Skip to main content

Does physiotherapy applied in conjunction with compression brace treatment in patients with pectus carinatum have efficacy? A preliminary randomized-controlled study

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.

This is a preview of subscription content, access via your institution.

References

  1. 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

    Article  PubMed  PubMed Central  Google Scholar 

  2. 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

    Article  PubMed  Google Scholar 

  3. Kuhn MA, Nuss D (2011) Pectus deformities. In: Mattei P (ed) Fundamentals of pediatric surgery. Springer, New York, pp 313–322

    Chapter  Google Scholar 

  4. 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

    Article  PubMed  PubMed Central  Google Scholar 

  5. 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

    Article  PubMed  Google Scholar 

  6. Ravitch MM (1949) The operative treatment of pectus excavatum. Ann Surg 129:429–444. https://doi.org/10.1097/00000658-194904000-00002

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  7. 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

    Article  PubMed  Google Scholar 

  8. 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

    Article  PubMed  Google Scholar 

  9. Desmarais TJ, Keller MS (2013) Pectus carinatum. Curr Opin Pediatr 25(3):375–381. https://doi.org/10.1097/MOP.0b013e3283604088

    Article  PubMed  Google Scholar 

  10. 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

    Article  PubMed  Google Scholar 

  11. 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

    Article  PubMed  Google Scholar 

  12. 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

    Article  PubMed  Google Scholar 

  13. 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

    Article  Google Scholar 

  14. 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

    Article  PubMed  Google Scholar 

  15. 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

    Article  PubMed  Google Scholar 

  16. Borg GA (1982) Psychophysical bases of perceived exertion. Med Sci Sports Exerc 14(5):377–381

    CAS  Article  PubMed  Google Scholar 

  17. Riebe and Deborah (2018) ACSM's guidelines for exercise testing and prescription. Wolters Kluwer, Alphen aan den Rijn

    Google Scholar 

  18. 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

    Article  PubMed  Google Scholar 

  19. 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

    Article  PubMed  Google Scholar 

  20. 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

    Article  PubMed  Google Scholar 

  21. 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

    CAS  Article  PubMed  Google Scholar 

  22. Magee DJ. (1987). Orthopedic Physical Assessment. Gait Assessment. Chapter13. W.B.Saunders Company, Toronto. pp 362–376.

  23. 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

    Article  PubMed  PubMed Central  Google Scholar 

  24. 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

    Article  PubMed  Google Scholar 

  25. 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

    Article  Google Scholar 

  26. 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

    Article  PubMed  Google Scholar 

  27. 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

    CAS  Article  PubMed  Google Scholar 

  28. 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

    CAS  Article  PubMed  Google Scholar 

  29. 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

    CAS  Article  PubMed  Google Scholar 

  30. 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

    Article  PubMed  Google Scholar 

  31. 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

    CAS  Article  PubMed  Google Scholar 

  32. 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

    Article  PubMed  Google Scholar 

  33. 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

    Article  PubMed  PubMed Central  Google Scholar 

  34. 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

    Article  PubMed  Google Scholar 

Download references

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

Authors

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

Correspondence to Nuray Alaca.

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

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

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

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-020-04675-3

Keywords

  • Pectus carinatum
  • Non-invasive treatment
  • Brace
  • Physiotherapy
  • Exercises