JOURNAL PRESENTATION
Mudasir Rashid Baba
Reg number: 201/Jan 2016
Moderator: Dr. Vineetha Pai
ARTICLE
• Physical capacity of girls with mild and moderate
idiopathic scoliosis: influence of the size, length and
number of curvatures.
Dariusz Czaprowski , Tomasz Kotwicki.
Ryszard Biernat , Jerzy Urniaz , Aleksander Ronikier.
• European Spine Journal,2012; Volume 21, 1099–1105.
• Impact Factor: 5.771
INTRODUCTION
• Scoliosis is a 3-dimensional rotational deformity.
• It is characterized by side to side curvature of the
spine>10 degrees and a reduced kyphosis in
thoracic curves.
• Idiopathic scoliosis (IS) is a multiplane spine
distortion of unknown etiology
• This leads to deformation of the chest wall
thereby reducing the pulmonary capacity.
• As a result, Vo2 max(which determines the
organism’s capacity to transport and use oxygen)
also decreases.
• This causes a decrease in the physical capacity
and effort.
PURPOSE
• To assess the impact of
1. The curvature angle value,
2. The number of vertebrae in curvatures and
3. The number of curvatures on the physical
capacity of girls aged 10–18 with mild and
moderate idiopathic scoliosis.
METHODS
• Ninety-seven girls, aged 10–18 (70 girls in the
study group and 27 in the control group) were
examined.
• The study group was divided into two subgroups:
(A) mild scoliosis: 42 girls with 10–24° curves
(mean 17.1 ± 4.6) and
(B) moderate scoliosis: 28 girls with 25–40°
curves(mean 32.1 ± 4.3).
INCLUSION CRITERIA:
• Female, aged 10–18 years.
• Having idiopathic thoracic scoliosis, Cobb angle
ranging from 10° to 40° on standing frontal
radiograph.
• The absence of contraindications for exercise
tests, child’s and parents’ consent.
• Primary outcome measure was “physical
capacity” which was assessed by the PWC170
(Physical Working Capacity) test.
• Secondly, the average heart rate was monitored
after each 5 min physical effort.
INTERVENTION
• The PWC170 (Physical Working Capacity) test was
done on MONARK 874 E cycle ergometer.
• Two 5-min sub maximal physical effort events
were carried out where the level of effort was
concluded with the heart rate (HR) approaching
130 and 150 beats per minute.
• The average heart rate recorded was used to
determine the strain output in accordance with
PWC170 indicator.
• The indicator was calculated on the basis of
Sjostrand’s formula: PWC170 =[(P2- P1)/(HR2HR1)]x (170- HR2)+P2
• Where P1 and P2 are output of subsequent
physical efforts in watts (W), HR1 and HR2 are
heart rate during a particular strain test.
• Next, VO2max was calculated using Karpman’s
formula :
VO2 max(l/min)= 1.7xPWC170+1,240.
• where VO2max is maximum oxygen intake
(l/min), 1.7 and 1,240 are constant values
(unsigned)
• PWC170 is the absolute value (without sign)
STATISTICAL ANALYSIS
• The results were analyzed using Statistica 8.1.
(StatSoft, USA).
• Distribution was assessed by way of Shapiro–Wilk’s
test.
• The Wald–Wolfowitz, Kruskal–Wallis, and Dunn tests
were used as well as Spearman’s correlation of
ranks.
• A value of p<0.05 was adopted as the significance
level.
RESULTS
• The values of all measured parameters were
lower in the scoliosis group than in the control
group.
• Table 1 shows baseline comparison of all three
groups with respect to age,weight,height and BMI
• No differences were found between the three
groups A, B, C) regarding the age, weight and BMI
• However difference in height was found (A and B
vs. C)
Impact of the angle of thoracic curvature on physical
capacity.
• Girls with moderate idiopathic scoliosis (25–40°) had
considerably lower values of VO2max and absolute
output value during the PWC170test (l/min) than the
controls.
• There was no significant difference of maximum
oxygen intake in relation to weight (ml/kg/min)
among the groups:
• (A) scoliosis 10–24°, (B) scoliosis 25–40° and (C)
control group
• Table 3 shows that girls with scoliosis between25
to 40° obtained a significantly lower value of
relative output during the PWC170 (W/kg) test in
comparison with the control group.
• When the relationship between examined
parameters and curvature angle were
determined, their values decreased with increase
in the thoracic curvature value.( spearman's
correlation of ranks)table 4.
Impact of the number of scoliosis vertebrae on
physical capacity
• No significant difference in the maximum oxygen
intake expressed in l/min and ml/kg/min and
absolute value of the PWC170 indicator (W) was
found between the groups{(i.e. number of
vertebrae below and equal [<9 vertebrae], or
above [>9] the average number [=9] and the
control group}.
• Girls with an above average scoliosis length
showed a significantly lower value of PWC170
(W/kg) indicator than girls from the control group.
Table 5.
• Also, for the relative output, a weak negative
correlation with the number of scoliotic vertebrae
was confirmed (Table 6).
Impact of the number of curvatures on physical
capacity.
• The girls with double-curve scoliosis had
significantly lower value of the PWC170 indicator
expressed in relation to weight (W/kg) than the
girls from the control group.(Table 7)
LIMITATION/CRITICAL ANALYSIS
• No mention about ethical clearance .
• Did not mention whether the girls had undergone
surgery previously
• No mention whether or not the girls are currently
under conservative management( e. g. bracing).
• Exclusion criteria was also not mentioned.
DISCUSSION
• This study attempted to assess the multifactorial
impact of mild and moderate idiopathic scoliosis
on the physical capacity of girls aged 10–18 years.
• As the early stages of the impact of scoliosis on
respiratory system are not fully understood there
was a need to establish the relationship between
physical capacity and idiopathic scoliosis.
• The most widely known parameter of physical
capacity is the maximum oxygen intake
(VO2max).
• It indicates the maximum oxygen capacity
absorbed by the organism per minute during
dynamic physical effort.
• Physical capacity was indirectly assessed by
PWC170 indicator and cycle ergometer.
• The higher the value of this(PWC170) indicator,
the more strenuous effort a person can make
without any disturbance to the cardiovascular
system functioning.
• Increase of the angle of curvature entails
significant decrease of the physical capacity
which is confirmed by Schneerson and Madgwick
in their work.
• However, The authors of this study did not
confirm any significant correlation between the
angle of curvature and the parameters describing
the physical capacity (VO2max,RVO2max).
• This might be due to the fact that the girls
included in the observation had mild and
moderate scoliosis.
• However, a significant decrease in the maximum
oxygen intake (l/min) and the PWC170 indicator
was observed in girls with scoliosis ranking from
25°to 40° in relation to the control group.
• Single-curve scoliosis is usually connected with a
large trunk decompensation, which can cause
decreased physical fitness in girls with idiopathic
scoliosis.
• This may lead to impairment of physical capacity
and decrease the ability to adjust to strain.
• As the available literature lacks the evidence for
relationship between the number of scoliotic
vertebrae, the number of curvatures and the
physical capacity, the authors of this study
wanted to assess those relationships.
• This study, however, presented the relationships
between the number of scoliotic vertebrae,
curvatures and physical capacity in an equivocal
way.
CONCLUSION
1. The maximum oxygen intake and the output
during the PWC170 test was lower in girls with
moderate scoliosis (25–40°°) than in the control
group.
2. The value of maximum oxygen intake and
output obtained during the PWC170 test in girls
with mild scoliosis (up to 25°) did not differ
significantly from the values obtained in the
control group.
3.a) The number of vertebrae involved in scoliotic
deformation and the number of curvatures
caused significant decrease in only the relative
value of the output obtained during an exercise
test.
b)The number of scoliotic vertebrae and the
number of curvatures did not influence the
maximal oxygen intake and the absolute value of
PWC170 indicator.