JOURNAL PRESENTATION Mudasir Rashid Baba Reg number 201Jan

JOURNAL PRESENTATION Mudasir Rashid Baba Reg number: 201/Jan 2016 Moderator: Dr. Vineetha Pai

ARTICLE • Physical capacity of girls with mild and moderate idiopathic scoliosis: influence of the size, length and number of curvatures. Dariusz Czaprowski , Tomasz Kotwicki. Ryszard Biernat , Jerzy Urniaz , Aleksander Ronikier. • European Spine Journal, 2012; Volume 21, 1099– 1105. • Impact Factor: 5. 771

INTRODUCTION • Scoliosis is a 3 -dimensional rotational deformity. • It is characterized by side to side curvature of the spine>10 degrees and a reduced kyphosis in thoracic curves. • Idiopathic scoliosis (IS) is a multiplane spine distortion of unknown etiology

• This leads to deformation of the chest wall thereby reducing the pulmonary capacity. • As a result, Vo 2 max(which determines the organism’s capacity to transport and use oxygen) also decreases. • This causes a decrease in the physical capacity and effort.

PURPOSE • To assess the impact of 1. The curvature angle value, 2. The number of vertebrae in curvatures and 3. The number of curvatures on the physical capacity of girls aged 10– 18 with mild and moderate idiopathic scoliosis.

METHODS • Ninety-seven girls, aged 10– 18 (70 girls in the study group and 27 in the control group) were examined. • The study group was divided into two subgroups: (A) mild scoliosis: 42 girls with 10– 24° curves (mean 17. 1 ± 4. 6) and (B) moderate scoliosis: 28 girls with 25– 40° curves(mean 32. 1 ± 4. 3).

v. INCLUSION CRITERIA: • Female, aged 10– 18 years. • Having idiopathic thoracic scoliosis, Cobb angle ranging from 10° to 40° on standing frontal radiograph. • The absence of contraindications for exercise tests, child’s and parents’ consent.

• Primary outcome measure was “physical capacity” which was assessed by the PWC 170 (Physical Working Capacity) test. • Secondly, the average heart rate was monitored after each 5 min physical effort.

INTERVENTION • The PWC 170 (Physical Working Capacity) test was done on MONARK 874 E cycle ergometer. • Two 5 -min sub maximal physical effort events were carried out where the level of effort was concluded with the heart rate (HR) approaching 130 and 150 beats per minute.

• The average heart rate recorded was used to determine the strain output in accordance with PWC 170 indicator. • The indicator was calculated on the basis of Sjostrand’s formula: PWC 170 =[(P 2 - P 1)/(HR 2 HR 1)]x (170 - HR 2)+P 2 • Where P 1 and P 2 are output of subsequent physical efforts in watts (W), HR 1 and HR 2 are heart rate during a particular strain test.

• Next, VO 2 max was calculated using Karpman’s formula : VO 2 max(l/min)= 1. 7 x. PWC 170+1, 240. • where VO 2 max is maximum oxygen intake (l/min), 1. 7 and 1, 240 are constant values (unsigned) • PWC 170 is the absolute value (without sign)

STATISTICAL ANALYSIS • The results were analyzed using Statistica 8. 1. (Stat. Soft, USA). • Distribution was assessed by way of Shapiro–Wilk’s test. • The Wald–Wolfowitz, Kruskal–Wallis, and Dunn tests were used as well as Spearman’s correlation of ranks. • A value of p<0. 05 was adopted as the significance level.

RESULTS

• The values of all measured parameters were lower in the scoliosis group than in the control group. • Table 1 shows baseline comparison of all three groups with respect to age, weight, height and BMI • No differences were found between the three groups A, B, C) regarding the age, weight and BMI • However difference in height was found (A and B vs. C)

v. Impact of the angle of thoracic curvature on physical capacity. • Girls with moderate idiopathic scoliosis (25– 40°) had considerably lower values of VO 2 max and absolute output value during the PWC 170 test (l/min) than the controls. • There was no significant difference of maximum oxygen intake in relation to weight (ml/kg/min) among the groups: • (A) scoliosis 10– 24°, (B) scoliosis 25– 40° and (C) control group

• Table 3 shows that girls with scoliosis between 25 to 40° obtained a significantly lower value of relative output during the PWC 170 (W/kg) test in comparison with the control group. • When the relationship between examined parameters and curvature angle were determined, their values decreased with increase in the thoracic curvature value. ( spearman's correlation of ranks)table 4.

v. Impact of the number of scoliosis vertebrae on physical capacity • No significant difference in the maximum oxygen intake expressed in l/min and ml/kg/min and absolute value of the PWC 170 indicator (W) was found between the groups{(i. e. number of vertebrae below and equal [<9 vertebrae], or above [>9] the average number [=9] and the control group}.

• Girls with an above average scoliosis length showed a significantly lower value of PWC 170 (W/kg) indicator than girls from the control group. Table 5. • Also, for the relative output, a weak negative correlation with the number of scoliotic vertebrae was confirmed (Table 6).

v. Impact of the number of curvatures on physical capacity. • The girls with double-curve scoliosis had significantly lower value of the PWC 170 indicator expressed in relation to weight (W/kg) than the girls from the control group. (Table 7)

LIMITATION/CRITICAL ANALYSIS • No mention about ethical clearance. • Did not mention whether the girls had undergone surgery previously • No mention whether or not the girls are currently under conservative management( e. g. bracing). • Exclusion criteria was also not mentioned.

DISCUSSION • This study attempted to assess the multifactorial impact of mild and moderate idiopathic scoliosis on the physical capacity of girls aged 10– 18 years. • As the early stages of the impact of scoliosis on respiratory system are not fully understood there was a need to establish the relationship between physical capacity and idiopathic scoliosis.

• The most widely known parameter of physical capacity is the maximum oxygen intake (VO 2 max). • It indicates the maximum oxygen capacity absorbed by the organism per minute during dynamic physical effort. • Physical capacity was indirectly assessed by PWC 170 indicator and cycle ergometer.

• The higher the value of this(PWC 170) indicator, the more strenuous effort a person can make without any disturbance to the cardiovascular system functioning. • Increase of the angle of curvature entails significant decrease of the physical capacity which is confirmed by Schneerson and Madgwick in their work.

• However, The authors of this study did not confirm any significant correlation between the angle of curvature and the parameters describing the physical capacity (VO 2 max, RVO 2 max). • This might be due to the fact that the girls included in the observation had mild and moderate scoliosis.

• However, a significant decrease in the maximum oxygen intake (l/min) and the PWC 170 indicator was observed in girls with scoliosis ranking from 25°to 40° in relation to the control group. • Single-curve scoliosis is usually connected with a large trunk decompensation, which can cause decreased physical fitness in girls with idiopathic scoliosis.

• This may lead to impairment of physical capacity and decrease the ability to adjust to strain. • As the available literature lacks the evidence for relationship between the number of scoliotic vertebrae, the number of curvatures and the physical capacity, the authors of this study wanted to assess those relationships.

• This study, however, presented the relationships between the number of scoliotic vertebrae, curvatures and physical capacity in an equivocal way.

CONCLUSION 1. The maximum oxygen intake and the output during the PWC 170 test was lower in girls with moderate scoliosis (25– 40°°) than in the control group. 2. The value of maximum oxygen intake and output obtained during the PWC 170 test in girls with mild scoliosis (up to 25°) did not differ significantly from the values obtained in the control group.

3. a) The number of vertebrae involved in scoliotic deformation and the number of curvatures caused significant decrease in only the relative value of the output obtained during an exercise test. b)The number of scoliotic vertebrae and the number of curvatures did not influence the maximal oxygen intake and the absolute value of PWC 170 indicator.