The experience of living with adolescent idiopathic scoliosis: a qualitative evidence synthesis using meta-ethnography.

BACKGROUND: Adolescent idiopathic scoliosis (AIS) is a common spinal deformity with physical and psychosocial implications for adolescents. The aim of this qualitative evidence synthesis (QES) was to systematically search for, identify, and synthesise qualitative research in order to improve our understanding of what it is like to live with AIS and to facilitate empathetic and effective healthcare. METHODS: We systematically searched 4 databases (Medline, EMBASE, PsycINFO and CINAHL) and used the 7 phases of meta-ethnography to synthesise qualitative evidence including studies with children and adolescents, and additional viewpoints from parents about the experience of AIS. RESULTS: We distilled 7 themes. (1) Diagnosis turned time on its head revolves around the AIS diagnosis and the uncertainty of the future that accompanied it. (2) Usual activities no longer the same explores how activities and participation in everyday life are impacted by AIS. (3) Hiding my body describes the pervasive struggle with self-image and appearance. (4) I want to feel normal again explores adolescents' desire to return to 'normality' and challenges of feeling different. (5) Balancing isolation and support considers the relationships in the adolescents' lives alongside their feelings of isolation. (6) Trying to keep control of treatment decisions explores how adolescents and their parents strive to feel in control. (7) Fearing surgery yet feeling hopeful focused on the apprehension and fear around spinal surgery and the beacon of hope it represented. CONCLUSIONS: Our QES contributes to the understanding of the adolescent experience of living with AIS. From our findings, clinicians can better understand the physical and psychosocial obstacles and the challenges faced throughout the journey of AIS to inform their clinical interactions with these patients.

Associations Between Physical Activity and Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-analysis.

OBJECTIVE: To investigate the associations between adolescent idiopathic scoliosis (AIS) and physical activity (PA). DATA SOURCES: MEDLINE, EMBASE, AMED, SPORTDiscus, Cochrane Library, and CINAHL electronic databases were searched from inception to August 2022/plus citation tracking. STUDY SELECTION: Observational studies of participants with radiographically confirmed AIS with ≥10° lateral spinal curvature (Cobb method) and comparator groups without AIS that measured PA were selected by 2 reviewers. DATA EXTRACTION: Data were extracted independently and cross-checked by 2 reviewers. Risk of bias was evaluated using Newcastle Ottawa Scales and overall confidence in the evidence using the GRADE approach. DATA SYNTHESIS: Sixteen studies with 9627 participants (9162, 95% women) were included. A history of vigorous PA significantly reduced the odds of being newly diagnosed with AIS by 24% (odds ratio [OR] 0.76, 95% confidence interval [CI] 0.65-0.89) (high certainty). Moderate PA reduced odds by 13% (moderate certainty) and light PA increased odds by 9% (low certainty), but neither analysis was statistically significant. Ballet or gymnastics (OR 1.47, 95% CI 3.08 (1.90, 5.00) were the only individual sports significantly associated with AIS diagnosis (moderate certainty). Case-control studies of people with and without AIS provided greater evidence that having AIS reduces vigorous PA and sports participation, and less evidence light PA and walking are affected. CONCLUSION: Adolescents who participate in more vigorous PA are less likely to be diagnosed with AIS. Ballet and gymnastics are associated with AIS diagnosis, but the direction of this association is uncertain. People with AIS are likely to do less vigorous physical and sporting activity compared with those without AIS, which could negatively affect health and quality of life. Further research is warranted into the inter-relations between PA and AIS, studies need to be of sufficient size, include men, and evaluate vigorous including higher-impact PA compared with moderate or light PA.

Accuracy of a computer vision system for estimating biomechanical measures of body function in axial spondyloarthropathy patients and healthy subjects.

OBJECTIVE: Advances in computer vision make it possible to combine low-cost cameras with algorithms, enabling biomechanical measures of body function and rehabilitation programs to be performed anywhere. We evaluated a computer vision system's accuracy and concurrent validity for estimating clinically relevant biomechanical measures. DESIGN: Cross-sectional study. SETTING: Laboratory. PARTICIPANTS: Thirty-one healthy participants and 31 patients with axial spondyloarthropathy. INTERVENTION: A series of clinical functional tests (including the gold standard Bath Ankylosing Spondylitis Metrology Index tests). Each test was performed twice: the first performance was recorded with a camera, and a computer vision algorithm was used to estimate variables. During the second performance, a clinician measured the same variables manually. MAIN MEASURES: Joint angles and inter-limb distances. Clinician measures were compared with computer vision estimates. RESULTS: For all tests, clinician and computer vision estimates were correlated (r2 values: 0.360-0.768). There were no significant mean differences between methods for shoulder flexion (left: 2 ± 14° (mean ± standard deviation), t = 0.99, p < 0.33; right: 3 ± 15°, t = 1.57, p < 0.12), side flexion (left: - 0.5 ± 3.1 cm, t = -1.34, p = 0.19; right: 0.5 ± 3.4 cm, t = 1.05, p = 0.30) and lumbar flexion ( - 1.1 ± 8.2 cm, t = -1.05, p = 0.30). For all other movements, significant differences were observed, but could be corrected using a systematic offset. CONCLUSION: We present a computer vision approach that estimates distances and angles from clinical movements recorded with a phone or webcam. In the future, this approach could be used to monitor functional capacity and support physical therapy management remotely.

Validity and feasibility of remote measurement systems for functional movement and posture assessments in people with axial spondylarthritis.

INTRODUCTION: This study aimed to estimate the criterion validity of functional movement and posture measurement using remote technology systems in people with and without Axial spondylarthritis (axSpA). METHODS: Validity and agreement of the remote-technology measurement of functional movement and posture were tested cross-sectionally and compared to a standard clinical measurement by a physiotherapist. The feasibility of remote implementation was tested in a home environment. There were two cohorts of participants: people with axSpA and people without longstanding back pain. In addition, a cost-consequence analysis was performed. RESULTS: Sixty-two participants (31 with axSPA, 53% female, age = 45(SD14), BMI = 26.6(SD4.6) completed the study. In the axSpA group, cervical rotation, lumbar flexion, lumbar side flexion, shoulder flexion, hip abduction, tragus-to-wall and thoracic kyphosis showed a significant moderate to strong correlation; in the non-back pain group, the same measures showed significant correlation ranging from weak to strong. CONCLUSIONS: Although not valid for clinical use in its current form, the remote technologies demonstrated moderate to strong correlation and agreement in most functional and postural tests measured in people with AxSA. Testing the CV-aided system in a home environment suggests it is a safe and feasible method. Yet, validity testing in this environment still needs to be performed.

Physiotherapy exercise rehabilitation with tailored exercise adherence support for people with osteoporosis and vertebral fractures: protocol for a randomised controlled trial - the OsteoPorosis Tailored exercise adherence INtervention (OPTIN) study.

INTRODUCTION: Vertebral fragility fractures affect at least 20% of the older population in the UK. Best practice guidelines recommend the use of exercise to slow the rate of bone loss, to maintain muscle strength and physical function, and to prevent falls and further fractures. However, treatment effects are often small and difficult to sustain and adherence, or the extent to which patients engage in treatment, has been identified as an important issue by many studies. Our hypothesis is that integrating adherence intervention strategies with an exercise intervention will be beneficial. We will compare physiotherapy exercise rehabilitation with adherence support versus physiotherapy exercise rehabilitation alone in terms of effects on (A) physical function, quality of life and fear of falling and (B) exercise self-efficacy and adherence. METHODS AND ANALYSIS: A multicentre, two-arm, parallel group, superiority randomised controlled trial with blinded assessments at baseline (0) and 4, 8 and 12 months, with a nested qualitative study and health economic analysis. 116 participants will be allocated to either (1) outpatient physiotherapy which will include a musculoskeletal assessment and treatment including balance, posture, strength training and low impact weight-bearing exercises over 16 weeks or (2) OsteoPorosis Tailored exercise adherence INtervention intervention. This includes standard physiotherapy as above plus an additional, integrated assessment interview (30 min) and 60 min of adherence support spread over the subsequent 16 weeks. ETHICS AND DISSEMINATION: The study protocol was approved by West of Scotland Research Ethics Committee 4 (21/WS/0071). Trial registration number ISRCTN 14465704. The paper is based on Protocol V.4. TRIAL REGISTRATION NUMBER: ISRCTN 14465704.

Validity of sagittal thoracolumbar curvature measurement using a non-radiographic surface topography method.

PURPOSE: To estimate the criterion validity of sagittal thoracolumbar spine measurement using a surface topography method in a clinical population against the gold standard and to estimate concurrent validity against two non-radiographic clinical tools. METHODS: In this cross-sectional validity study, thoracolumbar curvature was measured in adults with spinal conditions recruited from a specialist orthopaedic hospital. A surface topography method using a Kinect sensor was compared to three other measurement methods: spinal radiograph (gold standard), flexicurve and digital inclinometer. Correlation coefficients and agreement between the measurement tools were analysed. RESULTS: Twenty-nine participants (79% female) were included in criterion validity analyses and 38 (76% female) in concurrent validity analyses. The surface topography method was moderately correlated with the radiograph (r = .70, p < .001) in the thoracic spine, yet there was no significant correlation with the radiograph in the lumbar spine (r = .32, p = .89). The surface topography method was highly correlated with the flexicurve (rs = .91, p < .001) and digital inclinometer (r = .82, p < .001) in the thoracic spine, and highly correlated with the flexicurve (r = .74, p < .001) and digital inclinometer (r = .74, p < .001) in the lumbar spine. CONCLUSIONS: The surface topography method showed moderate correlation and agreement in thoracic spine with the radiograph (criterion validity) and high correlation with the flexicurve and digital inclinometer (concurrent validity). Compared with other non-radiographic tools, this surface topography method displayed similar criterion validity for kyphosis curvature measurement.

Does thoracic kyphosis severity predict response to physiotherapy rehabilitation in patients with osteoporotic vertebral fracture? A secondary analysis of the PROVE RCT.

OBJECTIVES: To describe participant characteristics based on kyphosis severity, examine the relationship between kyphosis and physical function, and investigate whether kyphosis severity predicts improvement after physiotherapy intervention. DESIGN AND SETTING: Secondary longitudinal analysis of the PROVE trial, a multicentre RCT. Data from all three trial arms were pooled and divided into quartile groups according to baseline kyphosis severity for linear mixed model analysis. PARTICIPANTS: 604 men and women with osteoporotic vertebral fracture. MAIN OUTCOME MEASURES: Estimated marginal means reported from adjusted mixed models for thoracic kyphosis, Six-minute Walk Test (6MWT), functional reach and Short Performance Physical Battery (SPPB). RESULTS: Thoracic kyphosis improved at 4-months and 12-months in participants with moderate hyperkyphosis (-2.4 ° and -3.0 °) and severe hyperkyphosis (-5.7 ° and -8.0 °). Functional reach scores were lower in the severe hyperkyphosis group compared to normal and hypokyphosis groups by at least 2.3 cm. 6MWT scores were worse in the severe hyperkyphosis group compared to the normal kyphosis group by 39.6 m. SPPB scores were worse in severe hyperkyphosis group compared to the normal kyphosis group by 0.72 points, but all participants, regardless of kyphosis severity, improved SPPB at 4 months by 0.42 points and at 12 months by 0.25 points. CONCLUSIONS: Results suggest that presenting with hyperkyphosis and osteoporotic vertebral fracture does not prevent improvement in thoracic curvature and physical performance after physiotherapy compared with baseline values. While higher kyphosis correlated with poorer physical function scores, baseline kyphosis severity could not predict change in physical function measures. REGISTRY: ISRCTN 49117867.

Minimal clinically important difference of the Four Square Step Test in people with degenerative spinal conditions.

OBJECTIVE: To identify the minimal clinically important difference (MCID) in the Four Square Step Test (FSST) for patients with degenerative spinal conditions before and after a six-week group-based physiotherapy programme. DESIGN: Secondary analysis of a longitudinal cohort study. SETTING: Physiotherapy department within a specialised orthopaedic hospital in the UK. PARTICIPANTS: Men and women with degenerative spinal conditions. INTERVENTIONS: All participants had a routine care package of up to six group-based physiotherapy led exercise and education sessions. MAIN OUTCOME MEASURES: An anchor-based approach using a self-report outcome measure (Activities-specific Balance Confidence [ABC] Scale) was utilised as a comparator to determine the MCID of the FSST. The MCID for the FSST was calculated as the difference in mean change scores from those who improved on the ABC Scale against those who did not improve (based on the standard error of measurement of the ABC Scale). RESULTS: Twenty-eight participants with degenerative spinal conditions (19 female) had a mean age of 73 years (SD 7.7). The mean ABC Scale scores for the whole sample were 61% (SD 19.1) at baseline and 66% (SD 18.3) post-physiotherapy. The mean FSST scores for the whole sample were 19.1seconds (SD 9.8) at baseline and 13.9seconds (SD 6.3) post-physiotherapy. The MCID for the FSST was 3.6seconds. CONCLUSIONS: The MCID for improvement in balance was 3.6seconds, indicating people with degenerative spinal conditions are likely to perceive an improvement of ≥3.6seconds in their FSST score as an important change in their balance performance and confidence.

A Healing Journey with Chronic Pain: A Meta-Ethnography Synthesizing 195 Qualitative Studies.

OBJECTIVE: There is a large body of research exploring what it means for a person to live with chronic pain. However, existing research does not help us understand what it means to recover. We aimed to identify qualitative research that explored the experience of living with chronic pain published since 2012 and to understand the process of recovery. DESIGN: A synthesis of qualitative research using meta-ethnography. METHODS: We used the seven stages of meta-ethnography. We systematically searched for qualitative research, published since 2012, that explored adults' experiences of living with, and being treated for, chronic pain. We used constant comparison to distill the essence of ideas into themes and developed a conceptual model. RESULTS: We screened 1,328 titles and included 195 studies. Our conceptual model indicates that validation and reconnection can empower a person with chronic pain to embark on a journey of healing. To embark on this journey requires commitment, energy, and support. CONCLUSIONS: The innovation of our study is to conceptualize healing as an ongoing and iterating journey rather than a destination. Health interventions for chronic pain would usefully focus on validating pain through meaningful and acceptable explanations; validating patients by listening to and valuing their stories; encouraging patients to connect with a meaningful sense of self, to be kind to themselves, and to explore new possibilities for the future; and facilitating safe reconnection with the social world. This could make a real difference to people living with chronic pain who are on their own healing journeys.

The reliability and reproducibility of sagittal spinal curvature measurement using the Microsoft Kinect V2.

BACKGROUND: Abnormal sagittal spinal curvature is associated with pain, decreased mobility, respiratory problems and increased mortality. Time-of-flight technology of the Microsoft Kinect sensor can reconstruct a three-dimensional image of the back quickly and inexpensively. OBJECTIVE: To estimate the extent of the reproducibility of sagittal spine curvature measurement using the Microsoft Kinect sensor. METHODS: Simultaneous measurement of thoracic and lumbar spine using the Microsoft Kinect sensor in 37 participants. Two investigators gave standardised instructions and each captured 3 images. Thoracic kyphosis and lumbar lordosis angle indexes were calculated using maximum height divided by the length. RESULTS: Adult participants (mean age in years (SD) = 51.7 (20.6); 57% female; BMI in kg/m2 (SD) = 24.9 (3.3)) kyphosis and lordosis indexes showed high intra-rater and inter-rater ICC values (0.960-0.973). The means of the first images from both raters had significantly larger kyphosis indexes compared to the second and third images, yet no difference between means in lordosis data. CONCLUSIONS: The results indicate that the Microsoft Kinect sensor has a reproducible method with high intra-rater and inter-rater reliability. The difference between the means over repeated measures suggest the second image capture is more consistent. It is a reproducible and quick method in clinical and research settings.

Knee Arthroplasty Patients Predicted Versus Actual Recovery: What Are Their Expectations About Time of Recovery After Surgery and How Long Before They Can Do the Tasks They Want to Do?

OBJECTIVES: (1) To determine evidence-based guidance for the length of time to return to specific valued functional and leisure activities after knee arthroplasty (KA). (2) To determine what patients feel are the most important functional or leisure activities to recover after KA. (3) To collect information about patients' expectations and compare them to the actual time it takes to return. DESIGN: Prospective longitudinal cohort observational survey. SETTING: Specialist orthopedic hospital. PARTICIPANTS: Patients (N=99) with osteoarthritis or rheumatoid arthritis (mean=69.9y [range 44-88]) listed for total knee arthroplasty (TKA) or unicompartmental knee arthroplasty. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Valued activities list (VAL) used to select activities patients expect to return to and report the actual time taken to return. RESULTS: Participants in unicompartmental knee arthroplasty group returned to the 6 most popular valued activities (walking >1km, stair climbing, housework, driving, gardening, and kneeling) 8%-33% more quickly than TKA group, and they were satisfied with performing these activities sooner on average (4%-18%) than the TKA group. The percentage of participants satisfied at 12 months postsurgery ranged from 96% returning to housework to 36% returning to kneeling. The Wilcoxon signed-rank test was used to compare the expected time and the actual time to return: Housework (Z=-5.631, P<.05, effect size=0.64) and swimming (Z=-3.209, P<.05, effect size=0.59) were quicker than expected, and walking >1 km (Z=-2.324, P<.05, effect size=0.27) was slower than expected. CONCLUSIONS: A more tailored and personalized approach with consideration of prior level of activity and comorbidities must be taken into account and adequately discussed to help bridge the gap between the expected and actual recovery time.

What interventions are used to improve exercise adherence in older people and what behavioural techniques are they based on? A systematic review.

OBJECTIVES: To conduct a systematic review of interventions used to improve exercise adherence in older people, to assess the effectiveness of these interventions and to evaluate the behavioural change techniques underpinning them using the Behaviour Change Technique Taxonomy (BCTT). DESIGN: Systematic review. METHODS: A search was conducted on AMED, BNI, CINAHL, EMBASE, MEDLINE and PsychINFO databases. Randomised controlled trials that used an intervention to aid exercise adherence and an exercise adherence outcome for older people were included. Data were extracted with the use of a preprepared standardised form. Risk of bias was assessed with the Cochrane Collaboration's tool for assessing risk of bias. Interventions were classified according to the BCTT. RESULTS: Eleven studies were included in the review. Risk of bias was moderate to high. Interventions were classified into the following categories: comparison of behaviour, feedback and monitoring, social support, natural consequences, identity and goals and planning. Four studies reported a positive adherence outcome following their intervention. Three of these interventions were categorised in the feedback and monitoring category. Four studies used behavioural approaches within their study. These were social learning theory, socioemotional selectivity theory, cognitive behavioural therapy and self-efficacy. Seven studies did not report a behavioural approach. CONCLUSIONS: Interventions in the feedback and monitoring category showed positive outcomes, although there is insufficient evidence to recommend their use currently. There is need for better reporting, use and the development of theoretically derived interventions in the field of exercise adherence for older people. Robust measures of adherence, in order to adequately test these interventions would also be of use. PROSPERO REGISTRATION NUMBER: CRD42015020884.

A mega-ethnography of eleven qualitative evidence syntheses exploring the experience of living with chronic non-malignant pain.

BACKGROUND: Each year over five million people develop chronic non-malignant pain and can experience healthcare as an adversarial struggle. The aims of this study were: (1) to bring together qualitative evidence syntheses that explore patients' experience of living with chronic non-malignant pain and develop conceptual understanding of what it is like to live with chronic non-malignant pain for improved healthcare; (2) to undertake the first mega-ethnography of qualitative evidence syntheses using the methods of meta-ethnography. METHODS: We used the seven stages of meta-ethnography refined for large studies. The innovation of mega-ethnography is to use conceptual findings from qualitative evidence syntheses as primary data. We searched 7 bibliographic databases from inception until February 2016 to identify qualitative evidence syntheses that explored patients' experience of living with chronic non-malignant pain. RESULTS: We identified 82 potential studies from 556 titles, screened 34 full text articles and included 11 qualitative evidence syntheses synthesising a total of 187 qualitative studies reporting more than 5000 international participants living with chronic pain. We abstracted concepts into 7 conceptual categories: (1) my life is impoverished and confined; (2) struggling against my body to be me; (3) the quest for the diagnostic 'holy grail'; (4) lost personal credibility; (5) trying to keep up appearances; (6) need to be treated with dignity; and (7) deciding to end the quest for the grail is not easy. Each conceptual category was supported by at least 7 of the 11 qualitative evidence syntheses. CONCLUSIONS: This is the first mega-ethnography, or synthesis of qualitative evidence syntheses using the methods of meta-ethnography. Findings help us to understand that the decision to end the quest for a diagnosis can leave patients feeling vulnerable and this may contribute to the adversarial nature of the clinical encounter. This knowledge demonstrates that treating a patient with a sense that they are worthy of care and hearing their story is not an adjunct to, but integral to health care.