THE RELATION BETWEEN RADIOGRAPHIC SPINOPELVIC ALIGNMENT AND PHYSICAL PERFORMANCE TEST IN A COMMUNITY-BASED FEMALE COHORT

H. Chiba¹, T. Kobayashi², M. Shimizu³, I. Senoo², M. Imai², H. Sugisawa⁴, T. Sugawara⁵, T. Kumamoto⁶, T. Ino⁷

¹Furano Geriatric Health Services Facility, Rehabilitation, Furano, Japan, ²Asahikawa Medical University, Orthopaedic Surgery, Asahikawa, Japan, ³Kyoritsu Hospital, Orthopaedic Surgery, Obihiro, Japan, ⁴Furano Kyokai Hospital, Rehabilitation, Furano, Japan, ⁵Biei Hospital, Rehabilitation, Biei, Japan, ⁶Hokkaido Chitose College of Rehabilitation, Department of Rehabilitation, Faculty of Health Science, Chitose, Japan, ⁷Hokkaido University of Science, Department of Physical Therapy, Faculty of Health Sciences, Sapporo, Japan

Background: In adult patients with spinal deformity, spinal kyphosis changes are caused by disc degeneration and vertebral fracture. A previous study reported that spinal deformity in the sagittal phase is progressive, and influences low back pain, risk of falls, and health-related quality of life. Adult spinal deformity has been elaborated radiographically, however, clinical data about physical function have not been well-documented.

Purpose: The purpose of this study was to investigate the relation between radiographic spinopelvic alignment and physical performance test in a community-based female cohort.

Methods: This study was a component of our ongoing prospective cohort study (ASAP study), which recruited community-dwelling volunteers from a population register in Hokkaido, Japan. A total of 405 female volunteers (mean age 66.9 years) were recruited and provided written informed consent. We reviewed whole-spine radiographs taken with the volunteers in a standing position. We measured standard sagittal spinopelvic parameters including thoracic kyphosis, lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence, pelvic tilt (PT), and sacral slope (SS). We also measured physical performance test including muscle strengths of trunk flexor and extensor (TEX) using an isometric device, grip power, active back extension test (aBET; distance of from floor and to the sternal notch at maximal active back extension in the prone position with fixed legs) and passive back extension test (pBET), and functional reach test (FRT). Trunk inclination angle (TIA) was also recorded using as the angle between a line connecting surface markers attached on the C7 and L4 spinous processes and the vertical level, and the difference of TIA between walking and standing at rest was calculated (dTIA=TIA at walking -TIA at rest), with large values indicating increased ambulatory kyphosis. Sagittal spinopelvic parameters and physical performance test were statistically analyzed using correlation and multiple regression analysis. Statistical significance was set at p-value of less than 0.05.

Results: LL was correlated with aBET (r=0.33) and dTIA (r=-0.22). SVA was correlated with TEX (r=-0.21), aBET (r=-0.40), pBET (r=-0.25) and dTIA (r=0.22). PT was correlated with TEX (r=-0.24), aBET (r=-0.37), pBET (r=-0.22) and dTIA (r=0.39). SS was correlated with aBET (r=0.39), dTIA (r=-0.27) and FRT (r=0.20). The multiple regression analysis showed that aBET (β=0.33) and dTIA (β=-0.18) were significantly associated with LL, aBET (β=-0.37) and dTIA (β=0.14) were significantly associated with SVA, dTIA (β=0.34), aBET (β=-0.29) and TEX (β=-0.09) were significantly associated with PT, and aBET (β=0.37) and dTIA (β=-0.16) were significantly associated with SS.

Conclusions: Clinical data from this study showed aBET and ambulatory kyphosis were constantly associated with sagittal spinopelvic parameters. In particular, aBET should be recognized not only as a clinical marker of aggravation to the sagittal spinopelvic alignment but also an early detection in the community.

Implications: aBET was suggested as a useful physical performance test for aggravation of the sagittal spinopelvic alignment.

Funding acknowledgements: We sincerely thank the staffs of Memuro Public Hospital for their dedication to the collection of data for this study.

Keywords:
back extension test
sagittal spinopelvic alignment
physical performance test

Topics:
Musculoskeletal: spine
Health promotion & wellbeing/healthy ageing/physical activity

Did this work require ethics approval? Yes

Institution: Asahikawa Medical University

Committee: Asahikawa Medical University

Ethics number: approval number 372