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Purpose: To determine if there is an association between a test commonly used by chiropractors as a sign of subluxation/joint dysfunction – supine leg length alignment (LLA) asymmetry - and health-related quality of life as measured by the SF-12 questionnaire, in a non-clinical population.
Design: Volunteers answered the SF-12 and background questionnaires and were then examined for supine LLA by a chiropractor blinded to their answers.
Setting: Gatherings of people in the general population. Participants: Fifty-five unscreened volunteers.
Examiner: Chiropractor with approximately 20 years of clinical experience.
Main Outcome Measures: The association of supine LLA asymmetry with general health based on the two summary scores - physical (PCS) and mental (MCS) - of the SF-12.
Results: There were 27 volunteers with LLA asymmetry, they had a mean PCS of 49.6 and a mean MCS of 47.9. In the no-LLA asymmetry group (n=23) the mean PCS was 50.8, and mean MCS of 54.0. A multiple regression analysis found that of the variables gender, age, back pain (current/former) and LLA asymmetry, the only factor to approach significance with the SF-12 MCS/PCS was the presence of LLA asymmetry. A t-test found there was a significant difference (p=0.017) in the MCS between the supine LLA asymmetry and no-LLA asymmetry groups.
Conclusion: This pilot study suggests that in this group of volunteers (n=50) from the non-clinical general population, those who demonstrated a commonly used sign of subluxation/joint dysfunction - supine leg length alignment asymmetry - had a significantly (P=0.017) lower measure of general health as determined by the SF-12 survey than those volunteers without such asymmetry. Further investigation to clarify this relationship and to establish whether there is a connection between the putative entity of chiropractic subluxation and unloaded leg length alignment asymmetry is recommended.
What say you?
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
Dear All,
I do one day a week in a rehab team, we get many post hip replacement people that have an LLD. I have not kept stats etc but it appears that the greater the LLD after the surgery the less happy they are with the overall result. I believe it is not always clear in the first few months how much effect the LLD is going to have. There seems to be a lag effect where some seem to not have resulting pathology from motion patterns for quite some time and with others you can see assymetry of motion which while not desirable seems not to cause much trouble.
The main hassle is that the system ejects them from rehab and re-assessment before these issues become clear. I'd love to do a 12 month and 24 month follow up.
I have seen a number of young trauma victims, motor bike crashes etc, where more rapid and "aggressive" treatment.....lift the short one kind of immediately seems to be the answer, particularly with shank length where hip damage has been less of an issue.
In general I have developed the impression that dynamic changes to the "equilibrium" of gait in a given individual may take quite some time to manifest all the results of that change. I tend to think the more hip/spine stuff involved the more problematic it will all be......stating the obvious I'm sure.
The primary goal of surgical equalization of lower extremity limb length discrepancy is to enhance the quality of life of patients by improving their function, gait, appearance, and pain secondary to compensation for the limb length discrepancy. While many surgeons use a cutoff point of 2 cm as an indication for intervention, little attention has been given to the effect of limb length discrepancy on quality of life. Therefore, the purpose of this study was to determine the relationship between limb length discrepancy and health-related quality of life and to assess whether the commonly accepted 2 cm cutoff serves to predict patients with and without quality of life perturbations. The Child Health Questionnaire was used to collect information from the parents of 76 children diagnosed with limb length discrepancy, and these data were compared with data from scanograms. Differences in quality of life became more apparent with increasing limb length discrepancy, especially among psychosocial health domains. As expected, patients with a limb length discrepancy of 2 cm or below generally fared better than patients with larger discrepancies, but no discrete cutoff could be identified within this group.
Given that leg length varies from person to person and that in general children's legs are shorter, often considerably shorter, than adult legs it might be more appropriate to use a percentage leg length difference as the criterion for intervention.
For example if the longer leg length (inside leg or anterior sup. iliac spine to ground or malleolus?) is 50cm and the difference in leg length is 2cm the percentage difference is 2/50 x 100% = 4%. However if the longer leg length is 100cm and the leg length difference is 2cm the percentage difference is 2%.
One would imagine that all else being equal a percentage limb length difference would clarify the issue more effectively, unless, of course, the study cohort consisted of bilateral amputees?
Leg Length Differences and Quality of Life
Linear Mode
