Data Extraction, Quality Assessment, Search Methods
The review team included a doctoral student and two senior professors
with consulting by an experienced medical librarian. Variables for QOL
and depression/mood were measured by established instruments. Posture
was measured by inclinometer, x-ray, chest height, or perceived body
postures. As informed by the Shape-Shifter Model,15two levels of search strategy (biologic, behavioral) were employed,
guided by the Preferred Reporting Items for Systematic Reviews and
Meta-analyses (PRISMA) statement.16 Inclusion criteria
were: a) posture measured by the standard thoracic kyphosis angle; b)
measurement of QOL or depression/mood; c) English language; d) fully
published empirical studies with descriptive, cross-sectional, and
randomized clinical trial (RCT) designs. Exclusion criteria were: a)
surgical posture intervention studies, abstracts, case studies, case
reports, dissertations, literature reviews, and qualitative studies. No
studies were identified in children with cancer (Figure 2).
First, the existing literature reporting an association between posture
and QOL (Biologic Perspective) was searched using PubMed and Ovid
Medline with the indexed term for QOL, and the key words postureand thoracic kyphosis (MeSH headings Quality of Life orLife Quality or Health Related Quality of Life orHRQOL ). The initial search included the prior ten years from 2008
to 2018, but due to a low number of results, the time range was
increased to the years from 2000 to 2018. The resulting 118 articles
were scanned for appropriate titles and abstracts, revealing 8 studies
(Table 1). Next, existing research literature investigating the
relationship between mood (defined as emotional reactions or depression)
and posture (Behavioral Perspective) was searched using Pubmed and Ovid
Medline for the prior ten years from 2008 to 2018 using the key wordsposture , thoracic kyphosis , mood ,depression , and anxiety . This resulted in 307 articles.
Resulting articles were scanned for appropriate titles and abstracts,
revealing 6 studies (Table 2). In summary, 14 total studies met criteria
for inclusion in this systematic review.