Interrater and Intrarater Reliability in the Measurement of Kyphosis in Postmenopausal Women With Osteoporosis Radiographic measures of thoracic kyphosis in osteoporosis: Cobb and vertebral centroid angles Clinical measurement of the thoracic kyphosis. A study of the intra-rater reliability in subjects with and without shoulder pain Prediction of thoracic kyphosis using the Debrunner kyphometer. Development and validation of the Liverpool infant bronchiolitis severity score: a research protocol. Use of Condition-Specific Patient-Reported Outcome Measures in Clinical Trials among Patients with Wrist Osteoarthritis: A Systematic Review Measurement of Thoracic and Lumbar Fracture Kyphosis: Evaluation of Intraobserver, Interobserver, and Technique Variability A new skin-surface device for measuring the curvature and global and segmental ranges of motion of the spine: reliability of measurements and comparison with data reviewed from the literature Postural taping decreases thoracic kyphosis but does not influence trunk muscle electromyographic activity or balance in women with osteoporosis.
Study Design . A reliability study was performed using repeated r and om measurements involving three observers , 26 subjects and three instruments . Objectives . To determine the most reliable , cost‐effective , noninvasive , and clinical ly feasible method of measuring spinal kyphosis .  Summary of Background Data . The most clinical ly useful , noninvasive and reliable method of measuring postural deformity in spinal osteoporosis ( kyphosis ) remains unqualified . Despite traditional use of costly , invasive roentgenographs for the evaluation of spinal kyphosis , the reliability of this method remains question able . Methods . Twenty‐six postmenopausal women with known bone mineral density and a diagnosis of osteoporosis were recruited from the Osteoporosis Program at Women 's College Hospital , Toronto , Canada . Noninvasive measurements of thoracic kyphosis were obtained by three trained examiners using the DeBrunner 's kyphometer and the flexicurve ruler . The intrarater and interrater reliability of and between each method was compared , using roentgenographic films obtained in the sagittal plane . Spinal posture was classified according to the method of Itoi ( 1990 ) . Statistical computations were performed using SAS statistical software . Results . Consistent measurements were obtained with the  DeBrunner 's kyphometer  and the flexicurve ruler by each observer , according to the results of critical two‐way analysis of variance ( Intraclass Correlation Coefficient 2,1 ) . Measurements in two subgroups , healthy backs ( n = 11 ) and rounded backs ( n= 13 ) , showed consistent use of each noninvasive instrument with some examiner preference for specific tools . There was marginally better intrarater and interrater reliability using the DeBrunner 's kyphometer compared with that obtained with the flexicurve ruler . Two‐way analysis of variance ( Intraclass Correlation Coefficient 2,1 ) of collapsed data showed no significant difference in the reliability of the kyphometer , flexicurve ruler , or roentgenographs in the measurement of thoracic kyphosis . Conclusions . The flexicurve ruler and DeBrunner 's kyphometer had the closest agreement in the measurement of spinal kyphosis . The kyphometer demonstrated the least variation in intrarater and interrater reliability when compared with the flexicurve ruler and roentgenographs . The flexicurve ruler permits qualitative assessment of posture , however , and is the most costeffective instrument . The results of this study challenge the traditional belief that roentgenographic analysis is the best method for evaluating spinal kyphosis . The DeBrunner 's kyphometer and flexible ruler may represent viable , cost‐effective and noninvasive alternatives to roentgenographic evaluation of spinal kyphosis ObjectiveS everal measures can quantify thoracic kyphosis from radiographs , yet their suitability for people with osteoporosis remains uncertain . The aim of this study was to examine the validity and reliability of the vertebral centroid and Cobb angles  in people with osteoporosis . Design and patients  Lateral radiographs of the thoracic spine  were captured in 31 elderly women with osteoporosis .  Thoracic kyphosis was measured globally ( T1–T12 ) and regionally ( T4–T9 ) using Cobb and vertebral centroid angles . Multisegmental curvature was also measured by fitting polynomial functions to the thoracic curvature profile . Canonical and Pearson correlations were used to examine correspondence ; agreement between measures was examined with linear regression . Results Moderate to high intra- and inter-rater reliability was achieved ( SEM = 0.9–4.0 ° ) . Concurrent validity of the simple measures was established against multisegmental curvature ( r = 0.88–0.98 ) . Strong association was observed between the Cobb and centroid angles globally ( r = 0.84 ) and regionally ( r = 0.83 ) . Correspondence between measures was moderate for the Cobb method r = 0.72 ) , yet stronger for the centroid method ( r = 0.80 ) . The Cobb angle was 20 % greater for regional measures due to the influence of endplate tilt . Conclusions Regional Cobb and centroid angles are valid and reliable measures of thoracic kyphosis in people with osteoporosis . However , the Cobb angle is biased by endplate tilt , suggesting that the centroid angle is more appropriate for this population Background Clinical sagittal plane assessment of the thoracic kyphosis angle is considered an essential component of the postural examination of patients presenting with upper body pain syndromes . Cervical headaches and conditions involving the shoulder , such as subacromial pain syndrome , have all been associated with an increase in the thoracic kyphosis . Concomitantly a decrease in the thoracic kyphosis as a result of a stretching and strengthening rehabilitation programme is believed to be associated with a reduction in symptoms and pain and improvement in function . Clinicians generally measure the sagittal plane kyphosis angle visually . There is no certainty that this method is reliable or is capable of measuring angular changes over time or in response to intervention . As such a simple and reliable clinical method of measuring the thoracic kyphosis would enable clinicians to record this information . The aim of this investigation was to determine the intra-tester reliability of measuring the thoracic kyphosis angle using a clinical method Methods Measurements were made in 45 subjects with and 45 subjects without upper body symptoms . Measurements were made with the subjects in relaxed st and ing . Two gravity dependent inclinometers were used to measure the kyphosis . The first was placed over the region of the 1st and 2nd thoracic spinous processes . The other , over the region of the 12th thoracic and 1st lumbar spinous processes . The angle produced by each inclinometer was measured 3 times in succession . Each set of 3 measurements was made on two occasions ( separated by a minimum of 30 minutes and additional data collection involving 46 further measurements of posture and movement on the same and an additional subject before the thoracic kyphosis measurements were re-measured ) by one rater . The reliability of the measurements was analyzed using 2-way ANOVA intraclass correlation coefficients ( ICC ) , 95 % confidence intervals ( CI ) and st and ard error of measurement ( SEM ) for precision , for a single measurement [ ICC(single ) ] and the average of 3 measures [ ICC(average ) ] . The assessor remained ' blinded ' to data input and the measurements were staggered to reduce examiner bias . Results The measurement of the thoracic kyphosis as used in this investigation was found to have excellent intra-rater reliability for both subjects with and without symptoms . The ICC(single ) results for the subjects without symptoms were , .95 ; ( 95 % CI .91-.97 ) . The corresponding ICC(average ) results were ; .97 ; ( 95 % CI .95-.99 ) . The results for the subjects with symptoms were ; 93 ; ( 95 % CI .88-.96 ) , for ICC(single ) and for ICC(average ) ; .97 ; ( 95 % CI .94-.98 ) . The SEM results for subjects without and with symptoms were 1.0 ° and 1.7 ° , respectively . Conclusions The findings of this immediate test-retest reliability study suggest that the clinical measurement of the thoracic kyphosis using gravity dependent inclinometers demonstrates excellent intra-rater reliability . Additional research is required to determine the inter-rater reliability of this method .Trial registration National Research Register : The Debrunner kyphometer is an accepted tool for detecting and evaluating  thoracic kyphosis .  This prospect i ve study was conducted to create a mathematical formula that provides , with high approximation , the roentgenographic angle of thoracic kyphosis ( T4-T12 ) using only the kyphometer . Several clinical ( kyphometer value , age , and sex ) and radiographic ( Cobb angle [ T4-T12 ] ) parameters from 90 consecutively screened adolescents ( 44 male and 46 female ) were correlated using simple and multiple linear regression analyses . The reliability of measurement using the Debrunner kyphometer was high . The kyphometer value was strongly correlated with the roentgenographically measured thoracic Cobb angle ( simple linear regression analysis ; probability range , 0.0026 to 0.0002 ) . There was no correlation between age or sex and thoracic kyphosis . The predicted kyphosis angle using the kyphometer and the mathematic formula was 44.66 degrees + /- 2.68 degrees , ( range 27 to 62 degrees ) , and the real roentgenographic kyphosis angle was 47.5 degrees + /- 3.53 degrees , ( range , 24 to 70 degrees ) . The kyphometer and formula were more reliable and accurate when kyphosis less than 50 degrees was measured . In this study , the authors constructed a mathematical formula that accurately provides the roentgenographic T4-T12 kyphosis angle in adolescents using only the Debrunner kyphometer with a deviation of less than 3 degrees . The authors recommend that all physicians engaged in kyphosis screening programs use the kyphometer combined with the recently constructed simple mathematic formula . This method will reduce the cost of school screening programs , overdiagnoses , and unnecessary exposure of adolescents to irradiation AIM To develop and vali date a  bronchiolitis severity scoring instrument  for use by nurses and other healthcare professions . BACKGROUND Bronchiolitis is a viral lower respiratory tract infection of infancy . In industrialized countries , admission rates have increased over the last decade with up to 3 % of all infants born being admitted to hospital . A small number of these hospitalized infants will require admission to critical care for either invasive or non-invasive ventilation . During the seasonal epidemic , the number of unplanned admissions to critical care with bronchiolitis substantially increases . DESIGN We will use a mixed methods study design . METHODS We will use scale development and psychometric methods to develop a scoring instrument and to test the instrument for content , construct and criterion validity and reliability in several different clinical locations . This study protocol has been review ed and approved by the NHS National Research Ethics Service , January 2011 . DISCUSSION There is an urgent need to develop a valid and reliable severity scoring instrument sensitive to clinical changes in the infant , to facilitate clinical decision-making and help st and ardize patient care . Furthermore , a valid and reliable scoring instrument could also be used as a proxy patient-reported outcome measure to evaluate the efficacy of clinical interventions in r and omized controlled trials Background . This paper aim ed to identify condition-specific patient-reported outcome measures used in clinical trials among people with wrist osteoarthritis and summarise empirical peer- review ed evidence supporting their reliability , validity , and responsiveness to change . Methods . A systematic review of r and omised controlled trials among people with wrist osteoarthritis was undertaken . Studies reporting reliability , validity , or responsiveness were identified using a systematic reverse citation trail audit procedure . Psychometric properties of the instruments were examined against predefined criteria and summarised . Results . Thirteen clinical trials met inclusion criteria . The most common patient-reported outcome was the disabilities of the arm , shoulder , and h and question naire ( DASH ) . The DASH , the  Michigan H and Outcomes Question naire ( MHQ ) , the  Patient Evaluation Measure ( PEM ) , and the  Patient-Reported Wrist Evaluation ( PRWE ) had evidence supporting their reliability , validity , and responsiveness . A post-hoc review of excluded studies revealed the AUSCAN Osteoarthritis H and Index as another suitable instrument that had favourable reliability , validity , and responsiveness . Conclusions . The DASH , MHQ , and AUSCAN Osteoarthritis H and Index instruments were supported by the most favourable empirical evidence for validity , reliability , and responsiveness . The PEM and PRWE also had favourable empirical evidence reported for these elements . Further psychometric testing of these instruments among people with wrist osteoarthritis is warranted Study Design . Statistical analysis of various measurement techniques for thoracolumbar burst fracture kyphosis on lateral radiograph . Objective . To determine the most reliable measurement technique . Summary of Background Data . The treatment of thoracic and lumbar burst fractures involves many factors , including the degree of result ant kyphosis . Although various methods have been described , no study has directly compared these methods for reliability and reproducibility . Methods . Fifty lateral radiographs of thoracic and lumbar burst fractures were r and omly selected and measured on two separate occasions by three spine surgeons using five different measurement techniques .  Radiograph quality , fracture type , and the center beam location were determined . Statistical analysis included analysis of variance for repeated measures and analysis of variance using a generalized linear model . Results . Intraclass correlation coefficients were most consistent for Method 1 ( rho = 0.83–0.94 ) followed by Method 4 ( rho = 0.65–0.89 ) and Method 5 ( rho = 0.73–0.85 ) . Intraobserver agreement ( % of repeated measures within 5 ° of the original measurement ) ranged between 72 % and 98 % for all techniques for all three observers , with Method 1 showing the best agreement ( 84%–98 % ) . Paired comparisons between observers varied considerably with interobserver reliability correlation coefficients ranging from 0.52 to 0.93 . Method 1 showed the highest interobserver reliability coefficient ( 0.81 , range 0.71–0.93 ) followed by Method 5 ( 0.71 , range 0.68–0.75 ) . Method 1 also had the highest percentage of agreement within categories ( 90 % within 5 ° ) . Conclusions . Method 1 ( measuring from the superior endplate of the vertebral body one level above the injured vertebral body to the inferior endplate of the vertebral body one level below ) showed the best intraobserver and interobserver reliability overall There is an increasing awareness of the risks and dangers of exposure to radiation associated with repeated radiographic assessment of spinal curvature and spinal movements . As such , attempts are continuously being made to develop skin-surface devices for use in examining the progression and response to treatment of various spinal disorders . However , the reliability and validity of measurements recorded with such devices must be established before they can be recommended for use in the research or clinical environment . The aim of this study was to examine the reliability of measurements using a newly developed skin-surface device , the Spinal Mouse .  Twenty healthy volunteers ( mean age 41±12 years , nine males , 11 females ) took part . On 2 separate days , spinal curvature was measured with the Spinal Mouse during st and ing , full flexion , and full extension ( each three times by each of two examiners ) . Paired t-tests , intraclass correlation coefficients ( ICC ) , and st and ard errors of measurement ( SEM ) with 95 % confidence intervals were used to characterise between-day and interexaminer reliability for : st and ing sacral angle , lumbar lordosis , thoracic kyphosis , and ranges of motion ( flexion , extension ) of the thoracic spine , lumbar spine , hips , and trunk . The between-day reliability for segmental ranges of flexion was also determined for each motion segment from T1 - 2 to L5-S1 . The majority of parameters measured for the ‘ global regions ’ ( thoracic , lumbar , or hips ) showed good between-day reliability . Depending on the parameter of interest , between-day ICCs ranged from 0.67 to 0.92 for examiner 1 ( average 0.82 ) and 0.57 to 0.95 for examiner 2 ( average 0.83 ) ; for 70 % of the parameters measured , the ICCs were greater than 0.8 and generally highest for the lumbar spine and whole trunk measures . For lumbar spine range of flexion , the SEM was approximately 3 ° . The ICCs were also good for the interexaminer comparisons , ranging from 0.62 to 0.93 on day 1 ( average 0.81 ) and 0.70 to 0.94 on day 2 ( average 0.86 ) , although small systematic differences were sometimes observed in their mean values . The latter were still evident even if both examiners used the same skin markings . For segmental ranges of flexion , the ICCs varied between vertebral levels but overall were lower than for the global measures ( average for all levels in all analyses , ICC 0.6 ) . For each examiner , the average between-day SEM over all vertebral levels was approximately 2 ° . For ‘ global ’ regions of the spine , the Spinal Mouse delivered consistently reliable values for st and ing curvatures and ranges of motion which compared well with those reported in the literature . This suggests that the device can be reliably implemented for in vivo studies of the sagittal profile and range of motion of the spine . As might be expected for the smaller angles being measured , the segmental ranges of flexion showed lower reliability . Their usefulness with regard to the interpretation of individual results and the detection of ‘ real change ’ on an individual basis thus remains question able . Nonetheless , the group mean values showed few between-day differences , suggesting that the device may still be of use in providing clinical ly interesting data on segmental motion when examining groups of individuals with a given spinal pathology or undergoing some type of intervention BACKGROUND Greater thoracic kyphosis is associated with increased biomechanical loading of the spine which is potentially problematic in individuals with osteoporotic vertebral fractures . Conservative interventions that reduce thoracic kyphosis warrant further investigation . This study aim ed to investigate the effects of therapeutic postural taping on thoracic posture . Secondary aims explored the effects of taping on trunk muscle activity and balance . METHODS Fifteen women with osteoporotic vertebral fractures participated in this within-participant design study . Three taping conditions were r and omly applied : therapeutic taping , control taping and no taping .  Angle of thoracic kyphosis was measured after each condition . Force plate-derived balance parameters and trunk muscle electromyographic activity ( EMG ) were recorded during three static st and ing tasks of 40s duration . RESULTS There was a significant main effect of postural taping on thoracic kyphosis ( p=0.026 ) , with a greater reduction in thoracic kyphosis after taping compared with both control tape and no tape . There were no effects of taping on EMG or balance parameters . CONCLUSIONS The results of this study demonstrate that the application of postural therapeutic tape in a population with osteoporotic vertebral fractures induced an immediate reduction in thoracic kyphosis . Further research is needed to investigate the underlying mechanisms associated with this decrease in kyphosis
The strongest levels of evidence for reliability exists in support of the Debrunner kyphometer , Spinal Mouse and Flexicurve index , and for validity supports the arcometer and Flexicurve index .
BACKGROUND A wide array of instruments are available for non-invasive thoracic kyphosis measurement .
Guidelines for selecting outcome measures for use in clinical and research practice recommend that properties such as validity and reliability are considered .
This systematic review reports on the reliability and validity of non-invasive methods for measuring  thoracic kyphosis .