Women who used an active spinal orthosis demonstrated a clinically relevant improvement in back extensor strength, and clinically relevant differences in pain and physical functioning, according to a study published inProsthetics and Orthotics International.
“Vertebral fractures are a common clinical manifestation of osteoporosis and can result in hyperkyphosis, which is associated with chronic back pain, diminished daily functioning, decreased quality of life and increased risk of falls. The degree of thoracic kyphosis in women with osteoporotic fractures may be influenced especially by changes in back extensor strength,” Gitte Valentin, PT, MSc, public health and quality improvement, Central Denmark region, told O&P Business News. “In Denmark, we do not recommend the use of a traditional rigid orthosis because they are believed to contribute to atrophy of the trunk muscles. Therefore, we were a bit skeptical when we first heard about the active orthosis, Spinomed, which was claimed to increase propioceptive feedback in the trunk muscles and thereby increase the strength in the trunk and abdominal muscles. On this basis we decided to test the effect of the active orthosis on a small population of women with osteoporotic vertebral fractures.”
Thirteen women older than 50 years receiving standard medical treatment for osteoporosis used an active spinal orthosis (Spinomed III, Medi USA) for 3 months. All women completed questionnaires about clinical characteristics, pain intensity and health-related quality of life and researchers measured back extensor strength of each participant. Outcomes included changes in isometric back extensor strength, changes in back pain and changes in physical functioning.
Study results showed an increase in back extensor strength of 50% when women wore the orthosis during the 3-month period. Researchers found a reduction in pain intensity among nine women, which was clinically relevant and borderline significant. Overall, all the participants had improved physical functioning but the difference was not statistically significant.
“The great improvement in back extensor strength was a big surprise to us,” Valentin said. “Other trials have found an increase in back extensor strength by 24% to 26% with traditional back exercises. Our results indicated that back extensor training with an active orthosis is more effective than traditional exercise alone.”
Factors influencing orthosis
According to the researchers, women’s walking and standing abilities seemed to influence the effect of the orthosis. When instructed to wear the orthosis for 2 hours to 4 hours during the day while walking or standing, women who were only able to walk or stand for a short time did not have as significant an improvement in back extensor strength compared with women who had better walking abilities. These results indicate that patients must have a certain functional level to gain the best results when using the orthosis.
Although the orthosis could be recommended for women with vertebral fractures as a supplement to traditional back strengthening exercises, the researchers said it is “essential that the orthosis is adjusted correctly by a physiotherapist or another professional and there is an individual program concerning the amount of time the orthosis has to be worn every day.”
Based on a small study population, the overall effect of the orthosis should be tested in a larger study, the researchers said. However, they found consistency between the present results and the results from two former randomized controlled trials concerning the effect of the active orthosis, increasing the validity of their results.
“In future research it could be interesting to compare the effects of the active orthosis with the effect of traditional training,” Valentin said. “The results from our trial indicate that training with an active orthosis is more effective than traditional exercises, but it has not been tested in a clinical trial. We also need to test the effects of the active orthosis in the long term and test if the use of an active orthosis can reduce the risk of vertebral fractures.” — by Casey Murphy
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Disclosure: Facilities and assessment equipment was provided by Aarhus University Hospital. Medi donated Spinomed III to the 13 women in the project. The SF-36 and the software program Health Outcomes Scoring Software 0.4 was granted as a student license by the company.