Andrew M. Briggs

The vertebral fracture cascade in osteoporosis: a review of aetiopathogenesis

Once an initial vertebral fracture is sustained, the risk of subsequent vertebral fracture increases significantly. This phenomenon has been termed the “vertebral fracture cascade”. Mechanisms underlying this fracture cascade are inadequately understood, creating uncertainty in the clinical environment regarding prevention of further fractures. The cascade cannot be explained by low bone mass alone, suggesting that factors independent of this parameter contribute to its aetiopathogenesis. This review explores physiologic properties that may help to explain the vertebral fracture cascade. Differences in bone properties, including bone mineral density and bone quality, between individuals with and those without osteoporotic vertebral fractures are discussed. Evidence suggests that non-bone parameters differ between individuals with and those without osteoporotic vertebral fractures. Spinal properties, including vertebral macroarchitecture, intervertebral disc integrity, spinal curvature and spinal loading are compared in these groups of individuals. Cross-sectional studies also indicate that neurophysiologic properties, particularly trunk control and balance, are affected by the presence of a vertebral fracture. This review provides a synthesis of the literature to highlight the multi-factorial aetiopathogenesis of the vertebral fracture cascade. With a more comprehensive understanding of the mechanisms underlying this clinical problem, more effective preventative strategies may be developed to offset the fracture cascade.

Thoracic Kyphosis Affects Spinal Loads and Trunk Muscle Force

Background and Purpose Patients with increased thoracic curvature often come to physical therapists for management of spinal pain and disorders. Although treatment approaches are aimed at normalizing or minimizing progression of kyphosis, the biomechanical rationales remain unsubstantiated. Subjects Forty-four subjects (mean age [±SD]=62.3±7.1 years) were dichotomized into high kyphosis and low kyphosis groups. Methods Lateral standing radiographs and photographs were captured and then digitized. These data were input into biomechanical models to estimate net segmental loading from T2–L5 as well as trunk muscle forces. Results The high kyphosis group demonstrated significantly greater normalized flexion moments and net compression and shear forces. Trunk muscle forces also were significantly greater in the high kyphosis group. A strong relationship existed between thoracic curvature and net segmental loads (r =.85–.93) and between thoracic curvature and muscle forces (r =.70–.82). Discussion and Conclusion This study provides biomechanical evidence that increases in thoracic kyphosis are associated with significantly higher multisegmental spinal loads and trunk muscle forces in upright stance. These factors are likely to accelerate degenerative processes in spinal motion segments and contribute to the development of dysfunction and pain.

Thoracic spine pain in the general population: Prevalence, incidence and associated factors in children, adolescents and adults. A systematic review

BackgroundThoracic spine pain (TSP) is experienced across the lifespan by healthy individuals and is a common presentation in primary healthcare clinical practice. However, the epidemiological characteristics of TSP are not well documented compared to neck and low back pain. A rigorous evaluation of the prevalence, incidence, correlates and risk factors needs to be undertaken in order for epidemiologic data to be meaningfully used to develop evidence-based prevention and treatment recommendations for TSP.MethodsA systematic review method was followed to report the evidence describing prevalence, incidence, associated factors and risk factors for TSP among the general population. Nine electronic databases were systematically searched to identify studies that reported either prevalence, incidence, associated factors (cross-sectional study) or risk factors (prospective study) for TSP in healthy children, adolescents or adults. Studies were evaluated for level of evidence and method quality.ResultsOf the 1389 studies identified in the literature, 33 met the inclusion criteria for this systematic review. The mean (SD) quality score (out of 15) for the included studies was 10.5 (2.0). TSP prevalence data ranged from 4.0–72.0% (point), 0.5–51.4% (7-day), 1.4–34.8% (1-month), 4.8–7.0% (3-month), 3.5–34.8% (1-year) and 15.6–19.5% (lifetime). TSP prevalence varied according to the operational definition of TSP. Prevalence for any TSP ranged from 0.5–23.0%, 15.8–34.8%, 15.0–27.5% and 12.0–31.2% for 7-day, 1-month, 1-year and lifetime periods, respectively. TSP associated with backpack use varied from 6.0–72.0% and 22.9–51.4% for point and 7-day periods, respectively. TSP interfering with school or leisure ranged from 3.5–9.7% for 1-year prevalence. Generally, studies reported a higher prevalence for TSP in child and adolescent populations, and particularly for females. The 1 month, 6 month, 1 year and 25 year incidences were 0–0.9%, 10.3%, 3.8–35.3% and 9.8% respectively. TSP was significantly associated with: concurrent musculoskeletal pain; growth and physical; lifestyle and social; backpack; postural; psychological; and environmental factors. Risk factors identified for TSP in adolescents included age (being older) and poorer mental health.ConclusionTSP is a common condition in the general population. While there is some evidence for biopsychosocial associations it is limited and further prospectively designed research is required to inform prevention and management strategies.

HEALTH LITERACY AND BELIEFS AMONG A COMMUNITY COHORT WITH AND WITHOUT CHRONIC LOW BACK PAIN

&NA; Health literacy, the ability to seek, understand and utilise health information, is important for good health. Suboptimal health literacy has been associated with poorer health outcomes in many chronic conditions although this has not been studied in chronic low back pain (CLBP). We examined the health literacy of individuals with CLBP using a mixed methods approach. One‐hundred and seventeen adults, comprising 61 with no history of CLBP and 56 with CLBP (28 with low and high disability, respectively, as determined by a median split in Oswestry scores) participated. Data regarding severity of pain, LBP‐related disability, fear avoidance, beliefs about LBP and pain catastrophizing were collected using questionnaires. Health literacy was measured using the Short‐form Test of Functional Health Literacy in Adults (S‐TOFHLA). A sub‐sample of 36 participants with CLBP also participated in in‐depth interviews to qualitatively explore their beliefs about LBP and experiences in seeking, understanding and using information related to LBP. LBP‐related beliefs and behaviours, rather than pain intensity and health literacy skills, were found to be important correlates of disability related to LBP. Individuals with CLBP‐high disability had poorer back pain beliefs and increased fear avoidance behaviours relating to physical activity. Health literacy (S‐TOFHLA) was not related to LBP beliefs and attitudes. Qualitatively, individuals with CLBP‐high disability adopted a more passive coping style and had a pathoanatomic view of their disorder compared to individuals with CLBP‐low disability. While all participants with CLBP had adequate health literacy scores (S‐TOFHLA), qualitative data highlighted difficulties in seeking, understanding and utilising LBP information.

The health literacy management scale (HeLMS): a measure of an individual's capacity to seek, understand and use health information within the healthcare setting.

OBJECTIVE Health literacy refers to an individuals ability to seek, understand, and use health information. This paper describes the development and psychometric testing of the health literacy management scale (HeLMS). METHODS Content areas were identified from a conceptual framework derived from interviews and concept mapping. Items were generated from statements from concept mapping participants. Construction (N=333) and replication (N=350) samples were participants in chronic disease self-management programs and emergency department attendees. Factor analysis was used to refine constructs and define psychometric properties. RESULTS Consultations generated 8 scales each with 4-5 items: Understanding health information, Accessing GP healthcare services, Communication with health professionals, Being proactive and Using health information, Patient attitudes towards their health, Social support, and Socioeconomic considerations. Confirmatory factor analyses indicated good fit of the data with the model (RMSEA=0.07, SRMR=0.05, CFI=0.97) and all domains had high internal consistency (Cronbach alpha>0.82). CONCLUSION The HeLMS has acceptable psychometric properties and assesses a range of health literacy constructs important to patients when seeking, understanding and using health information within the healthcare system. PRACTICE IMPLICATIONS The HeLMS presents a new approach to assessing health literacy in healthcare settings.

Musculoskeletal Health Conditions Represent a Global Threat to Healthy Aging: A Report for the 2015 World Health Organization World Report on Ageing and Health

Persistent pain, impaired mobility and function, and reduced quality of life and mental well-being are the most common experiences associated with musculoskeletal conditions, of which there are more than 150 types. The prevalence and impact of musculoskeletal conditions increase with aging. A profound burden of musculoskeletal disease exists in developed and developing nations. Notably, this burden far exceeds service capacity. Population growth, aging, and sedentary lifestyles, particularly in developing countries, will create a crisis for population health that requires a multisystem response with musculoskeletal health services as a critical component. Globally, there is an emphasis on maintaining an active lifestyle to reduce the impacts of obesity, cardiovascular conditions, cancer, osteoporosis, and diabetes in older people. Painful musculoskeletal conditions, however, profoundly limit the ability of people to make these lifestyle changes. A strong relationship exists between painful musculoskeletal conditions and a reduced capacity to engage in physical activity resulting in functional decline, frailty, reduced well-being, and loss of independence. Multilevel strategies and approaches to care that adopt a whole person approach are needed to address the impact of impaired musculoskeletal health and its sequelae. Effective strategies are available to address the impact of musculoskeletal conditions; some are of low cost (e.g., primary care-based interventions) but others are expensive and, as such, are usually only feasible for developed nations. In developing nations, it is crucial that any reform or development initiatives, including research, must adhere to the principles of development effectiveness to avoid doing harm to the health systems in these settings.

Upper quadrant postural changes of school children in response to interaction with different information technologies

The objective of this study was to quantitatively analyse the sitting posture of school children interacting with both old (book) and new (laptop and desktop computers) information technologies to test the hypothesis that posture is effected by the type of information technology (IT) used. A mixed model design was used to test the effect of IT type (within subjects) and age and gender (between subjects). The sitting posture of 32 children aged 4 – 17 years was measured whilst they read from a book, laptop, and desktop computer at a standard school chair and desk. Video images were captured and then digitized to calculate mean angles for head tilt, neck flexion, trunk flexion, and gaze angle. Posture was found to be influenced by IT type (p < 0.001), age (p < 0.001) and gender (p = 0.024) and significantly correlated to the stature of the participants. Measurement of resting posture and the maximal range of motion of the upper and lower cervical spines in the sagittal plane was also undertaken. The biophysical impact and the suitability of the three different information technologies are discussed.

Prevalence and associated factors for thoracic spine pain in the adult working population: a literature review.

Prevalence and Associated Factors for Thoracic Spine Pain in the Adult Working Population: A Literature Review: Andrew M. Briggs, et al. School of Physiotherapy, Curtin University of Technology, Australia

Radiographic measures of thoracic kyphosis in osteoporosis: Cobb and vertebral centroid angles

ObjectiveSeveral measures can quantify thoracic kyphosis from radiographs, yet their suitability for people with osteoporosis remains uncertain. The aim of this study was to examine the validity and reliability of the vertebral centroid and Cobb angles in people with osteoporosis.Design and patientsLateral radiographs of the thoracic spine were captured in 31 elderly women with osteoporosis. Thoracic kyphosis was measured globally (T1–T12) and regionally (T4–T9) using Cobb and vertebral centroid angles. Multisegmental curvature was also measured by fitting polynomial functions to the thoracic curvature profile. Canonical and Pearson correlations were used to examine correspondence; agreement between measures was examined with linear regression.ResultsModerate to high intra- and inter-rater reliability was achieved (SEM = 0.9–4.0°). Concurrent validity of the simple measures was established against multisegmental curvature (r = 0.88–0.98). Strong association was observed between the Cobb and centroid angles globally (r = 0.84) and regionally (r = 0.83). Correspondence between measures was moderate for the Cobb method r = 0.72), yet stronger for the centroid method (r = 0.80). The Cobb angle was 20% greater for regional measures due to the influence of endplate tilt.ConclusionsRegional Cobb and centroid angles are valid and reliable measures of thoracic kyphosis in people with osteoporosis. However, the Cobb angle is biased by endplate tilt, suggesting that the centroid angle is more appropriate for this population.

Moving from evidence to practice: Models of care for the prevention and management of musculoskeletal conditions

With musculoskeletal conditions now identified as the second highest cause of the morbidity-related global burden of disease, models of care for the prevention and management of disability related to musculoskeletal conditions are an imperative. Musculoskeletal models of care aim to describe how to operationalise evidence-based guidelines for musculoskeletal conditions and thus support implementation by clinical teams and their health systems. This review of models of care for musculoskeletal pain conditions, osteoarthritis, rheumatoid arthritis, osteoporosis and musculoskeletal injuries and trauma outlines health system and local implementation strategies to improve consumer outcomes, including supporting access to multidisciplinary teams, improving access for vulnerable populations and levering digital technologies to support access and self-management. However, the challenge remains of how to inform health system decision-makers and policy about the human and fiscal benefits for broad implementation across health services. Recommendations are made for potential solutions, as well as highlighting where further evidence is required.