Source and GRADE Evidence Level Purpose Design and Sample Independent Variable or Intervention Dependent Variable Findings
Petcharaporn, Pawelek, Bastrom, Lonner, Newton 21 GRADE Level: Low
To evaluate the association between thoracic hyperkyphosis and patient QOL measures.
Retrospective comparative study 50 children with scoliosis, thoracic kyphosis > 45° and 50 children without scoliosis; ages 14 + 4 (8-18) years, 50% female
Posture (X-ray)
QOL (SRS-24)
Significant negative correlation between kyphotic curve and all domains of QOL scores (r=-0.601, p<0.001). Self-image showed the strongest association (r=-0.66, p<0.001).
Greendale, Huang, Karlamangla, Seeger, Crawford 31 GRADE Level: High
To assess whether a specific yoga intervention can reduce hyperkyphosis.
RCT 118 people, ages 75.5 years (range 59.8–90), 81% women, 88% caucasian Intervention: yoga class 1-hour, 3 days/week for 6 months Attention Control: monthly luncheon and seminar and mailings Posture (Debrunner kyphometer), QOL (Rand 36-item) Yoga group had 0.93° decrease (improvement) in kyphosis angle while those in control had an increase of 0.82° (4.4% difference) (p = .005) Yoga group had decrease (improvement) in kyphosis index of 0.006 while those in control had an increase (worsened) of 0.003 (5% difference)(p = .004). Intervention did not result in significant difference in QOL between groups.
Lonner, Yoo, Terran, Sponseller, Samdani, Betz, Shuffelbarger, Shah, Newton 24 GRADE Level: Moderate
To compare QOL and kyphosis in 3 groups (Scheuermann kyphosis (SK), adolescent idiopathic scoliosis (AIS), normal population).
Prospective comparative study 86 patients with SK (40% female, mean age 16.1 years (4–22 years)) 184 patients with AIS (78% female, mean age 14.9 (10–21)) 31 normal controls (72% female, mean age 14.2 (11–17))
Posture (xray)
QOL (Visual Analog Scale and SRS-22)
Patients with SK had significantly lower scores on SRS-22 (mean 3.61, SE 0.05) than patients with AIS (mean 3.94, SE 0.02), or the control (mean 4.31, SE 0.08, p<0.001). Negative correlation between kyphosis and SRS-22 scores in the male subset (r=-0.246, p=0.001).
Noh, You, Koh, Kim, Kim, Ko, Shin 8 GRADE Level: Low
To compare therapeutic effects of a corrective spinal exercise technique (CST) and a conventional exercise (CE) program on altered spine curvature and QOL in patients with AIS.
Retrospective comparative study 32 patients with AIS, CST (13.8 + 2.8 years, 75% female) versus CE (14.9 + 2.3 years, 88% female) Intervention: CST Control: CE Each group: 60 min/day, 2-3 times/wk. Mean 30 sessions. Posture (X-ray), QOL (SRS-22) Greater improvement in posture angle in CST (8.1 ° + 4.5 [SD] in CST) compared to CE (4.3 ° + 2.1 in CE, 95% CI −6.4 to −1.2, p=0.003). The intervention group had improved pre-post QOL (pre: 3.8±1.8 vs. post: 4.5±0.4, p=0.012) while the control group did not.
Sangtarash, Manshadi, Sadeghi 22 GRADE Level: Low
To investigate the relationship between magnitude of kyphosis and quality of life (QOL) and gait performance.
Descriptive cross-sectional study 34 women with osteoporosis, ages 50-68 years (60.8 ± 4.40).
Posture (dual digital inclinometer)
QOL (SF36)
Significant negative correlation between kyphosis and QOL (r=-0.48, p<0.005).
Jang, Hughes, Oh, Kim 32 GRADE Level: High
To identify effects of corrective exercise for thoracic kyphosis on posture, balance, and well-being in Korean older women.
Double-blind, controlled, repeated measures intervention study Convenience assignment, 50 women, ages 74.6 + 4.6 (experimental group) and 76.4 + 4.9 (control group) Intervention: thoracic corrective program, 1-hour, twice weekly for 8 weeks Control: education on exercise and booklet
Posture (dual digital inclinometer, Flexicurve), well-being (Geriatric Depression Scale Short Form, SF-36)
Intervention group showed significant improvements in percent change of kyphosis angle over time (-3.8±2.2%) vs. control (+1.4±3.8%) (p < .01). Time by group interaction showed significantly better QOL on both measures for the intervention group (p<0.01-0.05).
Katzman, Parimi, Gladin, Poltavskiy, Schafer, Long, Fan, Wong, Lane 33 GRADE Level: High
To determine if specific exercise improves kyphosis, if it differs between men and women, and if physical function and QOL are affected.
RCT 60 women, 41 men, 70.0 years (SD = 5.7) Intervention: kyphosis exercise program, 1 hour twice weekly for 3 months Control: waitlist for 3 months
Posture (xray), QOL (SRS-30, Global health index)
Kyphosis angle degree improved more in the intervention group (-3.8°, 95%CI -5.3 to -2.3) than the control (+1°, 95%CI -0.05 to 2.4; p<0.0001). Between group changes in QOL scores were not significantly different, although both groups had high QOL at baseline.
Miyakoshi, Kudo, Hongo, Kasukawa, Ishikawa, Shimada 25 GRADE Level: Moderate
To compare spinal alignment, muscular strength, and QOL between women with post-menopausal osteoporosis and healthy volunteers.
Cross-sectional comparative study 236 women patients (ages 69-75 years (SD 6)) at osteoporosis clinic to 93 healthy volunteers
Posture (X-ray, SpinalMouse surface curvature)
QOL (SF-36)
Women with osteoporosis were younger but had worse QOL scores across SF-36 scales compared to controls (all p<0.05; difference remained when adjusted for age) Physical scale QOL significantly lower in the osteoporosis group (39.4, 95% CI 37.0 to 41.9 and 47.5, 95% CI 44.7 to 50.2, p< 0.001); Kyphosis was correlated with physical QOL (r=0.253, p<0.05).