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Intra- and inter-rater agreement of PostureScreen

Inter- and intra-rater agreement of static posture analysis using a mobile application
David M. Boland1), Eric V. Neufeld1), Jack Ruddell1), Brett A. Dolezal1), Christopher B. Cooper1)

1) Exercise Physiology Research Laboratory, Departments of Medicine and Physiology, David Geffen School of Medicine at the University of California, Los Angeles: 10833 Le Conte Ave, Los Angeles, California, USA  Journal of Physical Therapy Science Vol. 28 (2016) No. 12 December p. 3398-3402

[Purpose] To determine the intra- and inter-rater agreement of a mobile application, PostureScreen Mobile® (PSM), that assesses static standing posture. 

[Subjects and Methods] Three examiners with different levels of experience of assessing posture, one licensed physical therapist and two untrained undergraduate students, performed repeated postural assessments of 10 subjects, fully clothed or minimally clothed, using PSM on two nonconsecutive days. Anterior and right lateral images were captured and seventeen landmarks were identified on them. Intraclass correlation coefficients (ICCs) were calculated for each of 13 postural measures to evaluate inter-rater agreement on the first visit (fully or minimally clothed), as well as intra-rater agreement between the first and second visits (minimally clothed).

[Results] Eleven postural measures were ultimately analyzed for inter- and intra-rater agreement. Inter-rater agreement was almost perfect (ICC≥0.81) for four measures and substantial (0.60<ICC≤0.80) for three measures during the fully clothed exam. During the minimally clothed exam, inter-rater agreement was almost perfect for four measures and substantial for four measures. Intra-rater agreement between two minimally clothed exams was almost perfect for two measures and substantial for five measures. 

[Conclusion] PSM is a widely available, inexpensive postural screening tool that requires little formal training. To maximize inter- and intra-rater agreement, postural screening using this mobile application should be conducted with subjects wearing minimal clothing. Assessing static standing posture via PSM gives repeatable measures for anatomical landmarks that were found to have substantial or almost perfect agreement. Our data also suggest that this technology may also be useful for diagnosing forward head posture.