AbstractIntroduction: Age-related hyperkyphosis has been linked to impaired balance, increased falls and fear of falling. However, the mechanisms of how back shape and posture influence balance, falling and fear of falling are unclear. Exercise-based interventions have been developed to reduce hyperkyphosis together with any associated complications. However, limited studies have paid attention to improving falls, fear of falling, together with any satisfaction with educational booklets. Furthermore, very little is understood about subjects’ experiences of living with hyperkyphosis and taking part in a hyperkyphosis-specific exercise programme.
Aim: The overall aim of this thesis was to explore the effects of back shape and posture on balance, falling, and a fear of falling in older adults with hyperkyphosis.
Methods: Firstly, a systematic review was conducted to evaluate the relationship between back shape and posture with balance, falling, and fear of falling. Secondly, a cross-sectional primary study was undertaken to investigate the relationship between 3D back shape and posture with balance, falling, and fear of falling. Thirdly, a second systematic review was then conducted to determine the effects of exercise programmes on back shape and posture, balance, falling, and fear of falling in older people with hyperkyphosis. Finally, an empirical study was conducted to test the effect of a 16-week hyperkyphosis-specific exercise on falling, fear of falling, and satisfaction with an educational booklet. In addition, the study also explored the subjects’ experiences of living with hyperkyphosis as well as participating in the exercise programme.
Results: The first systematic review identified that the existing evidence was limited and at a relatively high risk of bias indicating that older women with hyperkyphosis had greater postural sway and a greater number of falls than older women without kyphosis. Subsequently, the results of the secondsystematic review identified a significant research gap created by a lack of evidence for the effects of exercise interventions on back shape and posture, postural sway, the limits of stability, falling, and fear of falling in older people with hyperkyphosis. No primary papers were found, and this resulted in an empty review.
The results of the cross-sectional study revealed that 3D back shape and posture were related to postural sway, the limits of stability, history of falls, and fear of falling. Furthermore, in the intervention study, there was no statistically significant interaction between group (exercise group and control group) and time (before-intervention versus post-intervention) on the history of falls and the fear of falling. However, the effect size of the interaction effect was large. This means there was a probability that significance improve in the history of falls and the fear of falling would be observed with a larger sample size. Hyperkyphosis-specific exercises were found to have significant benefits for older adults in terms of improved body awareness, back shape and posture, as well as improved lifestyles. In the participants’ experience, severe hyperkyphosis did not affect their activities of daily living.
Discussion: An investigation into the relationship between different types of hyperkyphosis (upper, mid, and lower thoracic) with balance, falling and fear of falling needs to be conducted in future studies. This knowledge would help health professionals understand which type of hyperkyphosis will affect balance and falls. Furthermore, a larger RCT is needed to confirm the effects of the exercise programme in reducing the number of falls, fear of falling, back posture and balance.
|Date of Award||1 Jun 2022|
|Supervisor||Josette Bettany-Saltikov (Supervisor), Paul Van Schaik (Supervisor) & Gok Kandasamy (Supervisor)|