacerbation. The sample was submitted to postural assessment, spirometry (FEV 1 , FVC and FEV 1 /FVC) and 6-minute walk test distance (6-MWT distance). Data were analyzed using the Mann Whitney test, Spearman correlation and logistic regression.Results: Forty-two patients were enrolled, 61.9% presented increase of thoracic kyphosis. There was no difference in values of FEV 1 , FVC, FEV 1 /FVC and 6-MWT distance between the groups with or without thoracic kyphosis (p = 0.407; p = 0.756; p = 0.415; p = 0.294). In the group without alteration, patients with more disease severity had a mean FEV 1 of 74.1±21.9% and FVC of 79.8±18.7% while in those of lesser severity higher values were found (95.6±12.2% and 97.6±13.2%, respectively) (p = 0.027 and p = 0.027). The presence of kyphosis was correlated with age (p = 0.048) but not with severity (p = 0.151) and body mass index (p = 0.088). Conclusions:There was a high prevalence of increased thoracic kyphosis in children and adolescents with CF. The deformity did not affect pulmonary function and functional capacity and there was no relationship with disease severity. Regardless of posture, worsening of disease severity determined worsening of pulmonary function.J Pediatr (Rio J). 2012;88(4):310-6: Posture, cystic fibrosis, pulmonary function. ResumoObjetivos: Avaliar a repercussão do aumento da cifose torácica na função pulmonar e na capacidade funcional de crianças e adolescentes com fibrose cística e verificar a influência da gravidade da doença, idade e aspectos nutricionais sobre essa deformidade.Método: Estudo analítico de corte transversal, realizado em um hospital universitário. Incluiu fibrocísticos com diagnóstico confirmado e fora de exacerbação pulmonar. A amostra foi submetida à avaliação postural, registro de parâmetros espirométricos -volume expiratório forçado no primeiro segundo (VEF 1 ), capacidade vital forçada (CVF) e VEF 1 /CVF -e da distância percorrida pelo teste de caminhada de 6 minutos. Para análise dos dados, utilizou-se teste de Mann-Whitney, correlação de Spearman e regressão logística, considerando-se nível de significância de 5%. Resultados:No total, 42 pacientes foram incluídos, e 61,9% apresentaram aumento da cifose torácica. Não houve diferença nos valores de VEF 1 , CVF, VEF 1 /CVF e distância percorrida pelo teste de caminhada de 6 minutos entre os grupos com e sem cifose torácica (p = 0,407; p = 0,756; p = 0,415; p = 0,294). No grupo sem alteração postural, fibrocísticos mais graves apresentaram média de VEF 1 de 74,1±21,9% e CVF de 79,8±18,7%, enquanto naqueles de menor gravidade foram verificados valores superiores...

Association between lung function, thoracoabdominal mobility and posture in cystic fibrosis: pilot study

“…However, in children and adolescents with the disease, this relationship does not seem to be present yet. A study of individuals aged 7 to 19 years showed that, despite the high prevalence of kyphosis, postural changes were unrelated to pulmonary function [12], which was also observed in a recent study of individuals with average age of 14.04 years [36], which supports our results.…”

“…The results showed a high prevalence of thoracic kyphosis, which corroborates other studies with children [12,35] and adolescents with CF [12,35,36], and may be responsible for the great anteroposterior imbalance evidenced in this study by the great asymmetry of the projection of the center of gravity on the support base in the sagittal plane (48.98 ± 18.55%), as kyphosis shifts the center of gravity in this direction. However, the postural deviations identified by photogrammetric evaluation, which basically considered the alignment of the head, shoulders and pelvis, can be considered small.…”

“…In addition to impaired pulmonary function, children with CF have been shown to have reduced peak cough flow (PCF) values [9], high prevalence of musculoskeletal diseases [10] and postural changes [10][11], which have been related to the severity of pulmonary involvement [11], but there are still controversies on the subject [12], which deserves to be better studied.…”

Reliability and Validity of the 6‐Minute Walk Test in Hypophosphatasia

“…This would be expected, as normative values for the average 6MWT distance walked increase with height and age in healthy children, peak in adolescents and young adults, and decrease with increasing age in older adults. (29,30) The median 6MWT distances walked at screening and baseline by children (380 and 350 m) and adolescents (532 and 491 m) with HPP who completed the 6MWT were lower than distances reported for healthy children and adolescents (mean: 618 m) (49) and for those with conditions such as cystic fibrosis (mean: 556 to 640 m) (50) and obesity (mean: 571 m), (51) reflecting the substantial burden of HPP on mobility. Similarly, the median 6MWT distances walked by adults with HPP (screening: 383 m; baseline: 401 m) were lower than values reported for healthy adults (mean: 614 m).…”

Physiotherapy and cystic fibrosis

“…Okuro et al [19] reported a prevalence of 61.9% in children and adolescents with CF, whereas Garcia et al [20] reported a 46% prevalence in the adult CF population. The prevalence of an increased thoracic kyphosis in the CF population is higher when compared with the non-CF population.…”