Impairment of scapular control in individuals with chronic obstructive pulmonary disease (COPD): Systematic review and meta-analysis

Abstract

Background: Upper quadrant geometrical changes in individuals with chronic obstructive pulmonary disease (COPD) appear to have negative influences on geometrical arrangements of the thorax and scapula. Objective: The purpose of this systematic review was to assess the impairment of scapular control in individuals with COPD as compared with healthy controls. Methods: We systematically searched seven electronic databases from inception to June 2021 and updated the searches again in December 2021. Eligible studies included the participants with COPD and compared scapular control outcomes (scapular/shoulder kinematic or related muscle activity) with a control group. Two researchers independently searched for, screened, extracted data from, and evaluated the quality of all articles. Results: Seven studies met the inclusion criteria and only five studies with 190 subjects were included in the meta-analyses. Subgroup analyses showed that the control group exhibited more scapular anterior tilt (SMD: 0.46; 95% CI: 0.01 to 0.90) and shoulder flexion (SMD: −1.02; 95% CI: −1.79 to −0.26) as compared with the COPD group. Conversely, the COPD group exhibited more scapular elevation (SMD: −1.03; 95% CI: −1.69 to −0.37), internal rotation (SMD: −1.65; 95% CI: −3.19 to −0.10), and protraction (SMD: −0.75; 95% CI: −1.18 to −0.32) compared with the control group. All other outcomes revealed non-significant findings. Conclusion: This review demonstrated scapular control impairments, such as scapular elevation, internal rotation, protraction, and anterior tilt in a static position in patients with COPD. To validate these findings, high-quality randomized control trials with large sample sizes and reliable outcome measures should be conducted.