Hyperkyphotic posture and poor physical functional ability in older community-dwelling men and women: the Rancho Bernardo study

Abstract

Background: Physical functional decline is often the determining factor that leads to loss of independence in older persons. Identifying risk factors for physical disability may lead to interventions that may prevent or delay the onset of functional decline. Our study objective was to determine the association between hyperkyphotic posture and physical functional limitations.

Methods: Participants were 1578 older men and women from the Rancho Bernardo Study who had kyphotic posture measured as the distance from the occiput to table (units = 1.7-cm blocks, placed under the participant's head when lying supine on a radiology table). Self-reported difficulty in bending, walking, and climbing was assessed by standard questionnaires. Physical performance was assessed by measuring grip strength and ability to rise from a chair without the use of the arms.

Results: Men were more likely to be hyperkyphotic than were women (p <.0001). In multiply adjusted comparisons, there was a graded stepwise increase in difficulty in bending, walking and climbing, measured grip strength, and ability to rise from a chair. For example, the odds ratio (OR) of having to use the arms to stand up from a chair increased from 1.6 (95% confidence interval [CI]: 0.9-3.0) for individuals defined as hyperkyphotic by 1 block to 2.9 (95% CI: 1.7-5.1) for individuals defined as hyperkyphotic by 2 blocks to 3.7 (95% CI: 2.1-6.3) for individuals defined as hyperkyphotic by > or = 3 blocks compared to those who were not hyperkyphotic (p for trend < .0001).

Conclusions: Older persons with hyperkyphotic posture are more likely to have physical functional difficulties.

Figure 1

Measure of hyperkyphotic posture. A, Neutral head and neck position; B, hyperextended neck position; C, head on blocks restores neutral head and neck position.

Figure 2

Age and sex adjusted analyses of kyphotic posture and odds of having poor physical functional ability. Reported as odds ratios with 95% confidence intervals. All p for trends < .0001 except for grip strength which had a p for trend = .048.