Postural abnormalities in phenotypes of chronic obstructive pulmonary disease

Abstract

Background: Few studies have demonstrated postural abnormalities in patients with chronic obstructive pulmonary disease - when compared with healthy individuals. However, none of these studies have compared postural abnormalities in different phenotypes of chronic obstructive pulmonary disease.

Objective: To compare the thoracic posture between two phenotypes of chronic obstructive pulmonary disease (emphysema and chronic bronchitis) with healthy individuals.

Methods: Forty individuals with chronic obstructive pulmonary disease (20 with chronic bronchitis, 67±3.5 years, 20 with emphysema, 67.7±4 years) and 20 age-matched healthy individuals (67.3±3.9 years) underwent postural assessment which was performed using photogrammetric measurements of head protraction, shoulder protraction, thoracic kyphosis angle, coronal shoulder angle, and scapular elevation.

Results: Significant differences were found amongst the groups in protraction of head (emphysema vs. chronic bronchitis, mean difference=7.63°, 95% confidence interval [CI]=2.10, 13.15°; emphysema vs. healthy, 7.91°, 95% CI=2.38, 13.43°), protraction of shoulder (emphysema vs. healthy, 13.69°, 95% CI=6.96, 20.43°; chronic bronchitis vs. healthy, 8.11°, 95% CI=1.38, 14.85°), thoracic kyphosis (emphysema vs. healthy, -11.59°, 95% CI=-17.26, -5.92°; chronic bronchitis vs. healthy, -6.75°, 95% CI=-12.41, -1.08°), coronal shoulder angle (emphysema vs. chronic bronchitis, 1.01°, 95% CI=.22, 1.80°; emphysema vs. healthy, 1.59°, 95% CI=.80, 2.38°) and scapular elevation (emphysema vs. chronic bronchitis, =.74cm, 95% CI=.34, 1.15cm; emphysema vs. healthy, .99cm, 95% CI=.59, 1.40cm).

Conclusion: People with emphysema show greater degree of postural malalignments in terms of head and shoulder protraction, thoracic kyphosis, symmetry of shoulders and scapular elevation than patients with chronic bronchitis and age-matched healthy individuals. These observations emphasize the importance of postural assessment in individuals with chronic obstructive pulmonary disease, particularly if they are emphysematous.

Keywords: Chronic bronchitis; Emphysema; Kyphosis; Postural angle; Posture; Protraction.

Figure 1

Pictorial representation of postural variables. (A) Protraction of head angle (between tragus, C7 and horizontal), (B) protraction of shoulder angle (between lateral shoulder, C7 and horizontal), (C) thoracic kyphosis angle (between T12 and C7), (D) coronal shoulder angle (between coracoids and horizontal), and (E) scapular elevation (between virtual C7 and centroid of scapula).