Posture and mobility of the upper body quadrant and pulmonary function in COPD: an exploratory study

Morais, Nuno; Cruz, Joana; Marques, Alda

doi:10.1590/bjpt-rbf.2014.0162

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Brazilian Journal of Physical Therapy

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Original Articles • Braz. J. Phys. Ther. 20 (4) • Jul-Aug 2016 • https://doi.org/10.1590/bjpt-rbf.2014.0162 copy

Posture and mobility of the upper body quadrant and pulmonary function in COPD: an exploratory study^* * Part of this work has been presented at the European Respiratory Society International Congress, Munich (Germany), 6-10 September 2014.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Background

There is limited evidence regarding interactions between pulmonary (dys)function, posture, and mobility of the upper body quadrant in patients with chronic obstructive pulmonary disease (COPD).

Objectives

This exploratory study aimed to investigate whether postural alignment and mobility of the upper quadrant are related to changes in pulmonary function and compare such variables between patients with COPD and healthy individuals.

Method

Fifteen patients with COPD (67.93±9.71yrs) and 15 healthy controls (66.80±7.47yrs) participated. Pulmonary function (FEV₁, FVC) was assessed with spirometry. Alignment and mobility of the head, thoracic spine, and shoulder were assessed using digital photographs. Pectoralis minor muscle (PmM) length and thoracic excursion were assessed with a measuring tape. Groups were compared and linear regression analyses were used to assess potential relationships between postural and mobility variables and pulmonary function.

Results

Patients with COPD were more likely to have a forward head position at maximal protraction (28.81±7.30º vs. 35.91±8.56º, p=0.02) and overall mobility of the head (21.81±10.42º vs. 13.40±7.84º, p=0.02) and a smaller range of shoulder flexion (136.71±11.91º vs. 149.08±11.58º, p=0.01) than controls. Patients’ non-dominant PmM length and maximal head protraction were predictors of FEV₁ (r²_adjusted=0.34). These variables, together with the upper thoracic spine at maximal flexion and thoracic kyphosis at maximal extension, were predictors of FVC (r²_adjusted=0.68).

Conclusion

Our findings suggest that impaired pulmonary function is associated with muscle length and mobility adaptations. Further studies are needed to understand the underlying mechanisms and clinical value of these relationships.

Keywords:
body alignment; chronic obstructive pulmonary disease; musculoskeletal adaptations; physical therapy; respiratory function

	Patients with COPD (n=15)	Healthy controls (n=15)	p-value
Age (years)	67.93±9.71	66.80±7.47	0.72
Gender (male), n (%)	13 (86.7%)	7 (46.7%)	0.05
Height (cm)	166.00±6.18	160.87±8.58	0.07
Weight (Kg)	77.37±17.95	72.47±10.39	0.37
BMI (Kg/m²)	28.00±5.87	28.01±3.30	0.99
FEV₁
Value (L)	1.72±0.52	2.27±0.53	0.01^* * Significant at p<0.05.
% pred	66.00±17.77	100.67±14.90	<0.01^* * Significant at p<0.05.
FVC
Value (L)	2.57±0.77	2.58±0.62	0.97
% pred	75.33±17.78	91.53±14.74	0.01^* * Significant at p<0.05.
GOLD grade, n (%)
Mild COPD	2 (13.3%)	-
Moderate COPD	11 (73.4%)	-
Severe-to-very-severe COPD	2 (13.3%)	-
Respiratory medication, n(%)
Long-acting beta2-agonists	1 (6.67%)	-
Short-acting beta2-agonists	3 (20.00%)	-
Long-acting anticholinergics	4 (26.67%)	-
Inhaled corticosteroids	1 (6.67%)	-
Combination of long-acting beta2-agonist plus corticosteroids	4 (26.67%)	-

	Position/side	Patients with COPD (n=15)	Healthy controls (n=15)	Mean difference [95% CI]	p-value	Effect size d	Observed power
Alignment and mobility (°)
Head	Neutral position	45.54±9.16	43.16±4.72	2.38 [–3.07 to 7.83]	0.38	0.33	0.14
	Maximal protraction	28.81±7.30	35.91±8.56	–7.09 [–13.0 to -1.15]	0.02^* * Significant at p<0.05.	0.89	0.65
	Maximal retraction	50.62±8.62	47.17±9.83	3.46 [–3.46 to 10.37]	0.31	0.37	0.16
	Total mobility	21.81±10.42	13.40±7.84	8.42 [1.52 to 15.31]	0.02^* * Significant at p<0.05.	0.91	0.67
Upper thoracic spine	Neutral position	21.68±6.88	22.58±4.58	–0.90 [–5.27 to 3.47]	0.68	0.15	0.07
	Maximal flexion	36.49±8.62	40.42±8.17	–3.93 [–10.22 to 2.35]	0.21	0.47	0.24
	Maximal extension	13.13±7.05	17.01±7.23	–3.87 [–9.21 to 1.47]	0.15	0.54	0.30
	Total mobility	23.35±10.28	23.41±10.64	–0.06 [–7.88 to 7.77]	0.99	0.01	0.05
Lower thoracic spine	Neutral position	–10.73±6.78	–8.82±4.13	-1.91 [-6.11 to 2.29]	0.36	0.34	0.15
	Maximal flexion	–2.00±9.64	0.95±7.31	-2.95 [-9.35 to 3.46]	0.35	0.34	0.15
	Maximal extension	-14.82±7.28	–11.61±4.31	–3.22 [–7.69 to 1.26]	0.15	0.54	0.30
	Total mobility	12.83±7.86	12.55±7.47	0.27 [–5.46 to 6.01]	0.92	0.04	0.05
Thoracic kyphosis	Neutral position	33.08±8.65	31.40±6.90	1.67 [–4.18 to 7.52]	0.56	0.21	0.09
	Maximal flexion	44.01±11.50	46.50±9.47	–2.49 [–10.37 to 5.38]	0.52	0.24	0.10
	Maximal extension	28.00±9.05	28.61±9.67	–0.61 [–7.62 to 6.39]	0.86	0.07	0.05
	Total mobility	16.01±14.22	17.99±12.31	–1.98 [–11.93 to 7.96]	0.69	0.15	0.07
Shoulder joint	Maximal flexion	136.71±11.91	149.08±11.58	–12.37 [–21.16 to –3.58]	0.01^* * Significant at p<0.05.	1.05	0.79
PmM length (cm)	Dominant	16.51±1.50	15.91±1.36	0.61 [–0.47 to 1.68]	0.26	0.42	0.20
	Non-dominant	16.77±1.75	15.65±1.44	1.13 [–0.07 to 2.32]	0.06	0.70	0.46

	Patients with COPD (n=15)	Healthy controls (n=15)	Mean difference [95% CI]	p-value	Effect size d	Observed power
Upper thorax (cm)
Thoracic circumference at PI	104.32±10.62	100.94±6.15	3.38 [–3.11 to 9.87]	0.30	0.39	0.18
Thoracic circumference at PE	101.97±11.24	98.33±5.72	3.64 [–3.03 to 0.31]	0.27	0.41	0.19
Thoracic excursion	2.35±1.38	2.61±1.06	–0.26 [–1.18 to 0.66]	0.57	0.21	0.09
Lower thorax (cm)
Thoracic circumference at PI	101.46±11.17	97.94±5.25	3.52 [–3.13 to 10.16]	0.28	0.40	0.18
Thoracic circumference at PE	98.59±11.72	94.32±4.82	4.27 [–2.59 to 11.13]	0.21	0.48	0.25
Thoracic excursion	2.86±1.24	3.62±1.	–0.75 [–1.85 to 0.35]	0.17	0.52	0.28

	B [95% CI]	β	p-value
Patients with COPD (n=15)
Non-dominant PmM length	0.193 [0.065 to 0.320]	0.652	0.01
Maximal head protraction	0.038 [0.007 to 0.068]	0.534	0.01
Healthy controls (n=15)
Thoracic circumference of the lower thorax at PI	0.070 [0.041 to 0.099]	0.688	<0.01
Head posture in neutral position	0.100 [0.058 to 0.143]	0.890	<0.01
Upper thoracic spine at maximal extension	–0.041 [–0.069 to –0.014]	–0.562	0.01

	B [95% CI]	β	p-value
Patients with COPD (n=15)
Non-dominant PmM length	0.423 [0.287 to 0.560]	0.958	<0.01
Upper thoracic spine at maximal flexion	0.045 [0.022 to 0.069]	0.505	<0.01
Maximal head protraction	0.047 [0.018 to 0.076]	0.441	0.01
Thoracic kyphosis at maximal extension	0.033 [0.007 to 0.058]	0.382	0.02
Healthy controls (n=15)
Thoracic circumference of the lower thorax at PI	0.090 [0.056 to 0.123]	0.761	<0.01
Head posture in neutral position	0.101 [0.051 to 0.151]	0.770	0.01
Upper thoracic spine at maximal extension	–0.043 [–0.075 to –0.010]	–0.498	0.01

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[1] *Correspondence Nuno Morais School of Health Sciences Polytechnic Institute of Leiria Rua Engenheiro Duarte Pacheco, 19-C, Fração AC CEP 3850-040, Albergaria-a-Velha, Portugal e-mail: rpgnunomorais@gmail.com

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Posture and mobility of the upper body quadrant and pulmonary function in COPD: an exploratory study* * Part of this work has been presented at the European Respiratory Society International Congress, Munich (Germany), 6-10 September 2014.

ABSTRACT

Background

Objectives

Method

Results

Conclusion

Posture and mobility of the upper body quadrant and pulmonary function in COPD: an exploratory study^* * Part of this work has been presented at the European Respiratory Society International Congress, Munich (Germany), 6-10 September 2014.