Inter and Intra-Rater Reliability of Measuring Photometric Craniovertebral Angle Using a Cloud-Based Video Communication Platform

Authors

  • Rylan Cote Department of Physical Therapy, College of Natural, Behavioral, and Health Sciences, Simmons University, Boston, Massachusetts, USA
  • Cassandra Vietas Department of Physical Therapy, College of Natural, Behavioral, and Health Sciences, Simmons University, Boston, Massachusetts, USA
  • Megan Kolakowski Department of Physical Therapy, College of Natural, Behavioral, and Health Sciences, Simmons University, Boston, Massachusetts, USA
  • Kayla Lombardo Department of Physical Therapy, College of Natural, Behavioral, and Health Sciences, Simmons University, Boston, Massachusetts, USA
  • Jacob Prete Department of Physical Therapy, College of Natural, Behavioral, and Health Sciences, Simmons University, Boston, Massachusetts, USA
  • Amit Dashottar Department of Physical Therapy, College of Natural, Behavioral, and Health Sciences, Simmons University, Boston, Massachusetts, USA

DOI:

https://doi.org/10.5195/ijt.2021.6346

Keywords:

Craniovertebral angle, Forward head posture, Physical therapy, Posture, Telehealth

Abstract

Objective: Due to social distancing guidelines during the Coronavirus (COVID-19) pandemic, most providers and patients have wanted to avoid close contact. This makes physical therapy (PT) assessments difficult because of the lack of empirical evidence about the reliability of various clinical measurements performed in a virtual environment. One such procedure is the photometric measurement of craniovertebral (CV) angle. Craniovertebral angle measurement is usually performed in an outpatient setting and is defined as the acute angle formed between a straight line connecting the spinous process of C7 to the tragus of the ear, and the horizontal line passing through the spinous process of the C7. Although the photometric measurement of CV angles is considered both valid and reliable in the clinics, no empirical evidence exists about the CV angle measurement reliability when performed in a virtual environment. Thus, the purpose of this study was to assess the inter- and intra-rater reliability of photometric CV angle measurement using a cloud-based video communication platform. Number of Subjects: 66 subjects (57 females). Methods: All measurements were performed by two final year PT students who had completed the musculoskeletal part of the curriculum and were blinded to each other’s measurements. Each subject was photographed in two postures over a HIPAA-compliant video-based telehealth platform: (1) normal/ relaxed posture and (2) ideal posture (posture the subject considered good). Student researcher 1 measured the CV angle in both the relaxed posture and ideal posture, while student researcher 2 measured the CV angle only in the relaxed posture. Each subject's CV angle measurement was performed three times on three separate days and the means were used for further analysis. The shape of the CV angle frequency distribution was assessed using kurtosis and skewness values. Rater reliability was assessed using intraclass correlation coefficients (ICC), and interpreted based on the guidelines provided by Portney and Watkins (2009). Results: The CV angles were normally distributed in both relaxed and ideal postures. The mean and standard deviation (SD) of relaxed posture was 50.7o ± 6.3o with kurtosis and skewness of 0.67 and -0.74 respectively. The mean and SD of ideal posture was 55.5o ± 5.4o, with kurtosis and skewness of 0.1 and -0.54 respectively. The ICC for inter-rater reliability in the relaxed posture was 0.88 and the ICC for intra-rater reliability for relaxed posture was 0.91.  Conclusion: Craniovertebral angles were normally distributed in the sample. An acceptable level of inter- and intra-rater reliability can be attained when measuring CV angle using a cloud-based video communication platform.

 

  

References

Akodu, A. K., Akinbo, S. R., & Young, Q. O. (2018). Correlation among smartphone addiction, craniovertebral angle, scapular dyskinesis, and selected anthropometric variables in physiotherapy undergraduates. Journal of Taibah University Medical Sciences, 13(6), 528–534. https://doi.org/10.1016/j.jtumed.2018.09.001

Bergqvist, U., Wologast, E., Nilsson, B., & Voss, M. (1995). Musculoskeletal disorders among visual display terminal workers: Individual, ergonomic, and work organizational factors. Ergonomics, 38(4), 763–776. https://doi.org/10.1080/00140139508925148

Cureton, T. K. (1941). Bodily position as an indicator of fitness. Research Quarterly. American Association for Health, Physical Education and Recreation, 12, 348–367.

Exum, E., Hull, B. L., Lee, A. C. W., Gumieny, A., Villarreal, C., & Longnecker, D. (2020). Applying telehealth technologies and strategies to provide acute care consultation and treatment of patients with confirmed or possible COVID-19. Journal of Acute Care Physical Therapy, 11(3), 103–112. https://doi.org/10.1097/JAT.0000000000000143

Garrett, T. R., Youdas, J. W., & Madson, T. J. (1993). Reliability of measuring forward head posture in a clinical setting. Journal of Orthopaedic & Sports Physical Therapy, 17(3), 155–160. https://doi.org/10.2519/jospt.1993.17.3.155

Khayatzadeh, S., Kalmanson, O. A., Schuit, D., Havey, R. M., Voronov, L. I., Ghanayem, A. J., & Patwardhan, A. G. (2017). Cervical spine muscle-tendon unit length differences between neutral and forward head postures: Biomechanical study using human cadaveric specimens. Physical Therapy, 97(7), 756–766. https://doi.org/10.1093/ptj/pzx040

Kocur, P., Wilski, M., Goliwąs, M., Lewandowski, J., & Łochyński, D. (2019). Influence of forward head posture on myotonometric measurements of superficial neck muscle tone, elasticity, and stiffness in asymptomatic individuals with sedentary jobs. Journal of Manipulative and Physiological Therapeutics, 42(3), 195–202. https://doi.org/10.1016/j.jmpt.2019.02.005

Lau, H. M. C., Chiu, T. T. W., & Lam, T.-H. (2010). Measurement of craniovertebral angle with Electronic Head Posture Instrument: Criterion validity. The Journal of Rehabilitation Research and Development, 47(9), 911. https://doi.org/10.1682/JRRD.2010.01.0001

Lee, A. C. (2020). COVID-19 and the advancement of digital physical therapist practice and telehealth. Physical Therapy, 100(7), 1054–1057. https://doi.org/10.1093/ptj/pzaa079

Lee, C., Lee, S., & Shin, G. (2017). Reliability of forward head posture evaluation while sitting, standing, walking, and running. Human Movement Science, 55, 81–86. https://doi.org/10.1016/j.humov.2017.07.008

Lee, K.-J., Han, H.-Y., Cheon, S.-H., Park, S.-H., & Yong, M.-S. (2015). The effect of forward head posture on muscle activity during neck protraction and retraction. Journal of Physical Therapy Science, 27(3), 977–979. https://doi.org/10.1589/jpts.27.977

Mahmoud, N. F., Hassan, K. A., Abdelmajeed, S. F., Moustafa, I. M., & Silva, A. G. (2019). The relationship between forward head posture and neck pain: A systematic review and meta-analysis. Current Reviews in Musculoskeletal Medicine, 12(4), 562–577. https://doi.org/10.1007/s12178-019-09594-y

Nam, S. H., Son, S. M., Kwon, J. W., & Lee, N. K. (2013). The intra- and inter-rater reliabilities of the forward head posture assessment of normal healthy subjects. Journal of Physical Therapy Science, 25(6), 737–739. https://doi.org/10.1589/jpts.25.737

Nejati, P., Lotfian, S., Moezy, A., & Nejati, M. (2015). The study of correlation between forward head posture and neck pain in Iranian office workers. International Journal of Occupational Medicine and Environmental Health. https://doi.org/10.13075/ijomeh.1896.00352

Pandemic brings telehealth to the forefront. (2020, April 5). PBS NewsHour. https://www.pbs.org/newshour/show/pandemic-brings-telehealth-to-the-forefront

Portney, L. G., & Watkins, M. P. (2009). Foundations of clinical research: Applications to practice (3rd ed). Pearson/Prentice Hall.

Raine, S., & Twomey, L. T. (1997). Head and shoulder posture variations in 160 asymptomatic women and men. Archives of Physical Medicine and Rehabilitation, 78(11), 1215–1223. https://doi.org/10.1016/S0003-9993(97)90335-X

Rasband, W. S. (1997). Image J. National Institutes of Health. https://imagej.nih.gov/ij/

Salahzadeh, Z., Maroufi, N., Ahmadi, A., Behtash, H., Razmjoo, A., Gohari, M., & Parnianpour, M. (2014). Assessment of forward head posture in females: Observational and photogrammetry methods. Journal of Back and Musculoskeletal Rehabilitation, 27(2), 131–139. https://doi.org/10.3233/BMR-130426

Silva, A. G., Punt, T. D., Sharples, P., Vilas-Boas, J. P., & Johnson, M. I. (2009). Head posture assessment for patients with neck pain: Is it useful? International Journal of Therapy and Rehabilitation, 16(1), 43–53. https://doi.org/10.12968/ijtr.2009.16.1.37939

Singla, D., Veqar, Z., & Hussain, M. E. (2017). Photogrammetric assessment of upper body posture using postural angles: A literature review. Journal of Chiropractic Medicine, 16(2), 131–138. https://doi.org/10.1016/j.jcm.2017.01.005

Subbarayalu, A. V. (2016). Measurement of craniovertebral angle by the Modified Head Posture Spinal Curvature Instrument: A reliability and validity study. Physiotherapy Theory and Practice, 32(2), 144–152. https://doi.org/10.3109/09593985.2015.1099172

Szikszay, T. M., Hoenick, S., von Korn, K., Meise, R., Schwarz, A., Starke, W., & Luedtke, K. (2019). Which examination tests detect differences in cervical musculoskeletal impairments in people with migraine? A systematic review and meta-analysis. Physical Therapy, 99(5), 549–569. https://doi.org/10.1093/ptj/pzz007

van Niekerk, S.-M., Louw, Q., Vaughan, C., Grimmer-Somers, K., & Schreve, K. (2008). Photographic measurement of upper-body sitting posture of high school students: A reliability and validity study. BMC Musculoskeletal Disorders, 9(1), 113. https://doi.org/10.1186/1471-2474-9-113

White, E., Barnette, A., Phillips, A., & Migliarese, S. (2018). Quantifying forward head posture based on practicing physical therapist’s opinions and cervical range of motion measurements. Orthopeadic Practice, 30(2), 76–80.

Zoom Encryption. (2020). file:///Users/Owner/Desktop/Zoom%20Encryption%20Whitepaper.pdf

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Published

2021-05-18

How to Cite

Cote, R., Vietas, C., Kolakowski, M., Lombardo, K., Prete, J., & Dashottar, A. (2021). Inter and Intra-Rater Reliability of Measuring Photometric Craniovertebral Angle Using a Cloud-Based Video Communication Platform. International Journal of Telerehabilitation, 13(1). https://doi.org/10.5195/ijt.2021.6346

Issue

Vol. 13 No. 1 (2021)

Section

Research

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