title: Effect of sitting posture on development of scoliosis in Duchenne Muscular Dystrophy cases.
abstract: BACKGROUND
  Scoliosis is a frequent association in boys with Duchenne Muscular Dystrophy when the ability to walk is lost around nine to 12 years of age. This study assessed the contribution of physical factors including lumbar posture to scoliosis in non-ambulatory youth with DMD in Nepal.
  
  
  METHODS
  Linear regression was used to assess effects of time since loss of ambulation, muscle strength, functional severity and lumbar angle as a binary variable on coronal Cobb angle; again logistic regression was used to assess effects of muscle strength and cross-legged sitting on the presence of a lordotic lumbar posture in 22 non-ambulant boys and young men.
  
  
  RESULTS
  The boys and young men had a mean (SD) age of 15.1 (4.0) years, had been non-ambulant for 48.6 (33.8) months and used a median of 3.5 (range 2 to 7) postures a day. The mean Cobb angle was 15.1 (range 0 to 70) degrees. Optimal accuracy in predicting scoliosis was obtained with a lumbar angle of -6° as measured by skin markers, and both a lumbar angle ≤-6° (P=0.112) and better functional ability (P=0.102) were associated with less scoliosis. Use of cross-legged sitting postures during the day was associated with a lumbar angle ≤-6° (OR 0.061; 95% CI 0.005 - 0.672; P=0.022).
  
  
  CONCLUSIONS
  Use of cross-legged sitting posture was associated with increase in lumbar lordosis. Higher angle of lumbar lordosis and better functional ability are associated with lesser degree of scoliosis.
authors.affiliation: Department of Orthopaedics, Institute of Medicine Tribhuvan University, Maharajgunj, Kathmandu Nepal.
authors.forename: R K
authors.initials: RK
authors.lastname: Pokharel
authors.affiliation: Muscular Dystrophy Foundation, Kathmandu, Nepal.
authors.forename: L
authors.initials: L
authors.lastname: Brisco
authors.affiliation: Muscular Dystrophy Foundation, Kathmandu, Nepal.
authors.forename: M
authors.initials: M
authors.lastname: Mandal
authors.affiliation: Department of Medicine, Institute of Medicine Tribhuvan University, Maharajgunj, Kathmandu, Nepal.
authors.forename: J P
authors.initials: JP
authors.lastname: Agrawal
authors.affiliation: Department of Orthopaedics, Princess Margaret Hospital, Perth, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Dillon
authors.affiliation: Morgan Stanley Children's Hospital of New York - Presbyterian, Columbia University Medical Centre, New York.
authors.forename: M
authors.initials: M
authors.lastname: Vitale
authors.affiliation: Department of Orthopaedics, Princess Margaret Hospital, Perth, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Woodland
authors.affiliation: Centre for Child Health Research, Telethon Institute for Child Health Research, The University of Western Australia, Perth, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Jacoby
authors.affiliation: School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Downs
mesh_terms: D000293:Adolescent; D002648:Child; D006801:Humans; D016014:Linear Models; D008297:Male; D053580:Muscle Strength / Q000502:physiology; D020388:Muscular Dystrophy, Duchenne / Q000150:complications* / Q000503:physiopathology*; D009390:Nepal; D011187:Posture / Q000502:physiology*; D012600:Scoliosis / Q000150:complications / Q000209:etiology* / Q000503:physiopathology*; D012720:Severity of Illness Index; D013997:Time Factors; D055815:Young Adult