Juliana Adami Sedrez

Risk factors associated with structural postural changes in the spinal column of children and adolescents

OBJECTIVE: To investigate the association between behavioral risk factors, specifically postural habits, with the presence of structural changes in the spinal column of children and adolescents. METHODS: 59 students were evaluated through the self-reporting Back Pain and Body Posture Evaluation Instrument and spinal panoramic radiographic examination. Spine curvatures were classified based on Cobb angles, as normal or altered in the saggital plane and as normal or scoliotic in the frontal plane. Data were analyzed using SPSS 18.0, based on descriptive statistics and chi-square association test (a=0,05). RESULTS: The prevalence of postural changes was 79.7% (n=47), of which 47.5% (n=28) showed frontal plane changes and 61% (n=36) sagital plane changes. Significant association was found between the presence of thoracic kyphosis and female gender, practice of physical exercises only once or twice a week, sleep time greater than 10 hours, inadequate postures when sitting on a seat and sitting down to write, and how school supplies are carried. Lumbar lordosis was associated with the inadequate way of carrying the school backpack (asymmetric); and scoliosis was associated wuth the practice of competitive sports and sleep time greater than 10 hours. CONCLUSIONS: Lifestyle may be associated with postural changes. It is important to develop health policies in order to reduce the prevalence of postural changes, by decreasing the associated risk factors.

Photogrammetry as a tool for the postural evaluation of the spine: A systematic review.

AIM To evaluate the use of photogrammetry and identify the mathematical procedures applied when evaluating spinal posture. METHODS A systematic search using keywords was conducted in the PubMed, EMBASE, Scopus, Science and Medicine(®) databases. The following inclusion criteria adopted were: (1) the use of photogrammetry as a method to evaluate spinal posture; (2) evaluations of spinal curvature in the sagittal and/or frontal plane; (3) studies published within the last three decades; and (4) written entirely in English. The exclusion criteria were: (1) studies which objective involved the verification of some aspect of validation of instruments; (2) studies published as abstracts and those published in scientific events; and (3) studies using evaluation of the anteriorization of the head to determine the angular positioning of the cervical spine. The articles in this review were included and evaluated for their methodological quality, based on the Downs and Black scale, by two independent reviewers. RESULTS Initially, 1758 articles were found, 76 of which were included upon reading the full texts and 29 were included in accordance with the predetermined criteria. In addition, after analyzing the references in those articles, a further six articles were selected, so that 35 articles were included in this review. This systematic review revealed that the photogrammetry has been using in observational studies. Furthermore, it was also found that, although the data collection methodologies are similar across the studies, in relation to aspects of data analysis, the methodologies are very different, especially regarding the mathematical routines employed to support different postural evaluation software. CONCLUSION With photogrammetry, the aim of the assessment, whether it is for clinical, research or collective health purposes, must be considered when choosing which protocol to use to evaluate spinal posture.

Test-retest, inter- and intra-rater reliability of the flexicurve for evaluation of the spine in children

Introduction: The early evaluation of the spine in children is desirable because it is at this stage of development that the greatest changes in the body structures occur. Objective: To determine the test-retest, intra- and inter-rater reliability of the Flexicurve instrument for the evaluation of spinal curvatures in children. Method: Forty children ranging from 5 to 15 years of age were evaluated by two independent evaluators using the Flexicurve to model the spine. The agreement was evaluated using Intraclass Correlation Coefficients (ICC), Standard Error of the Measurement (SEM), and Minimal Detectable Change (MDC). Results: In relation to thoracic kyphosis, the Flexicurve was shown to have excellent correlation in terms of test-retest reliability (ICC2,2=0.87) and moderate correlation in terms of intra-(ICC2,2=0.68) and inter-rater reliability (ICC2,2=0.72). In relation to lumbar lordosis, it was shown to have moderate correlation in terms of test-retest reliability (ICC2,2=0.66) and intra- (ICC2,2=0.50) and inter-rater reliability (ICC=0.56). Conclusion: This evaluation of the reliability of the Flexicurve allows its use in school screening. However, to monitor spinal curvatures in the sagittal plane in children, complementary clinical measures are necessary. Further studies are required to investigate the concurrent validity of the instrument in order to identify its diagnostic capacity.

Monitoring the prevalence of postural changes in schoolchildren

[Purpose] The aim of this study was to identify whether postural changes are prevalent with advancing age using a photogrammetric method performing one-year follow-up study. [Subjects and Methods] Thirty-eight schoolchildren were evaluated in 2011 and 2012 in this cohort study. The subjects underwent a postural evaluation, which involved palpation of reference anatomic points, placement of reflexive markers over the anatomic points, image acquisition, and point digitalization using the Digital Image-based Postural Assessment evaluation software. For data analysis, descriptive statistics and inferential statistics were analyzed by McNemar’s test. [Results] The results showed a significant increase in postural change prevalence for the lumbar spine in the sagittal plane (from 42.2% to 81.6%) and the knees in the frontal plane (from 39.5% to 63.2%) and a significant decrease in the prevalence of scoliosis (from 68.5% to 42.2%). [Conclusion] The findings indicate an increase in the prevalence of postural changes in schoolchildren from Teutônia, RS, Brazil, in 2012 compared with 2011. The development of longitudinal investigations for long-term monitoring of the evolution of posture and of schoolchildren habits’s representing a viable alternative to subsidize health actions.

Layout for Assessing Dynamic Posture: Development, Validation, and Reproducibility.

Purpose: To determine the psychometric properties of the layout for assessing dynamic posture (LADy). Methods: The study was divided into 2 phases: (1) development of the instrument and (2) determination of validity and reproducibility. The LADy was designed to evaluate the position adopted in 9 dynamic postures. Results: The results confirmed the validity and reproducibility of the instrument. From a total of 51 criteria assessing 9 postures, 1 was rejected. The reproducibility for each of the criteria was classified as moderate to excellent. Conclusions: The LADy constitutes a valid and reproducible instrument for the evaluation of dynamic postures in children 11 to 17 years old. It is low cost and applicable in the school environment.

Evaluation of the precision and accuracy of the DIPA software postural assessment protocol

Abstract To evaluate the repeatability and intra- and inter-rater reproducibility of the DIPA protocol for postural evaluation of the frontal and sagittal planes; and to evaluate the validity of the results of evaluating the spine in the sagittal plane using the DIPA software. To evaluate the intra- and inter-rater reproducibility and repeatability (n = 16), the DIPA protocol was conducted on the individuals by three raters, by the same rater on different two occasions and by same rater twice immediately, respectively. To evaluate validity, 54 individuals underwent X-ray evaluation of the spine in the sagittal plane and the DIPA protocol. The Intraclass Correlation Coefficient, the Standard Error of Measurement (SEM) and the Minimum Detectable Change (MDC) were used to evaluate the repeatability and reproducibility; and the Pearson’s correlation test, the independent t test and the Morgan–Pitman’s test were used to evaluate the validity. The knee angle, sagittal and scoliotic arrows presented acceptable levels of correlation, with low SEM and MDC values. When compared to X-ray examination, the results of the DIPA software were excellent, with no significant difference, random error and similar variance between measurements. The DIPA protocol is accurate and precise, and can be used by the same or different raters.

Can the adapted arcometer be used to assess the vertebral column in children

BACKGROUND: The adapted arcometer has been validated for use in adults. However, its suitability for use in children can be questioned given the structural differences present in these populations. OBJECTIVE: To verify the concurrent validity, repeatability, and intra- and inter-reproducibility of the adapted arcometer for the measurement of the angles of thoracic kyphosis and lumbar lordosis in children. METHOD: Forty children were evaluated using both sagittal radiography of the spine and the adapted arcometer. The evaluations using the arcometer were carried out by two trained evaluators on two different days. In the statistical treatment, the intraclass correlation coefficient (ICC), Pearsons product moment correlation, Spearmans rho, the paired t test, and Wilcoxons test were used (α=.05). RESULTS: A moderate and significant correlation was found between the x-ray and the adapted arcometer regarding thoracic kyphosis, but no correlation was found regarding lumbar lordosis. Repeatability and intra-evaluator reproducibility of the thoracic kyphosis and lumbar lordosis were confirmed, which was not the case of inter-evaluator reproducibility. CONCLUSION: The adapted arcometer can be used to accompany postural alterations in children made by the same evaluator, while its use for diagnostic purposes and continued evaluation by different evaluators cannot be recommended. Further studies with the aim of adapting this instrument for use in children are recommended.

IMMEDIATE AND FOLLOW-UP EFFECTS OF A POSTURE EDUCATION PROGRAM FOR ELEMENTARY SCHOOL STUDENTS

ABSTRACT Objective: To assess the short- and medium-term effects of the posture education program (PEP) for students of elementary school regarding theoretical knowledge and posture during activities of daily living (ADLs). Methods: The sample consisted of 38 students (aged 8-12 years) in the third grade of elementary school in Porto Alegre, Rio Grande do Sul (Southern Brazil). The children were evaluated in three moments: prior to attending the PEP (pretest); after attending the PEP (post-test); and five months after the conclusion of the PEP, immediately after a learning review of four lessons (five months follow-up). The posture during ADLs and the theoretical knowledge about spine and body posture were assessed, based on specific instruments (layout for assessing the dynamic posture - LADy; and questionnaire). The Friedman test, post hoc Wilcoxon test, and Bonferroni correction were applied to identify the differences among the evaluative moments, as they are statistically significant at α<0.05. Results: No statistically significant difference was found between the post-test and follow-up concerning the theoretical knowledge. In addition, no statistically significant difference was found between post-test and follow-up in relation to ADLs; however, the performance of students was higher in the post-test and follow-up, when compared with the pretest. Conclusions: Immediately after the PEP’s conclusion, the students improved their posture in ADLs. These positive effects and the theoretical knowledge were retained in the follow-up (after the review lessons).

Validation of a topography system for evaluation spine in sagittal plane for children in different nutrient profiles

Este estudio se propone a verificar la validez concurrente, la repetibilidad y la reproductibilidad interevaluadora del sistema Vert 3D en la evaluacion de las curvaturas toracica y lumbar de ninos con distintos perfiles nutricionales. Han participado del estudio 115 ninos, y se los dividieron en tres grupos: bajo peso y eutroficos, sobrepeso y obesos. Cada participante realizo una radiografia panoramica de la columna vertebral en el lateral derecho, de la cual se obtuvieron los angulos de Cobb de cifosis toracica y lordosis toracica. Ademas, a cada participante se les evaluaron con el sistema de topografia Vert 3D cinco veces al dia, tras evaluarles radiologicamente. Las evaluaciones las realizaron tres evaluadores independientes, las cuales fornecieron los angulos Vert de cifosis toracica y lordosis lumbar. En el software SPSS, se sometieron a los datos al coeficiente de correlacion de Pearson, coeficiente de correlacion interclase, prueba t pareada y ANOVA One-Way. El sistema Vert 3D presento excelentes niveles de repetibilidad y reproductibilidad interevaluadora, independiente del perfil nutricional evaluado, para los angulos de cifosis toracica y lordosis lumbar, en cambio, presento una debil correlacion con el angulo de Cobb para cifosis toracica y moderada correlacion para lordosis lumbar. Esos resultados apuntan que este sistema puede utilizarse en el seguimiento clinico de alteraciones posturales de la columna vertebral en el plano sagital de los ninos de todos perfiles nutricionales, en cambio, no se lo puede como forma de diagnosticar o de proponer el angulo de Cobb.

Validez de un sistema de topografía para evaluación de la columna vertebral en el plano sagital de niños con distintos perfiles nutricionales

Este estudio se propone a verificar la validez concurrente, la repetibilidad y la reproductibilidad interevaluadora del sistema Vert 3D en la evaluacion de las curvaturas toracica y lumbar de ninos con distintos perfiles nutricionales. Han participado del estudio 115 ninos, y se los dividieron en tres grupos: bajo peso y eutroficos, sobrepeso y obesos. Cada participante realizo una radiografia panoramica de la columna vertebral en el lateral derecho, de la cual se obtuvieron los angulos de Cobb de cifosis toracica y lordosis toracica. Ademas, a cada participante se les evaluaron con el sistema de topografia Vert 3D cinco veces al dia, tras evaluarles radiologicamente. Las evaluaciones las realizaron tres evaluadores independientes, las cuales fornecieron los angulos Vert de cifosis toracica y lordosis lumbar. En el software SPSS, se sometieron a los datos al coeficiente de correlacion de Pearson, coeficiente de correlacion interclase, prueba t pareada y ANOVA One-Way. El sistema Vert 3D presento excelentes niveles de repetibilidad y reproductibilidad interevaluadora, independiente del perfil nutricional evaluado, para los angulos de cifosis toracica y lordosis lumbar, en cambio, presento una debil correlacion con el angulo de Cobb para cifosis toracica y moderada correlacion para lordosis lumbar. Esos resultados apuntan que este sistema puede utilizarse en el seguimiento clinico de alteraciones posturales de la columna vertebral en el plano sagital de los ninos de todos perfiles nutricionales, en cambio, no se lo puede como forma de diagnosticar o de proponer el angulo de Cobb.