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Kapreli E.1, Argyrou S.1, Diamantis A.1, Kostakis K.1, Tsioutsoumaka M.1, Kanellopoulos A.1, Dimitriadis Z.1,2, Tziouma M.3, Strimpakos N.1,4
1Technological Educational Institution of Sterea Ellada, Physiotherapy, Lamia, Greece, 2Technological Educational Institution of Athens, Physiotherapy, Athens, Greece, 3Physiotherapy Center, Athens, Greece, 4University of Manchester, Manchester, United Kingdom
Background: Assessment of forward head posture (FHP) is a common procedure, especially in patients with chronic neck pain. Although, the static FHP measurement has well been established in literature, the assessment of dynamic FHP, such as during walking, has not yet been investigated. With the availability of inexpensive yet good quality videocameras, video-based two-dimensional (2D) motion analysis is gaining greater attention as a practical tool for use in the clinical setting. 2D video analysis has been purported to identify hip and knee flexion angles during walking or running. Therefore, it would be interesting to develop an analogous reliable protocol in order to assess dynamic FHP.
Purpose: To develop a protocol of assessing dynamic FHP using 2D video analysis and to establish the intra- rater and inter-rater reliability of the measurements.
Methods: Thirty six young healthy volunteers participated (men/women 15/21, age 23.6±7.65 years). Repeated test-retest measurements (three repeated measurements over two sessions with 8-15 days apart between them) from three different physiotherapists were employed to evaluate the intra-rater and inter-rater reliability of forward head posture during walking. Subjects were asked to walk in a normal speed, whereas a 2D sagittal-plane projection angle was obtained using a high speed 2D digital camera at 240 fps. The FHP was determined by calculating the craniovertebral angle (the angle between the line extending from the tragus of the ear to the C7 spinous process and the horizontal line through C7) using the open-license Kinovea 0.8.15 and AutoCAD softwares.
Intraclass correlation coefficients (ICC), standard error of measurement (SEM) and smallest detectable difference (SDD) were calculated to evaluate the within- and between-sessions and raters reliability as well as the measurement errors. Alpha levels were set at .05 for all tests.
Results: Within-session intra-rater ICCs showed excellent reliability and ranged from .89 to .92 for any of the raters in both sessions and between-session intra-rater ICCs were moderate to excellent, ranging from .45 to .91 depending to raters experience. Inter-rater reliability was also very high yielding ICCs > .92 especially in the second session. SEM and SDD values ranged from 1.49° to 1.74° and 8.5%-9.9% respectively for within-session intra-rater reliability and 1.13° to 1.4° and 6.6%-8.3% respectively for inter-rater reliability.
Conclusion(s): The assessment of dynamic FHP has been shown to be a feasible method using a video-based two-dimensional (2D) motion analysis yielding also reliable results with small errors. Raters experience and practice is a prerequisite for reliable and valid measurements.
Implications: The findings of the study showed that assessing the dynamic FHP with the proposed protocol is feasible, inexpensive and reliable.
Funding acknowledgements: The study was self-funded
Topic: Musculoskeletal: spine
Ethics approval: The study was approved by the Ethics Committee of Physiotherapy Department, Technological Educational Institution of Sterea Ellada, Lamia, Greece.
All authors, affiliations and abstracts have been published as submitted.
