Improved sagittal spinal alignment and standing body balance by a “locomotion training” rehabilitation program in patients with “locomotive syndrome” (#59)
INTRODUCTION: “Locomotive syndrome” is a degenerative condition of reduced mobility due to the impaired musculoskeletal system, which has gained increasing attention as a Japan’s health policy target. The Japanese Orthopaedic Association (JOA) recommends “locomotion training” exercises (basically squatting and single-leg standing) to be effective in preventing “locomotive syndrome”. However, the extent to which “locomotion training” affects body function is unknown. Therefore, a cohort study was designed. Our objective was to clarify effects of a “locomotion training”-based rehabilitation program on the sagittal spinal alignment and standing body balance.
METHODS: Patients who fulfilled the JOA criteria for “locomotive syndrome” were enrolled and prospectively followed in our outpatient clinic (n = 106: age, 76.1 ± 5.9 years; male:female = 12:94). While 44 patients accepted and completed our “locomotion training”-based rehabilitation program once per week for 6 months (20-min stretching and self-exercise achievement evaluation), 41 patients denied the exercise participation but received medicinal treatment (NSAIDs, pregabalin, duloxetine, and/or tramadol). Standing whole-spine radiographs for the spine-pelvis-lower extremity axis, ODI and SF-36 questionnaires for QOL, and piezoelectric force-plate measurements for postural stability were taken at baseline and >6 months. The chi-squared test or Student’s t-test was used.
RESULTS: [Exercise-intervention analysis] While there were no obvious differences in baseline sagittal vertical axis (SVA), >6-month changes were significantly different (exercise, −5.5 ± 20.0 mm; control, +5.2 ± 22.6 mm: P = 0.02). In other radiographic parameters, >6-month changes were more remarkable in the lumbar lordosis (LL) (exercise, +1.5 ± 8.1°; control, −1.3 ± 9.1°: P = 0.14), thoracic kyphosis between T5 and T12 (exercise, −0.05 ± 5.5°; control, +1.8 ± 6.0°: P = 0.13), and T1 slope (exercise, −0.4 ± 6.3°; control, +1.6 ± 5.8°: P = 0.14). Questionnaires of ODI and SF-36 did not reach statistical significance (P = 0.08). However, in force-plate examination, the center-of-pressure area (exercise, −0.4 ± 1.8 cm2; control, +0.2 ± 1.6 cm2: P = 0.07), speed (exercise, −0.1 ± 0.4 cm/s; +0.1 ± 0.4 cm/s: P = 0.03), and distance (exercise, −5.1 ± 24.3 cm; control, +6.5 ± 23.3 cm: P = 0.03) decreased after >6-month rehabilitation. [SVA analysis] Of 40 patients with baseline SVA ≥40 mm, endpoint SVA improvement to <40 mm was observed in 12 (30.0%). In the comparison between 12 patients with and 28 without improved SVA, baseline SVA (+51.6 ± 10.2 mm; +79.5 ± 34.0 mm: P < 0.01), C2–C7 angle (+10.9 ± 6.0°; +19.6 ± 13.0°: P = 0.03), and hip-flexion angle (+8.1 ± 2.4°; +11.2 ± 4.0°: P = 0.02) were significantly different. Then, >6-month changes were relatively obvious in LL (+4.6 ± 9.0°; −0.6 ± 8.1°: P = 0.08). In force-plate examination, >6-month changes were marked in the area (−1.6 ± 5.3 cm2; +0.2 ± 1.7 cm2: P < 0.01).
DISCUSSION: This is the first study to demonstrate that “locomotion training” protects against “locomotive syndrome”-associated positive SVA shift and improves the standing spinal balance. However, rehabilitation-induced SVA improvement is limited in patients with advanced baseline SVA positive shift, C2–C7 hyperlordosis, and hip contracture.