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Mizzou MU PT 8690 - Effects of a New Spinal Orthosis on Posture

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Authors:Michael Pfeifer, MDBettina Begerow, PhDHelmut W. Minne, MDAffiliations:From the Institute of ClinicalOsteology “Gustav Pommer” andClinic “Der Fürstenhof,” BadPyrmont, Germany.Disclosures:Supported, in part, by Medi-Bayreuth,which provided the orthoses andfunding for the study (Medi-Bayreuthhad no control over the decision toapprove or submit the manuscript forpublication).Presented, in part, as oralpresentations at the meeting of theInternational OsteoporosisFoundation, Lisbon, Portugal, 2002,and at the 24th Meeting of theAmerican Society for Bone andMineral Research, San Antonio,Texas, 2002.Correspondence:All correspondence and requests forreprints should be addressed toMichael Pfeifer, MD, Institute ofClinical Osteology, Am Hylligen Born7, 31812 Bad Pyrmont, Germany.0894-9115/04/8303-0177/0American Journal of PhysicalMedicine & RehabilitationCopyright © 2004 by LippincottWilliams & WilkinsDOI: 10.1097/01.PHM.0000113403.16617.93Effects of a New Spinal Orthosis onPosture, Trunk Strength, andQuality of Life in Women withPostmenopausal OsteoporosisA Randomized TrialABSTRACTPfeifer M, Begerow B, Minne HW: Effects of a new spinal orthosis onposture, trunk strength, and quality of life in women with postmeno-pausal osteoporosis: A randomized trial. Am J Phys Med Rehabil2004;83:177–186.Objective: One fourth of women ⱖ50 yrs of age in the general populationhave one or more vertebral fractures. The orthotic treatment modality in themanagement of vertebral fractures caused by osteoporosis remains subjectivebecause no objective data from clinical trials are available. The objective of thisresearch was to evaluate the efficacy of a newly developed spinal orthosis inpatients with osteoporotic vertebral fractures.Design: We conducted a study that measured trunk muscle strength, angleof kyphosis, body height, body sway, and variables of quality of life such aspain, well-being, and limitations of daily living.Results: Wearing the orthosis for 6-mo period was associated with a 73%increase in back extensor strength, a 58% increase in abdominal flexorstrength, an 11% decrease in angle of kyphosis, a 25% decrease in bodysway, a 7% increase in vital capacity, a 38% decrease in average pain, a 15%increase in well-being, and a 27% decrease in limitations of daily living. Theoverall tolerability of the orthosis was good, no side-effects were reported, andthe drop-out rate of 3% was rather low.Conclusions: The use of an orthosis increases trunk muscle strength andthus improves posture in patients with vertebral fractures caused by osteopo-rosis. In addition, a better quality of life is achieved by pain reduction, de-creased limitations of daily living, and improved well-being. Therefore, the useof an orthosis may represent an efficacious nonpharmacologic treatment op-tion for spinal osteoporosis.Key Words: Osteoporosis, Vertebral Fractures, Spinal Orthosis, TrunkMuscle Strength, Quality of Life, Body SwayMarch 2004 Effects of a Spinal Orthosis in Osteoporosis177Research ArticleOsteoporosisThe incidence of vertebral frac-tures caused by osteoporosis is rap-idly rising with aging in both sexes.1A fourth of women ⱖ50 yrs of age inthe general population have one ormore vertebral fractures resulting inloss of height and increased kypho-sis.2Kyphotic postural change is themost physically disfiguring and psy-chologically damaging effect of osteo-porosis and can contribute to an incre-ment in vertebral fractures and the riskof falling.3In addition, spinal osteopo-rosis may be associated with reducedpulmonary function,4chronic pain forseveral years,5limitations in everydaylife,6and emotional problems relatedto appearance.7Therapeutic interventions withproven efficacy include alendronate,8risedronate,9and raloxifene,10whichimprove bone quality.11These thera-peutics, however, only prevent ap-proximately 50% of spinal frac-tures.11In addition, there is need toimprove back muscle strength be-cause muscle atrophy parallels thedecline of bone mineral density of thespine12and contributes significantlyto kyphotic postural changes.13Themulti-disciplinary rehabilitation con-cept of spinal osteoporosis, therefore,includes back-strengthening exer-cises to counteract thoracic kyphosisin hyperkyphotic subjects.12,14Traditionally, spinal orthoseshave been used in the management ofthoracolumbar injuries treated withor without surgical stabilization. Thevast majority of orthoses, however,are used in patients with low backpain.15In the United States alone,⬎250,000 corsets are prescribed eachyear.16These orthoses, however, havenever been tested under standardizedconditions. Especially, no prospec-tive, randomized, and controlled clin-ical trials are available to documentefficacy according to the criteria ofevidence-based medicine. This is alsothe case for osteoporosis, in whichapproximately one-fourth of womenⱖ50 yrs of age have one or morevertebral fractures.17The orthotictreatment modality in the manage-ment of vertebral fractures caused byosteoporosis remains subjective be-cause, to our knowledge, no objectivedata are available on the effectivenessof orthoses in stabilizing osteoporoticvertebral fractures.18Furthermore,the use of rigid thoracolumbar bracesin osteoporosis is limited by factorssuch as atrophy of trunk muscles andrestricted respiration, leading to lowcompliances.18Therefore, a completely new or-thosis has been developed, especiallytaking into account the needs of pa-tients with vertebral osteoporosis. Onthe basis of important articles pub-lished by Sinaki et al.,19 –21our studywas designed as a prospective, ran-domized, and controlled crossoverstudy to determine the efficacy of thisnewly developed orthosis in patientswith spinal osteoporosis.METHODSStudy Participants. We studied ambu-latory, community-dwelling womenⱖ60 yrs of age who were recruitedthrough newspaper advertisements.The inclusion criteria were at least oneclinical vertebral fracture caused by os-teoporosis and an angle of kyphosis ofⱖ60 degrees as measured by stereo-photomorphometry. Exclusion criteriawere disorders affecting bone mineralmetabolism (e.g., hyperthyroidism, pri-mary hyperparathyroidism, hypercorti-solism, and osteomalacia) and severedegenerative diseases of the spine suchas osteoarthritis, scoliosis, and malig-nancies. All subjects received standardmedical treatment for osteoporosis, in-cluding calcium and vitamin D and anewer bisphosphonate. The subjectswere asked to wear the orthosis


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