Walking and Balance Related to Sagittal Spinal Posture Alignment

Study Overview
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Brief Summary
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This study aims to improve understanding of the relationship between spinal alignment and walking and balance in people who have degenerative spinal conditions.

Detailed Description
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This prospective cohort study will include people who are attending physiotherapy to address a degenerative spinal condition and measure them longitudinally. The investigators will measure spinal alignment, walking capacity and pattern, dynamic balance, and back muscle strength along with self-reported measures that reflect the person's functional self-efficacy, quality of life, and general health. Physical and self-reported outcome measures will be assessed at baseline before the physiotherapy-led exercise class commences, after completion at 6 weeks, and 6 months post baseline.

Official Title
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WiSPA: Walking and Balance Related to Sagittal Spinal Posture and Alignment

Conditions
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Hyperkyphosis, Walking, Difficulty, Balance; Distorted, Spinal Disease, Osteoporosis, Spine Degeneration

Intervention / Treatment
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* Other: Therapeutic exercise class


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Participant is diagnosed with a degenerative spinal condition. Participant is willing and able to give informed consent for participation in the study. Men and women aged 18 years or older. Participant is able to understand and participate safely in a physiotherapy measurement assessment. Participant is enrolled in physiotherapy. Exclusion Criteria: Participant is unable to stand independently. Participant has a neurological condition which alters motor function and/or postural control.
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Degenerative musculoskeletal spinal conditions<br>Participants are included who are enrolled in a 6-week physiotherapy exercise class aimed at improving function in people with degenerative spinal conditions. | Other: Therapeutic exercise class<br>* Physiotherapy exercise class includes education, stretching, strengthening, posture and balance interventions.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in sagittal spinal alignment | Alignment of the spine in the sagittal plane measured by a surface topography method | 6 weeks post-baseline | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Sagittal spinal alignment | Alignment of the spine in the sagittal plane measured by a surface topography method | 6 months | 
| 2 minute walk test | Distance walked in 2 minutes to measure exercise capacity | 6 weeks and 6 months | 
| Gait analysis | Spatiotemoral gait parameters measured using inertial measurement units | 6 weeks and 6 months | 
| Tragus to wall distance | Forward posture measurement using the distance from the ear to the wall | 6 weeks and 6 months | 
| Four Square Step Test | Dynamic balance test involving multidirectional stepping over obstacles | 6 weeks and 6 months | 
| Timed loaded standing test | Measurement of back extensor muscle strength and endurance | 6 weeks and 6 months | 
| 36-item Short Form Health Survey (SF-36) | Health survey measuring aspects of quality of life. The questionnaire contains 36 questions which form 8 subscales: physical functioning, role limitations due to physical health, role limitations due to emotional problems, energy/fatigue, emotional well-being, social functioning, pain, and general health. Each question is directly transformed into a 0-100 scale with the lower the score the more disability. | 6 weeks and 6 months | 
| Visual analogue pain scale | Measurement of pain in a participant's back. The scale is along a horizontal 10 cm line with markings from 0 to 10, 0 indicating no pain and 10 indicating the worst pain imaginable. | 6 weeks and 6 months | 
| Activities-specific Balance Confidence Scale | Questionnaire measuring balance confidence in various situations. It contains 16 questions in which participants rate their confidence in performing the activities on a scale from 0-100, 0 representing no confidence and 100 representing complete confidence. The total score is calculated to be on a similar 0 to 100 scale. | 6 weeks and 6 months | 
| Modified gait efficacy scale | Questionnaire measuring walking confidence and self-efficacy. Each of the 10 items is scored on a 10-point Likert scale with 1 representing no confidence and 10 representing complete confidence. The total score ranges from 10-100. | 6 weeks and 6 months | 
| Sagittal spinal alignment | Reliability re-test of alignment of the spine in the sagittal plane measured by a surface topography method | Within 2 weeks of baseline |