Abstract
Purpose
Non-invasive treatment of pectus carinatum (PC) deformity includes the use of a compression brace and exercises. In this study, we aimed to examine the effect of a physiotherapy protocol applied as adjunct to compression brace treatment in patients with PC.
Methods
The study included 30 male patients between 11 and 18 years of age. Patients were randomly assigned into two groups: a brace treatment only group (Group 1) and a brace and physiotherapy group (Group 2). Patient demographics and disease-related properties, protrusion measurements, postural evaluations, deformity perceptions, life quality, and treatment satisfaction were evaluated.
Results
Although both groups showed improvements based on external chest measurements related to PC protrusion following treatment (p < 0.001), Group 2 had more benefit from the treatment (effect size > 0.36) and displayed greater improvement in maximum protrusion degree and lateral length values (p < 0.05). Additionally, we found that patient perception of deformity, posture, psychological life quality, and treatment satisfaction scores were significantly better in Group 2 (p < 0.05).
Conclusion
Owing to the satisfaction and additional benefits observed in the physiotherapy group, we think that a proper cardiopulmonary and musculoskeletal exercise program should be applied concurrently with brace treatment for patients with PC deformity. Nevertheless, long-term outcomes need to be clarified in future studies.
Similar content being viewed by others
References
Blanco FC, Elliott ST, Sandler AD et al (2011) Management of congenital chest wall deformities. Semin Plast Surg 25:107–116. https://doi.org/10.1055/s-0031-1275177
Frey AS, Garcia VF, Brown RL et al (2006) Nonoperative management of pectus carinatum. J Pediatr Surg 41(1):40–45. https://doi.org/10.1016/j.jpedsurg.2005.10.076
Kuhn MA, Nuss D (2011) Pectus deformities. In: Mattei P (ed) Fundamentals of pediatric surgery. Springer, New York, pp 313–322
Martinez-Ferro M, Munzon GB, Fraire C et al (2016) Non-surgical treatment of pectus carinatum with the FMF® Dynamic Compressor System. J Vis Surg. https://doi.org/10.21037/jovs.2016.02.20
Steinmann C, Krille S, Mueller A et al (2011) Pectus excavatum and pectus carinatum patients suffer from lower quality of life and impaired body image: a control group comparison of psychological characteristics prior to surgical correction. Eur J Cardiothorac Surg 40(5):1138–1145. https://doi.org/10.1016/j.ejcts.2011.02.019
Ravitch MM (1949) The operative treatment of pectus excavatum. Ann Surg 129:429–444. https://doi.org/10.1097/00000658-194904000-00002
Varela P, Torre M (2011) Thoracoscopic cartilage resection with partial perichondrium preservation in unilateral pectus carinatum: preliminary results. J Pediatr Surg 46(1):263–266. https://doi.org/10.1016/j.jpedsurg.2010.08.010
Abramson H, D’Agostino J, Wuscovi S et al (2009) A 5-year experience with a minimally invasive technique for pectus carinatum repair. J Pediatr Surg 44:118–123. https://doi.org/10.1016/j.jpedsurg.2008.10.020
Desmarais TJ, Keller MS (2013) Pectus carinatum. Curr Opin Pediatr 25(3):375–381. https://doi.org/10.1097/MOP.0b013e3283604088
Kang DY, Jung J, Chung S et al (2014) Factors affecting patient compliance with compressive brace therapy for pectus carinatum. Interact Cardiovasc Thorac Surg 19(6):900–903. https://doi.org/10.1093/icvts/ivu280
Kravarusic D, Dicken BJ, Dewar R et al (2006) The Calgary protocol for bracing of pectus carinatum: a preliminary report. J Pediatr Surg 41:923–926. https://doi.org/10.1016/j.jpedsurg.2006.01.058
de Beer SA, Gritter M, de Jong JR et al (2017) The dynamic compression brace for pectus carinatum: intermediate results in 286 patients. Ann Thorac Surg 103:1742–1749. https://doi.org/10.1016/j.athoracsur.2016.12.019
Banever GT, Konefal SH Jr, Gettens K et al (2006) Nonoperative correction of pectus carinatum with orthotic bracing. J Laparoendosc Adv SA 16:164–167. https://doi.org/10.1089/lap.2006.16.164
Lee RT, Moorman S, Schneider M et al (2013) Bracing is an effective therapy for pectus carinatum: interim results. J Pediatr Surg 48:184–190. https://doi.org/10.1016/j.jpedsurg.2012.10.037
Giray E, Ermerak N, Bahar YO et al (2020) A comparative study on short-term effects of compression orthosis and exercises in the treatment of pectus carinatum: a randomized controlled pilot feasibility trial. Eur J Pedıatr Surg. https://doi.org/10.1055/s-0040-1701699
Borg GA (1982) Psychophysical bases of perceived exertion. Med Sci Sports Exerc 14(5):377–381
Riebe and Deborah (2018) ACSM's guidelines for exercise testing and prescription. Wolters Kluwer, Alphen aan den Rijn
Akkaş Y, Peri NG, Koçer B, Gülbahar G, Aksakal FNB (2018) The prevalence of chest wall deformity in Turkish children. Turk J Med Scı 48(6):1200–1206. https://doi.org/10.3906/sag-1807-180
Ewert F, Syed J, Wagner S et al (2017) Does an external chest wall measurement correlate with a CT-based measurement in patients with chest wall deformities? J Pediatr Surg 52(10):1583–1590. https://doi.org/10.1016/j.jpedsurg.2017.04.011
Canavan PK, Cahalin L (2008) Integrated physical therapy intervention for a person with pectus excavatum and bilateral shoulder pain: a single-case study. Arch Phys Med Rehabil 89(11):2195–2204. https://doi.org/10.1016/j.apmr.2008.04.014
Price DD, McGrath PA, Rafii A, Buckingham B et al (1983) The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain 17:45–56. https://doi.org/10.1016/0304-3959(83)90126-4
Magee DJ. (1987). Orthopedic Physical Assessment. Gait Assessment. Chapter13. W.B.Saunders Company, Toronto. pp 362–376.
Kamper SJ, Maher CG, Mackay G et al (2009) Global rating of change scales: a review of strengths and weaknesses and considerations for design. J Man Manip Ther 17(3):163–170. https://doi.org/10.1179/jmt.2009.17.3.163
Lawson ML, Cash TF, Akers R et al (2003) A pilot study of the impact of surgical repair on disease-specific quality of life among patients with pectus excavatum. J Pediatr Surg 38(6):916–918. https://doi.org/10.1016/s0022-3468(03)00123-4
Krasopoulos G, Dusmet M, Ladas G, Goldstraw P et al (2006) Nuss procedure improves the quality of life in young male adults with pectus excavatum deformity. Eur J Cardıo-Thorac 29:1–5. https://doi.org/10.1016/j.ejcts.2005.09.018
de Vet HC, Terwee CB, Bouter LM et al (2003) Current challenges in 490 clinimetrics. J Clin Epidemiol 56:1137–1141. https://doi.org/10.1016/j.jclinepi.2003.08.012
Norman GR, Stratford P, Regehr G et al (1997) Methodological problems 491 in the retrospective computation of responsiveness to change: 492 the lesson of Cronbach. J Clin Epidemiol 50:869–879. https://doi.org/10.1016/s0895-4356(97)00097-8
Shamberger RC, Welch KJ (1988) Surgical repair of pectus excavatum. J Pediatr Surg 23(7):615–622. https://doi.org/10.1016/s0022-3468(88)80629-8
Haje SA, Bowen JR (1992) Preliminary results of orthotic treatment of pectus deformities in children and adolescents. J Pediatr Orthop 12:795–800. https://doi.org/10.1097/01241398-199211000-00018
Lee SY, Lee SJ, Jeon CW, Lee CS, Lee KR et al (2008) (2008) Effect of the compressive brace in pectus carinatum. Eur J Cardiothorac Surg 34:146–149. https://doi.org/10.1016/j.ejcts.2008.04.012
Egan JC, DuBois JJ, Morphy M, Samples TL, Lindell B et al (2000) Compressive orthotics in the treatment of asymmetric pectus carinatum: a preliminary report with an objective radiographic marker. J Pediatr Surg 35:1183–1186. https://doi.org/10.1053/jpsu.2000.8724
Stephenson JT, Du Bois J (2008) Compressive orthotic bracing in the treatment of pectus carinatum: the use of radiographic markers to predict success. J Pediatr Surg 43:1776–1780. https://doi.org/10.1016/j.jpedsurg.2008.03.049
Jung J, Chung SH, Cho JK et al (2012) Brace compression for treatment of pectus carinatum. Korean J Thorac Cardiovasc Surg 45:396–400. https://doi.org/10.5090/kjtcs.2012.45.6.396
Colozza S (2013) Butter A (2013) Bracing in pediatric patients with pectus carinatum is effective and improves quality of life. J Pediatr Surg 48:1055–1059. https://doi.org/10.1016/j.jpedsurg.2013.02.028
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Author information
Authors and Affiliations
Contributions
The first draft of the manuscript was written by NA and all authors commented on the previous versions of the manuscript. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
The Research Ethics Committee of Acıbadem University and Acıbadem Healthcare Group has approved the study (reference no. ATADEK-2019–14/11). All procedures performed in studies involving human participants were in accordance with the 1964 Helsinki Declaration.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Alaca, N., Alaca, İ. & Yüksel, M. Does physiotherapy applied in conjunction with compression brace treatment in patients with pectus carinatum have efficacy? A preliminary randomized-controlled study. Pediatr Surg Int 36, 789–797 (2020). https://doi.org/10.1007/s00383-020-04675-3
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-020-04675-3