Feasibility of a Physical Therapy Intervention on Older Adults With Hyperkyphosis or Forward Head Posture

The University of Texas System (UT)

Status: Completed

Conditions: Hyperkyphosis; Postural, Thoracic Kyphosis; COPD; Pneumonia

Treatments: Other: Manual therapy and exercise

Study type: Interventional

Funder types: Other

Identifiers

NCT04114331

15-0098

Details and patient eligibility

About

The original intent was to use a manual therapy and therapeutic exercise intervention with older patients with pneumonia post-hospitalization. It was hypothesized that the physical therapy intervention would have a positive impact on posture, physical function, pulmonary function, gait, quality of life, and ultimately readmission. This patient population was found to be not feasible to recruit and the study target population was expanded to include older community dwelling adults with pneumonia, chronic obstructive pulmonary disease (COPD), or hyperkyphosis.

Full description

This original study was a feasibility study to determine the ability to recruit and to assess pilot data to determine the effects of a physical therapy intervention on physical function, gait, balance, posture, pulmonary function, and quality of life. Additionally the 30 day readmission, ER visits, and mortality was to be tracked. This study failed due to lack of recruitment. However, the aim to examine the effectiveness a physical therapy intervention was still used just in a broader population. The intervention and measures remained the same except for 30 day admission/mortality data.

The new aim was to examine the effectiveness of manual therapy and exercise on posture, function, gait, pulmonary function, and quality of life in older community dwelling adults with hyperkyphosis or forward head posture. Kyphosis, osteoporosis, decreased trunk flexibility, and pain are considered potential causes of restrictive lung function. The physical therapy intervention targets both soft tissue and skeletal restrictions to improve mobility. The outcomes were chosen to examine not only the direct impact on posture but also the indirect impact on physical function including pulmonary status. Lastly, cognitive mapping was used to record the change in the perceptions of the participants as they improved.

Enrollment: 24 patients

Sex: All

Ages: 50+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• at least 50 years of age
• hyperkyphosis, forward head posture, pneumonia, or chronic obstructive pulmonary disease (COPD)
• community dwelling
• self report of ability to walk 10 feet or greater with or without an assistive device
• ability to perform informed consent
• ability to transport to research facility
• ability to read and write in English or Spanish

Exclusion criteria

• Inability to perform informed consent
• Inability to follow directions
• Inability to perform transfers, sit, and stand independently
• Inability to ambulate 10 feet or more with or without an assistive device
• Inability to perform pulmonary function testing
• Inability to fully participate in testing and measures
• Inability to fully participate in the intervention
• Severe claustrophobia
• Unable to tolerate physical touch
• Morbid obesity (BMI greater than 40)
• History of prior lung disease such as cancer or transplant
• History of comorbidity that would affect lung function such as neuromuscular disease (ALS, MS), collagen disease (SLE), cardiovascular disease (CHF), or musculoskeletal disease with an autoimmune component (Ankylosing Spondylosis, RA).
• A prior discharge within 30 days of hospitalization for pneumonia or COPD
• Discharge against medical advice

Trial design

Primary purpose: Treatment

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

---

24 participants in 1 patient group

Manual therapy and exercise

Experimental group

Description:

The intervention (3 times a week for 4 weeks, for a total of 12 sessions) consisted primarily of manual therapy (soft tissue and joint mobilization) followed by therapeutic exercises (muscular control and coordination). Manual therapy: Joint mobilizations (Grades I-V) to cervical spine, thoracic spine and ribs Soft tissue mobilization to the pectoralis, scaleni, upper traps, thoracolumbar fascia, erector spinae, and suboccipital musculature Therapeutic exercises: Strengthening of mid and lower traps, lats, glut med, and glut max. Active \& passive stretching of thoracic and lumbar rotation, hip flexors, and plantarflexors. The treating therapists agreed on a protocol with treatment individualized to each patient.

Treatment:

Other: Manual therapy and exercise