Participants Subjects
The children aged 8-12 were assessed. The study group consisted of the patients diagnosed with the shape of spine deformity. Children in the study group underwent a four-month therapy conducted under the supervision of a physiotherapist. The control group consisted of the children who did not have posture defect in preventive medical examination or physiotherapeutic assessment.
The study group consisted of 211 children, 53% girls, 46.92% boys. The mean age in the study group was 10.72 years (SD = 1.25), body height 1.4 meters (SD = 0.16), body weight 34.7 kg (SD = 11.84), BMI 20.15 (SD = 2.35).
The control group consisted of 101 children, 50% girls, 50% boys. The mean age in the control group 10.69 (SD = 1.44), body height 1.39 meters (SD = 0.13), body weight 38.69 (SD = 8.03), BMI 20.02 (SD = 2.52).
Inclusion criteria:
- age 8-12 years
- diagnosed defect of shape of the spine
- good general health (≤2 acc. the ECOG Scale)
- the legal guardian’s consent to participate in the study.
Exclusion criteria:
- comorbidities that may affect the shape of the spine disorder
- interruption or non-compliance with the recommendations included in the therapeutic procedure
- BMI below the 10th and above the 90th percentile.
Participation in the research was voluntary, combined with ensuring anonymity. The legal guardians of the children participating in the study gave their informed consent.
Study project
The children in the study group were subjected to a three-dimensional computer analysis of shape of the spine and a physiotherapeutic functional assessment. Based on the obtained results, rehabilitation program was chosen, which assumed: 1. performing specific therapeutic activities by the child at home twice a day under parental control, 2. the use of a mirror in order to properly correct body posture. The examination was conducted and the choice of therapy was made by a physiotherapy specialist. The study protocol assumed 4 appointments at four-week intervals. During each appointment, the analyzed parameters were measured and a functional test was performed. Based on these, the therapy was chosen. The parents were thoroughly trained by the physiotherapist in the recommended techniques, which they would then perform with the children until the subsequent appointment.
In the control group, the measurement of the analyzed parameters as well as the functional test were performed once.
The study was approved by the Bioethics Committee at the Faculty of Medicine and Health Sciences, the Jan Kochanowski University in Kielce (Approval No. 1/2016, issued 15.01.2016). All methods were performed in accordance with the relevant guidelines and regulations.
Body posture assessment
The shape of the spine was assessed in static conditions in a standing habitual position, with the back to the camera, with eyes directed straight ahead. The DIERS Formetric 4D system was used to assess the posture. The system enables precise assessment of the shape of the spine [29]. The DIERS test was performed in both groups (study and control). In the study group it was performed four times (before the first and after the second, third and fourth therapeutic sessions). It involved the measurement of seven parameters enabling a complete assessment of body posture [33].
Parameters assessed:
- Trunk imbalance VP-DM [mm] - shows the deviation of the VP (spinous process of the 7th cervical vertebra) from the DM (the midline connecting the right and left dimples of Venus)
- VP-DM [mm] lateral deviation - means the maximum deviation of the spine midline from the VP-DM line in the frontal plane (value at the top of the curve)
- Pelvic tilt [mm] - means the difference in the height of lumbar dimples in relation to the horizontal plane (cross-section)
- Pelvic torsion [o] - calculated from the mutual torsion of the planes at the points of lumbar dimples (vertical component)
- Surface rotation [o] - maximum trunk rotation on the symmetry line
- Kyphosis angle [o] - the angle measured between VP and the estimated position of Th12
- Lordosis angle [o] - the angle measured between the estimated position of Th12 and DM
Intervention
In the rehabilitation program for children from the study group, global patterns chosen on the basis of functional and computer testing were used, based on two recognized therapeutic methods. The planned therapeutic program was realised by the treated children under their parents’ supervision. The therapeutic session was about 20 minutes long and was based on elements of the PNF and Vojta methods [34-36].
Statistical methods used
Statistical analyzes were performed with IBM SPSS Statistics 23 package. The basic descriptive statistics were analyzed: the mean, the median, standard deviation, skewness, kurtosis, the smallest and the biggest distribution value.
The sample size necessary to draw conclusions about the entire population was estimated [37], based on available epidemiological studies [38].
In order to assess normality of the distribution of variables, the non-parametric Kolmogorov-Smirnow test was used [39].
Percentage differences between the measurements were calculated. In order to assess the significance of differences between the parameters in the study and control groups, the Mann-Whitney U test was used due to the fact that most of the analyzed variables adopted different from normal distribution [40].
The analysis of changes occurring between consecutive measurements in the study group was conducted using the Friedman test [41]. This test was used because it allows to determine the differences between the four measurements simultaneously.
Statistically significant scores of the Friedman test underwent Post-Hoc tests using the Dunn-Bonferroni test to counteract the problem of multiple comparisons, consisting in reducing nominal significance level of each set of related tests [42].