Reliability of visual assessment of forward head posture in standing
Aitken, Andrew William
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Permanent link to Research Bank record:http://hdl.handle.net/10652/1613
Background. The visual assessment of a patients’ standing posture is one of the first steps in the physical examination process as performed by osteopaths and other manual medicine practitioners. The assessment of forward head posture is an important part of this postural assessment. Only a small number of studies investigating the reliability of visual assessment of posture have been identified. This study may potentially add data that could be helpful in developing improved guidelines for assessing forward head posture. This dissertation contains two main sections. Section one is a review of the literature that underlines the reliability of visual assessment of forward head posture. Section two consists of a manuscript that reports a study on the reliability of visual assessment of forward head posture in standing. The aim of the study was to investigate the intra and inter-rater reliability of visual assessment of forward head posture in standing as well as to determine the influence of osteopathic clinical experience on reliability of visual assessment of forward head posture. Methods. A blinded test-retest design was used to examine the intra-rater and inter-rater reliability of the visual assessment of forward head posture in standing. Intra-rater reliability was investigated by having observers visually rate a video clip of the forward head posture of the same subject (n=60) twice. Inter-rater reliability was investigated by comparing results of 78 randomly selected observers comprised of 16 laypeople, 40 osteopathy students, and 22 osteopathic practitioners. The influence of clinical experience was investigated by comparing observers from these various groups. Results. Intra-rater reliability across groups was only slightly better than would be expected by chance alone. Inter-rater reliability was universally statistically poor to fair, with only first and second year osteopathy students providing a moderate level of reliability. Conclusions. The results call into question the statistical reliability of the visual assessment of forward head posture. More research is required in order to determine the variables that may confound statistical reliability of this commonly used clinical assessment technique.