Research Letter
Preoperative pulmonary function and respiratory muscle strength in Portuguese adolescents with idiopathic scoliosis
a Department of Physiotherapy and CEMAH, School of Allied Health Sciences of Porto (ESTSP), Polytechnic Institute of Porto, Porto, Portugal
b Department of Orthophysiatry, Centro Hospitalar do Porto, Porto, Portugal
c School of Health Sciences, University of Aveiro and CINTESIS.UA, Aveiro, Portugal
d Director of the Department of Orthophysiatry, Centro Hospitalar do Porto and Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), University of Porto, Porto, Portugal
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Franco, P. Sousa, M. Gomes, A. Oliveira, A.R. Gaio, R. Duarte" "autores" => array:6 [ 0 => array:2 [ "nombre" => "I." "apellidos" => "Franco" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Sousa" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Gomes" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Oliveira" ] 4 => array:2 [ "nombre" => "A.R." "apellidos" => "Gaio" ] 5 => array:2 [ "nombre" => "R." 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"apellidos" => "Flores" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "Cavaleiro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:4 [ "nombre" => "A.A." "apellidos" => "Lopes" "email" => array:1 [ 0 => "adl@estsp.ipp.pt" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 3 => array:3 [ "nombre" => "F." "apellidos" => "Ribeiro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "A." "apellidos" => "Oliveira" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Department of Physiotherapy and CEMAH, School of Allied Health Sciences of Porto (ESTSP), Polytechnic Institute of Porto, Porto, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Orthophysiatry, Centro Hospitalar do Porto, Porto, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "School of Health Sciences, University of Aveiro and CINTESIS.UA, Aveiro, Portugal" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Director of the Department of Orthophysiatry, Centro Hospitalar do Porto and Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), University of Porto, Porto, Portugal" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Idiopathic scoliosis is a 3-dimensional deformity of the spine, with direct effects on the thoracic cage, characterized by the lateral displacement (greater than 10°) and rotation of vertebral bodies during periods of rapid somatic growth.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> Adolescent idiopathic scoliosis (AIS) is found between the age of 10 and skeletal maturity<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> and its prevalence is estimated at 2–4% in children between 10 and 16 years of age.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2,3</span></a> This condition encompasses several complications including back pain, poor body image, and impaired pulmonary function.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> In fact, previous studies have shown a decreased pulmonary function in adolescents with idiopathic scoliosis,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> and an inverse correlation between scoliosis Cobb angles and pulmonary function.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> Adolescents with severe scoliosis, with Cobb angles above 45–50°, are routinely managed with spinal fusion surgery.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> In addition to the mechanical restriction to ventilation, changes in spine and thoracic cage position may alter the length of respiratory muscles influencing the ability to generate tension. Therefore, the aim of this study was to evaluate pulmonary function and respiratory muscle strength in subjects with AIS.</p><p id="par0010" class="elsevierStylePara elsevierViewall">From November 2012 to May 2013, 12 females with AIS (15.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.6 years of age) and 12 age-matched controls (15.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.4 years of age) were enrolled in this study. The AIS group was recruited in the Paediatrics Department of Centro Hospitalar Porto-Hospital Santo António, Portugal, whereas the control group was recruited in the Porto metropolitan area. Eligible participants were those idiopathic scoliosis preoperative patients aged 10 or over, with thoracic Cobb angles of ≥40°. Exclusion criteria for this study included bronchial asthma and other pulmonary, cardiovascular or skeletal muscle problems, and previous spinal surgery. The study procedures were in accordance with the ethical standards on human experimentation. Written informed consent was obtained from parents/guardians. The Ethics Committee of the Centro Hospitalar Porto-Hospital Santo António approved the study. Lung function and respiratory muscle strength were measured before surgery. Forced expiratory volume in one second (FEV<span class="elsevierStyleInf">1</span>), forced vital capacity (FVC), peak expiratory flow (PEF) and the fraction of FVC expired in one second (FEV<span class="elsevierStyleInf">1</span>, FVC%) were assessed using a computerized spirometer (Spirolab III, MIR Medical International Research, Roma, Italy), according to standard methods.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) muscle strength was measured with a digital mouth pressure meter (Micro Respiratory Muscle Analyze, CareFusion, Basingstoke, UK).<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> Data were analyzed using SPSS 17.0. The normality of data distribution was tested with the Shapiro–Wilk test; the data were not normally distributed. Groups were compared by Mann–Whitney <span class="elsevierStyleItalic">U</span> tests. Associations between pulmonary function and respiratory muscle strength were tested with Spearman's rho test. The level of significance was set as <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>0.05.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In terms of the results, the Cobb angle ranged from 42° to 62°. The AIS group presented significantly lower FEV<span class="elsevierStyleInf">1</span>, FVC and PEF than the age-matched control group (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). With respect to the respiratory muscle strength, both MIP and MEP were significantly higher in the control group; indeed, the median values of MIP and MEP in the control group were two times higher than those in the control group (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). In the AIS group, no correlation was found between pulmonary function variables and MIP and MEP.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Our results are similar to others which have shown a restrictive lung defect and impaired respiratory muscle strength<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> in subjects with AIS. It is worth noting that the decrease in MIP is a major finding in the preoperative evaluation of the patient, since MIP and MEP of less than 30<span class="elsevierStyleHsp" style=""></span>cm H<span class="elsevierStyleInf">2</span>O augment the risk of postoperative respiratory failure.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> The inability to generate normal MIP and MEP could be a result of the chest wall deformity, which causes the respiratory muscles to work at a mechanical disadvantage.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> This study has some limitations, one of which is its small sample size. In conclusion, subjects with AIS referred to surgery showed worse pulmonary function and respiratory muscle strength than age-matched controls. From a practical standpoint, if our MIP and MEP results are corroborated by future studies, subjects with AIS could benefit from preoperative respiratory muscle strength training programmes aimed at decreasing the risk of postoperative complications.</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">FEV<span class="elsevierStyleInf">1</span>, forced expiratory volume in one second; FVC, forced vital capacity; FEV<span class="elsevierStyleInf">1</span>, FVC%, the fraction of FVC expired in one second; PEF, peak expiratory flow; MEP, maximal expiratory pressure; MIP, maximal inspiratory pressure.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AIS group \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Control group \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FVC (L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.69 (1.18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.54 (0.73) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.005 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FEV<span class="elsevierStyleInf">1</span> (L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.30 (1.00) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.42 (0.68) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PEF (L/min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">307.2 (147.60) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">387.6 (202.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.039 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FEV<span class="elsevierStyleInf">1</span>, FVC% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">91.50 (13.00) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">95.70 (9.00) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.178 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MIP (cm<span class="elsevierStyleHsp" style=""></span>H<span class="elsevierStyleInf">2</span>O) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23.50 (11.00) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.50 (21.00) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MEP (cm<span class="elsevierStyleHsp" style=""></span>H<span class="elsevierStyleInf">2</span>O) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29.50 (23.00) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54.00 (17.00) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.008 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab985486.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Spirometric and respiratory muscle strength values [median (interquartile range)].</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary function in children with idiopathic scoliosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 9 | 17 |
| 2024 October | 27 | 36 | 63 |
| 2024 September | 33 | 26 | 59 |
| 2024 August | 39 | 31 | 70 |
| 2024 July | 37 | 30 | 67 |
| 2024 June | 52 | 49 | 101 |
| 2024 May | 51 | 28 | 79 |
| 2024 April | 39 | 47 | 86 |
| 2024 March | 34 | 24 | 58 |
| 2024 February | 29 | 29 | 58 |
| 2024 January | 25 | 24 | 49 |
| 2023 December | 22 | 26 | 48 |
| 2023 November | 36 | 46 | 82 |
| 2023 October | 33 | 51 | 84 |
| 2023 September | 38 | 38 | 76 |
| 2023 August | 28 | 25 | 53 |
| 2023 July | 25 | 24 | 49 |
| 2023 June | 19 | 21 | 40 |
| 2023 May | 38 | 32 | 70 |
| 2023 April | 24 | 12 | 36 |
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