Aims: Thoracic hyperkyphosis has been associated with poor posture, back pain, and osteoporosis. Treatments such as exercise, manual therapy, bracing, and surgery are used to reduce thoracic hyperkyphosis, but treatment effectiveness is currently uncertain. This study aimed to systematically review the literature to investigate the effectiveness of treatments to reduce thoracic hyperkyphosis.
Methods: Medline, Embase, Cinahl, and Cochrane Central Register of Controlled Trials were searched to May 2019 for randomised controlled trials assessing the effectiveness of treatments to reduce thoracic hyperkyphosis in adults. Two authors independently extracted data and analysed risk of bias. Raw data on mean change in thoracic kyphosis were extracted and standardised mean differences (SMD) calculated. Meta-analysis was performed with studies homogenous for study population, intervention, control, and outcome measure. Strength of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation system.
Results: The search returned 7105 studies, 22 meeting inclusion criteria. Interventions assessed included exercise (N=15), bracing (N=3), multimodal care (exercise, manual therapy, and taping; N=3), biofeedback (N=1), muscle stimulation (N=1), and surgery (N=1). Thoracic kyphosis was significantly reduced in younger populations by exercise (N=178) compared to control (N=181) (SMD:-2.5, 95%CI:-3.8, -1.1; moderate quality evidence; 6 studies), in older populations by exercise (N=118) compared to control (N=110) (SMD:-0.5, 95%CI:-1.0, -0.1; moderate quality evidence; 3 studies), and in older populations by bracing (N=72) compared to control (N=72) (SMD:-1.0, 95%CI:-1.4, -0.6; moderate quality evidence, 2 studies). Surgery (N=40) showed evidence of effectiveness compared to usual medical care (N=42) in one study on patients with osteoporotic compression fractures (SMD:-2.79, 95%CI:-3.41, -2.18). Thoracic hyperkyphosis was not significantly decreased by multimodal treatment, biofeedback, or muscle stimulation.
Discussion: Moderate quality evidence indicates that exercise and bracing should be considered as treatment options to reduce thoracic hyperkyphosis. Further research is required to assess the effectiveness of surgery and manual therapy.