Relationship between thoracic kyphosis angle, dyspnea perception, and disease-specific health status in patients with COPD

Abstract

Purpose: This study was carried out to examine the relationship between thoracic kyphosis angle, dyspnea perception, and disease-specific health status in patients with COPD and thus to reveal the postural effect.
Methods: A total of 105 patients (68.10±8.59 years, FEV1:47.59±21.50%) diagnosed with COPD were included in the study. The thoracic kyphosis angle was evaluated using the Spinal Mouse® device and the dyspnea perception with the Modified Medical Research Council (MMRC) Dyspnea Scale. For the disease-specific health status, the COPD Assessment Test (CAT) and the Clinical COPD Questionnaire (CCQ) were used. The patients were separated into three groups according to the thoracic kyphosis angle as Group 1: 20°-50°, Group 2: 51°-60°, and Group 3: 61°-90° and groups were compared.
Results: While a significant positive relationship at a low level was observed between the thoracic kyphosis angle and the dyspnea perception (rho=0.23, p=0.02), no relationship was determined with the disease-specific health status (rho<0.20, p>0.05). CAT and CCQ scores were similar between groups (p>0.05). In group 3 with thoracic kyphosis angle>60°, the dyspnea perception was significantly higher (p=0.03).
Conclusion: As the thoracic kyphosis angle increase in patients with COPD, the dyspnea perception increases, but the disease-specific health status remains stable. The postures of patients with COPD should be evaluated in detail in physiotherapy and rehabilitation practices due to increased dyspnea caused by thoracic kyphosis. Also, preventive measures such as exercise and ergonomic arrangements should be taken for thoracic kyphosis in the early period.

Keywords

• Kyphosis
• Dyspnea
• Health Status
• Chronic Obstructive Pulmonary Disease

KOAH hastalarında torakal kifoz açısı ile dispne algısı ve hastalığa özgü sağlık durumu arasındaki ilişki

Abstract

Amaç: Bu çalışma, KOAH hastalarında torakal kifoz açısı ile dispne algısı ve hastalığa özgü sağlık durumu arasındaki ilişkiyi incelemek ve böylece postüral etkiyi ortaya koymak amacıyla gerçekleştirildi.
Yöntem: Çalışmaya KOAH tanısı almış toplam 105 hasta (68,10±8,59 yıl, FEV1: %47,59±21,50) dahil edildi. Torakal kifoz açısı Spinal Mouse® cihazı ile dispne algısı Modified Medical Research Council Dispne Scale (MMRC) ile değerlendirildi. Hastalığa özgü sağlık durumu için KOAH Değerlendirme Testi (CAT) ve Klinik KOAH Anketi (CCQ) kullanıldı. Hastalar torakal kifoz açılarına göre 20-50° (1. Grup), 51-60° (2.Grup) ve 61-90° (3.Grup) şeklinde üç gruba ayrıldı ve gruplar karşılaştırıldı.
Bulgular: Torakal kifoz açısı ile dispne algısı arasında pozitif düşük düzeyde anlamlı ilişki varken (rho=0,23, p=0,02) hastalığa özgü sağlık durumu ile ilişki yoktu (rho<0,20, p>0,05). CAT ve CCQ puanları gruplarda benzerdi (p>0,05). Torakal kifoz açısı 60°’den büyük olan 3. Grupta dispne algısı anlamlı olarak daha yüksekti (p=0,03).
Sonuç: KOAH hastalarında torakal kifoz açısı arttıkça dispne algısı da arttı, ancak hastaların hastalığa özgü sağlık durumu değişmedi. Torakal kifozun dispneyi arttırması nedeniyle fizyoterapi ve rehabilitasyon uygulamalarında KOAH hastalarının postürleri ayrıntılı olarak değerlendirilmelidir. Ayrıca, erken dönemde torakal kifoz için egzersiz ve ergonomik düzenlemeler gibi koruyucu önlemler alınmalıdır.

Keywords

• Kifoz
• Dispne
• Sağlık Durumu
• Kronik Obstrüktif Akciğer Hastalığı

References

1. 1. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2020 Report. http://www.goldcopd.org. Access date: May 25, 2020.
2. 2. Penafortes JTS, Guimaraes FS, Moco VJR, et al. Association among posture, lung function and functional capacity in cystic fibrosis. Rev Port Pneumol (English Edition). 2013;19:1-6.
3. 3. Culham EG, Jimenez HA, King CE. Thoracic kyphosis, rib mobility, and lung volumes in normal women and women with osteoporosis. Spine. 1994;19:1250-1255.
4. 4. Dewar M, Curry R. Chronic obstructive pulmonary disease: diagnostic considerations. Am Fam Physician. 2006;73:669-676.
5. 5. Aksoy C, Diracoglu D. Fiziksel Rehabilitasyon. Istanbul: Nobel Tip Kitabevleri Press; 2011.
6. 6. Bartynski WS, Heller MT, Grahovac SZ, et al. Severe thoracic kyphosis in the older patient in the absence of vertebral fracture: association of extreme curve with age. AJNR Am J Neuroradiol. 2005;26:2077-2085.
7. 7. Clement JL, Chau E, Kimkpe C, et al. Restoration of thoracic kyphosis by posterior instrumentation in adolescent idiopathic scoliosis: comparative radiographic analysis of two methods of reduction. Spine. 2008;33:1579-1587.
8. 8. De Smet AA, Robinson RG, Johnson BE, et al. Spinal compression fractures in osteoporotic women: patterns and relationship to hyperkyphosis. Radiology. 1988;166:497-500.

9. 9. Goncalves MA, Rodovalho PL, Bellini AJ, et al. Thoracic kyphosis comparison between a patient with chronic obstructive pulmonary disease and a healthy individual by flexicurve method. Fisioter. Pesqui. 2015;22:333-339.
10. 10. Witt PL, MacKinnon J. Trager Psychophysical Integration a method to improve chest mobility of patients with Chronic Lung Disease. Phys Ther. 1986;66:214-217.
11. 11. Putt MT, Watson M, Seale H. Muscle stretching technique increases vital capacity and range of motion in patients with chronic obstructive pulmonary disease. Arch Phys Med Rehabil. 2008;89:1103-1107.
12. 12. Kessler R, Partridge MR, Miravitlles M, et al. Symptom variability in patients with severe COPD: a pan-European cross-sectional study. Eur Respir J. 2011;37:264-272.
13. 13. Calverley PMA, Georgopoulos D. Chronic Obstructive Pulmonary Disease: symptoms and signs. European Respiratory Monograph. 2006;38:7-23.
14. 14. Di Bari M, Chiarlone M, Matteuzzi D, et al. Thoracic kyphosis and ventilatory dysfunction in unselected older persons: an epidemiological study in Dicomano, Italy. J Am Geriatr Soc. 2004;52:909-915.
15. 15. Polatli M, Yorgancioglu A, Aydemir O, et al. St. George solunum anketinin Turkce gecerlilik ve guvenilirligi. Tuberk Toraks. 2013;61:81-87.
16. 16. Livanelioglu A, Kaya F, Nabiyev V, et al. The validity and reliability of ‘‘Spinal Mouse’’ assessment of spinal curvatures in the frontal plane in pediatric adolescent idiopathic thoraco-lumbar curves. Eur Spine J. 2015;doi: 10.1007/s00586-015-3945-7.
17. 17. Wang JS. Effect of joint mobilization and stretching on respiratory function and spinal movement in very severe COPD with thoracic kyphosis. J Phys Ther Sci. 2015;27:3329-3331.
18. 18. Post RB, Leferink VJM. Spinal mobility: sagittal range of motion measured with the Spinal Mouse, a new non-invasive device. Arch Orthop Trauma Surg. 2004;124:187-192.
19. 19. Launois C, Barbe C, Bertin E, et al. The modified Medical Research Council scale for the assessment of dyspnea in daily living in obesity: a pilot study. BMC Pulm Med. 2012;12:61.
20. 20. Yorgancioglu A, Polatli M, Aydemir O, et al. KOAH değerlendirme testinin Türkçe geçerlilik ve güvenilirliği. Tuberk Toraks. 2012;60:314-320.
21. 21. http://www.catestonline.org. Access date: February 11, 2020.
22. 22. Jones PW, Harding G, Berry P, et al. Development and first validation of the COPD Assessment Test. Eur Respir J. 2009;34:648-654.
23. 23. http://www.ccq.nl. Access date: January 18, 2020.
24. 24. Van der Molen T, Willemse BW, Schokker S, et al. Development, validity and responsiveness of the Clinical COPD Questionnaire. Health and quality of life outcomes. BMC. 2003;1:13.
25. 25. Reda AA, Kotz D, Kocks JW, et al. Reliability and validity of the clinical COPD questionniare and chronic respiratory questionnaire. Respir Med. 2010;104:1675-1682.
26. 26. Alpar R. Spor, Saglik ve Eğitim Bilimlerinden Örneklerle Uygulamali İstatistik ve Gecerlik-Güvenirlik. Ankara: Detay Yayınları Press, 2010.
27. 27. Wang JS. Effect of joint mobilization and stretching on respiratory function and spinal movement in very severe COPD with thoracic kyphosis. J Phys Ther Sci. 2015;27:3329-3331.
28. 28. Morais N, Cruz J, Marques A. Posture and mobility of the upper body quadrant and pulmonary function in COPD: an exploratory study. Braz J Phys Ther .2016;20:345-354.
29. 29. Libby DM, Briscoe WA, Boyce B, et al. Acute respiratory failure in scoliosis or kyphosis: prolonged survival and treatment. Am J Med. 1982;73:532-538.
30. 30. Buyse B, Meersseman W, Demedts M. Treatment of chronic respiratory failure in kyphoscoliosis: oxygen or ventilation? Eur Respir J. 2003;22:525-528.
31. 31. Gaude GS, Savadatti R, Hattiholi J. Postural correction for kyphosis improves the dyspnea index and pulmonary functions in patients with chronic obstructive pulmonary disease: A randomized trial over 12 weeks. Int J Health Allied Sci. 2014;3:44-51.
32. 32. Lee SJ, Chang JY, Ryu YJ, et al. Clinical features and outcomes of respiratory complications in patients with thoracic hyperkyphosis. Lung. 2015;193:1009-1015.
33. 33. Heneghan N, Adab P, Jackman S, et al. Musculoskeletal dysfunction in Chronic Obstructive Pulmonary Disease (COPD): An observational study. Int J Ther Rehabil. 2015;22:119-128.
34. 34. Donesky-Cuenco D, Nguyen HQ, Paul S, et al. Yoga therapy decreases dyspnea-related distress and improves functional performance in people with chronic obstructive pulmonary disease: a pilot study. J Altern Complement Med. 2009;15:225-234.
35. 35. Sharp JT, Drutz WS, Moisan T, et al. Postural relief of dyspnea in severe Chronic Obstructive Pulmonary Disease 1–2. Am Rev Respir Dis. 1980;122:201-211.
36. 36. Ogino T, Mase K, Nozoe M, et al. Effects of arm bracing on expiratory flow limitation and lung volume in elderly COPD subjects. Respir Care. 2015;60:1282-1287.
37. 37. Mathur S, Bhasin P. A pilot trial to evaluate the effects of respiratory muscle stretch gymnastics and global postural re-education in patients with Chronic Obstructive Pulmonary Disease. Indian J Physiother Occup Ther. 2012;6:292-295.
38. 38. Fulambarker A, Farooki B, Kheir F, et al. Effect of yoga in Chronic Obstructive Pulmonary Disease. Am J Ther. 2012;19:96-100.
39. 39. Anand A, Narwal R, Sindhwani G. et al. Accessory inspiratory muscles energy technique effect on pulmonary function in COPD subjects. Indian J Physiother Occup Ther. 2013;7:192-197.
40. 40. Guermazi M, Ghroubi S, Kassis M, et al. Validity and reliability of Spinal Mouse to assess lumbar flexion. Ann Readapt Med Phys. 2006;49:172-177.