Abstract
BackgroundHyperkyphosis is common among older adults and is associated with multiple adverse health outcomes. Kyphosis-specific exercise and posture training programs improve hyperkyphosis, but in-person programs are expensive to implement and maintain over long periods. It is unclear if a technology-based posture training program disseminated through a mobile phone is a feasible or acceptable alternative to in-person training among older adults with hyperkyphosis.ObjectiveThe primary purpose was to assess the feasibility of subject recruitment, short-term retention and adherence, and acceptability of a technology-based exercise and posture training program disseminated as video clip links and text messaging prompts via a mobile phone. The secondary purpose was to explore the potential efficacy of this program for kyphosis, physical function, and health-related quality of life in older adults with hyperkyphosis.MethodsIn this 6-week pre-post design pilot trial, we recruited community-dwelling adults aged ≥65 years with hyperkyphosis ≥40° (±5°) and access to a mobile phone. The intervention had two parts: (1) exercise and posture training via video clips sent to participants daily via text messaging, including 6 weekly video clip links to be viewed on the participant’s mobile phone, and (2) text messaging prompts to practice good posture. We analyzed the subject recruitment, adherence, retention, and acceptability of the intervention. Outcomes included change in kyphometer-measured kyphosis, occiput-to-wall (OTW) distance, Short Physical Performance Battery score, Scoliosis Research Society (SRS-30) score, Center for Epidemiological Studies Depression score, and Physical Activity Scale for the Elderly (PASE) score.ResultsA total of 64 potential participants were recruited, 17 were enrolled, and 12 completed postintervention testing at 6 weeks. The average age was 71.6 (SD 4.9) years, and 50% were women. The median adherence to daily video viewing was 100% (range, 14%-100%) and to practicing good posture at least three times per day was 71% (range, 0%-100%). Qualitative evaluation of intervention acceptability revealed that the mobile phone screen was too small for participants to view the videos well and daily prompts to practice posture were too frequent. Kyphosis, OTW distance, and physical activity significantly improved after the 6-week intervention. Kyphosis decreased by 8° (95% CI –12 to –5; P<.001), OTW decreased by 1.9 cm (95% CI –3.3 to –0.7; P=.007), and physical activity measured by PASE increased by 29 points (95% CI 3 to 54; P=.03). The health-related quality of life SRS-30 score increased by 0.11 point (SD 0.19), but this increase was not statistically significant (P=.09).ConclusionsTechnology-based exercise and posture training using video clip viewing and text messaging reminders is feasible and acceptable for a small cohort of older adults with hyperkyphosis. Technology-based exercise and posture training warrants further study as a potential self-management program for age-related hyperkyphosis, which may be more easily disseminated than in-person training.
Highlights
Interventions that reduce or slow the progression of age-related hyperkyphosis could have a positive impact on the health status among aging populations
Kyphosis decreased by 8°, OTW decreased by 1.9 cm, and physical activity measured by Physical Activity Scale for the Elderly (PASE) increased by 29 points
Kyphosis progresses with age [3,2,5,6], and age-related hyperkyphosis is associated with reduced health-related quality of life (HRQoL), impaired physical function, falls, and elevated fracture risk, when kyphosis progresses to ≥53° [7,8,9,10,11,12,13,4]
Summary
Interventions that reduce or slow the progression of age-related hyperkyphosis could have a positive impact on the health status among aging populations. Recent randomized controlled trials demonstrated improvement in kyphosis and HRQoL after in-person physical therapist-guided kyphosis-specific spine-strengthening exercise and postural training programs over 3-6 months conducted in small groups of older adults with hyperkyphosis [14,15] These labor-intensive programs are expensive to implement and maintain over longer periods of time in clinical and community settings. One way to reduce the costs of such programs is to utilize digital technologies such as mobile phones, mobile apps, and text messages [16], which are becoming popular communication channels for older adults [17] It is not known whether a technology-based kyphosis exercise and posture training program could provide an alternative self-management intervention that is acceptable and more disseminated than in-person training. It is unclear if a technology-based posture training program disseminated through a mobile phone is a feasible or acceptable alternative to in-person training among older adults with hyperkyphosis
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