The prevalence of postural deformities among children age 11 to 13 years in some Western Cape schools

Stroebel, Suzanne (2002-12)

Thesis (MScSportSc)--University of Stellenbosch, 2002.

Thesis

ENGLISH ABSTRACT: Postural deformities are a commonly encountered problem among children. Most of the aches and pains of adults are the result, not of injuries, but of the long-term effects of distortions in posture or alignment that have their origins in childhood or adolescence. Television, video entertainment, motorized transportation, fast food and lack of regular physical activity contribute to the poor physical condition of children. School screening for scoliosis is mandated in schools in 26 states of the United States (US) for children between 10 and 16 years of age. Previous studies conducted in the US found that 160 out of 1000 people suffer from scoliosis. This means that scoliosis is as prevalent as hypertension or diabetes mellitus (Boachie-Adjei & Lonner, 1996). Identification of postural deformities at an early stage makes early treatment possible, which may, in future, prevent serious postural abnormalities. The American Academy of Orthopedic Surgeons approved the implementation of screening programs in schools in 1974 (Lonstein, 1988). Few studies have included the entire musculoskeletal system. The purpose of this study was to determine the prevalence of postural deformities among children aged 11 to 13 years in selected primary schools in the Western Cape. The study also proposes to investigate factors that may influence the prevalence rate of postural deformities. These factors included age, gender, school district, weight, height, BMI (Body Mass Index), fat%, waist-hip ratio, and physical activity. Letters were sent to 15 primary schools within a 30km radius of Stellenbosch. This region included Stellenbosch, Strand, and Kuilsrivier. Four schools replied, giving permission to conduct the study at their schools. The sample (N=288, mean age=12.36, SD=0.92) consisted of 78 scholars from grade five; 104 scholars form grade six; and 106 scholars from grade seven. Of the total number of scholars examined (288), 154 were boys, and 134 were girls. Only children with parental consent were allowed to participate in the study. Anthropometric measures included stature, mass, skinfoids (two-site skinfoid), waist- and hip circumferences and trochanterion leg length. Level of physical activity and family history of deformities were obtained by means of a questionnaire. The New York Posture Test was used for postural evaluation (Bloomfield et aI., 1994:320; Reedeo Inc., 2001. This Posture Test was designed for the screening of 13 categories of deformities. Using a "see-through" posture grid, lateral and posterior examinations were performed. The "Adam's position" (forward bending) was used for further scoliosis evaluation. Quantitative data was analyzed, using Statistica (Statsoft, 2001) and classification tree methodology (Breiman et aI., 1993). The anthropometric results indicated that the subjects had a mean stature of 1.54m, mass of 47.48kg, BMI of 19.75, waist-hip ratio of 0.79 and fat% (Lohman, 1987) of 21.35%. The prevalence of postural deformities was as follows: Lordosis, 70%; Kyphosis, 57%; Uneven shoulders, 55%; Inclined trunk, 43%; Winged scapulae, 42%; Pronated feet, 30%; Flat feet, 30%; Flat chest, 29%; Forward head, 28%; Protruding abdomen, 28%; Uneven hips, 11%; Scoliosis, 10%; and Twisted head, 1%. Uneven hips, scoliosis and twisted head were not considered for statistical purposes, because of their low incidence compared to the other deformities. The factors that influenced the prevalence rate of deformities the most were BMI and fat%. A higher BMI and fat% resulted in a higher prevalence rate in most deformities. The prevalence rate of postural deformities in this study was considerably high. Sedentary lifestyles of children (watching television, computer games, junk food and physical inactivity) were a contributing factor in the high prevalence rate of postural deformities. It is known that overweight and sedentary behavior of children is increasing and this could pose an alarming concern to the health of a child. Also, if a significant correlation does exist between the prevalence of postural deformities and conditions such as back pain, the high prevalence rate reported in this study is a matter of concern.

AFRIKAANSE OPSOMMING: Postuurafwykings is "n algemene probleem wat dikwels onder kinders voorkom. Baie van die skete en pyne by volwassenes spruit nie uit beserings nie, maar vanuit langtermyn gevolge van swak postuur wat huloorsprong uit die kinderjare het. Televisie, videospeletjies, vervoer per motor, kitskos en gebrek aan fisieke aktiwiteit dra by tot die swak fisieke kondisie van kinders. Evalueringsprogramme in skole word in 26 state in die Verenigde State van Amerika (VSA) toegepas vir kinders tussen die ouderdomme van 10 en 16 jaar. Vorige studies in die VSA het getoon dat 160 uit 1000 mense skoliose het (Boachie-Adjei & Lonner, 1996). Dit beteken dat skoliose net so veel voorkom soos hipertensie of diabetes mellitus. Identifikasie van postuurafwykings op "n vroeë stadium maak vroeë behandeling moontlik, wat in die toekoms ernstige postuurafwykings kan voorkom. Die "American Academy of Orthopedie Surgeons" het reeds in 1974 die implementering van assesseringsprogramme goedgekeur (Lonstein, 1988). Volgens navorsing het slegs "n beperkte aantal studies die hele spierskeletale stelsel geëvalueer. Die doel van hierdie studie was om die voorkoms van postuurafwykings by kinders tussen die ouderdomme van 11 en 13 jaar in geselekteerde Wes-Kaapse skole te bepaal. Die studie het ook faktore wat "n invloed op die voorkoms van postuurafwykings kan hê, ingesluit. Hierdie faktore het onder andere ouderdom, geslag, skool, gewig, lengte, LMI (Liggaamsmassa-indeks), vet%, middel-heup-ratio en fisieke aktiwiteit ingesluit. Uitnodigingsbriewe is na 15 laerskole binne "n 30km radius vanaf Stellenbosch gestuur. Dit het ingesluit Stellenbosch, Strand, en Kuilsrivier. Vier skole het toestemming verleen om die studie by die betrokke skole te loods. Die steekproef (N=288, gemiddelde ouderdom = 12.36, SD=0.92) het bestaan uit 78 leerlinge uit graad vyf; 104 leerlinge uit graad ses en 106 leerlinge uit graad sewe. Uit die totale aantal leerlinge wat geëvalueer is, was daar 154 seuns en 134 dogters. Antropometriese metings het die volgende ingesluit: lengte, gewig, velvoue (twee-velvou meting), middel- en heupomtrekke en trochanterion beenlengte. Fisieke aktiwiteitsvlak en familiegeskiedenis van postuurafwykings is bepaal met behulp van "n vraelys. Die "New York Posture Tesf' is gebruik vir postuurevaluasie (Bloomfield et al., 1994:320; Reedco Inc., 2001). Hierdie toets is ontwerp vir die evaluering van 13 deformiteite. Die kinders is vanuit 'n posterior en anterior aansig ge-evalueer met behulp van 'n "deurskynende" postuurruitnet (grid). Die "Adam's-" toets (vooroorbuig-toets) is gebruik vir verdere evaluering van skoliose. Statistica (StatSoft, 2001) en klassifikasieboom-metodologie (Breiman et al., 1993) is gebruik vir statistiese ontleding. Die proefpersone het 'n gemiddelde lengte van 1.54m, gewig van 47.48kg, LMI van 19.75, middel-heup-ratio van 0.79 en vet% (Lohman, 1987) van 21.35% gehad. Die voorkoms van die onderskeie postuurafwykings was as volg: Lordose,70%; Kifose, 57%; Ongelyke skouers, 55%; Romp na posterior gebuig, 43%; Gevleuelde skapulas, 42%; Voetpronasie, 30%; Plat voete, 30%; Plat bors, 29%; Protraksie: skedel, 28%; Uitstaan buik, 28%; Ongelyke heupe, 11%; Skoliose, 10%; en Gekantelde hoof, 1%. Ongelyke heupe, skoliose en gekantelde hoof het minder voorgekom in vergelyking met die ander deformiteite, daarom is die deformiteite nie vir statistiese analise in aammerking gebring nie. LMI en vet% was die faktore wat die voorkoms van postuurafwykings die meeste beïnvloed het. 'n Hoër LMI en vet% het 'n toenemende voorkoms in meeste deformiteite veroorsaak. Die voorkoms van postuurafwyking in hierdie studie was hoog. Sedentêre leefwyses van kinders (TV, rekenaarspeletjies, gemorskos, en fisieke onaktiwiteit) het bygedra tot die hoë voorkoms. Die voorkoms van oorgewig en sedentêre leefwyses is besig om te verhoog by kinders en kan ernstige gevolge vir die gesondheid van die kind inhou. Indien daar 'n betekenisvolle korrelasie tussen die voorkoms van postuurafwykings en kondisies soos rugpyn is, dan blyk die hoë voorkoms, wat in hierdie studie gevind is, 'n bron van bekommernis te wees. Postuurevalueringsprogramme is 'n effektiewe metode vir die vroeë identifikasie van postuurafwykings, aangesien dit vroeë identifikasie en konserwatiewe behandeling moontlik maak.

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