Respiratory Function and Respiratory Muscle Strength in Adolescent Idiopathic Scoliosis
Condition: Adolescent Idiopathic Scoliosis
MeSH terms: Scoliosis
Study type: Observational [Patient Registry]

Summary: 
      In this study, which aims to evaluate the respiratory functions and respiratory muscle
      strength of individuals with Adolescent Idiopathic Scoliosis (AIS), it is planned to
      investigate the relationship between the respiratory parameters obtained and the severity,
      type, location of the curvature, rotation angle and wearing brace.

      The population of the study consists of individuals with AIS, and the sample consists of
      individuals with AIS followed in the Goztepe Prof. Dr. Suleyman Yalcin City Hospital,
      Orthopedics and Traumatology Clinic. For this purpose, it was planned to include at least 60
      individuals with AIS, aged 10 years and older, with at least 20 degrees of scoliotic
      curvature, who applied to the clinic for the first time or came for control.

      Pulmonary Function Tests (PFT) will be applied to evaluate the respiratory functions of the
      participants involved, and intraoral pressure measurement (MIP, MEP) will be applied to
      evaluate the inspiratory and expiratory muscle strengths; The severity of the scoliotic
      curvature will be measured with the Cobb method on the same day's radiograph, and the axial
      rotation angle will be measured with the Scoliometer.

      IBM Statistical Package for Social Sciences Version 24 statistical program will be used in
      the analysis of the data. Continuous variables will be given as mean ± standard deviation,
      qualitative variables as numbers and percentages.

      Pearson Correlation analysis will be used for the relationship between the variables,
      Independent Samples t-test will be used for the comparison of independent groups, and
      statistical significance will be taken as p≤0.05 in all measurements.

      It is thought that this planned study will contribute to studies evaluating the respiratory
      functions and respiratory muscle strength of individuals with AIS, which have been designed
      in different types and reported different results in the literature.

      Evidence-based data obtained by determining the clinical parameters associated with these
      values are expected to guide clinicians in terms of being holistic in the treatment of
      individuals with scoliosis, and in which situations and for what purpose pulmonary
      rehabilitation approaches should be included.
    

Detailed description: 
      Scoliosis is a complex three-dimensional deformity characterized by a lateral deviation of
      the spine of at least 10 degrees in the coronal plane. Scoliosis, which develops due to many
      reasons, is called "Adolescent Idiopathic Scoliosis (AIS)" if it occurs in the period from
      the onset of puberty to the closure of the growth plates.

      The main treatment options for scoliosis are; Known as observation, orthosis and surgical
      intervention, the choice of the most appropriate treatment depends on the patient's age,
      menarche status, location and size of the curvature, and risk of progression.

      Scoliosis can cause a significant increase in respiratory workload by directly decreasing
      chest wall compliance and indirectly reducing lung compliance. Abnormal ventilation patterns,
      especially restrictive ventilatory disorders, are seen in individuals with AIS, especially in
      curves greater than 45°; Sagittal diameter of the thorax, total lung area and especially
      vertebral rotation at T8-T9 levels can affect respiratory functions. In a study, it was shown
      that patients with mild or moderate idiopathic scoliosis had significantly lower Forced Vital
      Capacity (FVC) values compared to healthy controls. On the other hand, in a recent study in
      which 30 individuals with scoliosis were included, FVC values were found to be low in only
      two cases, which was thought to be due to the fact that the curve intensities of the
      participants were mild (Cobb angle< 20ᴼ). In the literature, studies examining the
      relationship between location, type, angle of rotation, presence of brace and duration of
      use, apart from the severity of the curvature, and pulmonary functions in individuals with
      AIS are insufficient. Low FEV1 and FVC values were found in 19% of AIS patients who had
      pulmonary function test preoperatively, and individuals with high grade (Cobb angle > 70ᴼ)
      and wide main thoracic type curves were reported to be more affected. Although no significant
      results were obtained in the degree of axial rotation in the same study, it was observed that
      the rotation angles of the cases with low PFT parameters were higher. A different study
      reported that the size of the thoracic curve and the number of involved vertebrae were
      negatively correlated with pulmonary parameters in individuals with AIS, and that spirometric
      examination is necessary, especially in surgical planning. Although studies have shown that
      respiratory muscle strength of individuals with AIS is decreased compared to healthy
      controls, even with mild curvatures, the cause of muscle dysfunction is not known exactly and
      it is thought that several factors may affect muscle function (nutritional status, physical
      activity, systemic inflammation, etc.). In scoliosis, especially the distortion of the
      thorax, the placement of the diaphragm and intercostal muscles and affecting the force
      production can also reduce respiratory muscle strength. In a study, a weak correlation was
      found between the angular value of scoliosis and respiratory muscle strength in individuals
      with AIS, and it was reported that respiratory muscle strength may be associated with
      physical deconditioning. In individuals with a high progression rate and an indication for
      scoliosis surgery, decreased respiratory muscle strength before surgery may cause a serious
      increase in respiratory workload, causing the patient to be unable to extubat, and
      post-operative respiratory failure due to respiratory muscle weakness. Therefore, respiratory
      muscle strength and function levels are important in curves with a high progression rate and
      surgery is planned, and it is important to use methods that prevent and reduce respiratory
      muscle dysfunction.

      In the literature, studies evaluating respiratory muscle strength and related parameters of
      individuals with AIS are very limited. In our study, it was aimed to measure the respiratory
      functions and respiratory muscle strength of individuals with AIS objectively and to
      investigate the relationship of these values with the severity of curvature, type, location,
      rotation angle and corset use. It is expected that the evidence-based data obtained will
      guide the treatment of individuals with scoliosis to be holistic and in which situations and
      for what purpose pulmonary rehabilitation approaches should be included.
    

Observational model: Cohort
Time perspective: Cross-Sectional
Sampling method: Probability Sample
Study population: 
        Cases with Adolescent Idiopathic Scoliosis followed in a Prof. Dr. Suleyman Yalcin City
        Hospital (Secondary health institution)
      
Keywords: Adolescent Idiopathic Scoliosis; pulmonary function; respiratory muscle strength