Reliability and accuracy of visual assessment of static upright posture.

Item

Title
Reliability and accuracy of visual assessment of static upright posture.
Author(s)
Pattyn, E
Abstract
Title: Reliability and accuracy of visual assessment of the static upright posture. Introdnction: Postural evaluation routinely includes visual assessment of anatomical landmarks. For osteopaths and other manual practitioners, locating landmarks is important as it informs clinical reasoning in order to generate a diagnosis and treatment plan. Despite the common use of this technique, no study has ever assessed its reliability and validity. The aims of this study were: I) to measure inter- and intra- rater reliability of visually rating the A/P location of anatomical landmarks with respect to an imaginary vertical reference; 2) to see if inter-rater reliability isincreased when marking the landmarks; 3) to investigate if inter-rater reliability is different for individual landmarks; and 4) to measure the validity of this technique. Methods: Ethical approval to conduct the study was obtained from the ESO Research Ethics Committee. 40 lateral view photographs of 30 subjects were inserted into an online survey which included 20 photos without markers, 10 repetitions of these and 10 photos with markers placed on the lateral femoral epicondyle, the greater trochanter, the mastoid process and the acromion. Forty-eight osteopaths visually assessed the position of these landmarks with respect to an imaginary vertical line going through a reference marker placed anterior to the lateral malleolus.
Correct location of landmarks (i.e. the gold standard) was obtained by drawing the real vertical line through the reference marker. The data was analysed using AC I and Kendall's tau-B correlation coefficient and reported with 95% CI's and p-values respectively. Acceptable reliability and accuracy wee set for ACI > 0.40 and p 0.05 respectively Results: AC 1 value for inter-rater reliability was _fair' (AC I = 0.342; 95% CI= 0.279 : 0.404) for the photos without markers and _moderate' (ACI= 0.700; 95% CI= 0.596 : 0.805) for those with markers. AC I for inter-rater reliability was not significantly different for individual landmarks on both the photos with and without markers. AC I results for intra-rater agreement of the photos without markers ranged from _poor' (AC I = 0.160) to _ substantial' (AC I = 0.896) with a _fair' median (AC I= 0.522). Tau-
B for measuring accuracy of rating the photos with markers ranged from _weak' (TB=-0.070) to _low' (TB= 0.466) with a _low' median (TB= 0.327; p= 0.1 04). Discussion: Reliability of visual assessment of anatomical landmarks was only _fair' and its accuracy _low'. These results challenge the use of this technique in the clinical examination process. Inter-rater reliability was significantly increased and reached clinically acceptable agreement when markers were used to highlight
anatomical landmark position. This suggests that there is subjectivity related to identifying landmark location and questions the ability to teach such skills in an educational setting. Intra-rater agreement was generally clinically acceptable, however individually limited to 33/48 raters. On a hypothetical next occasion only 6/48 examiners are likely to again reach acceptable reliability because the lower end of their CI was above 0.40. Conclusion: A/P observation of landmark location is not reliable nor accurate. The application of this technique for diagnostic purposes should be re-evaluated.
presented at
European School of Osteopathy
Date Accepted
2011
Date Submitted
22.1.2013 16:23:36
Type
osteo_thesis
Language
English
Submitted by:
62
Pub-Identifier
15294
Inst-Identifier
1229
Keywords
Posture; visual assessment.
Recommended
0
Item sets
Thesis

Pattyn, E, “Reliability and accuracy of visual assessment of static upright posture.”, Osteopathic Research Web, accessed May 17, 2024, https://www.osteopathicresearch.com/s/orw/item/771