Reliability & Validity of PostureScreen
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Inter- and intra-rater agreement of static posture analysis using a mobile application.
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.
J Phys Ther Sci. 2016 Dec;28(12):3398-3402.
Rater reliability and construct validity of a mobile application for posture analysis.
PURPOSE Measurement of posture is important for those with a clinical diagnosis as well as researchers aiming to understand the impact of faulty postures on the development of musculoskeletal disorders. A reliable, cost-effective and low tech posture measure may be beneficial for research and clinical applications. The purpose of this study was to determine rater reliability and construct validity of a posture screening mobile application in healthy young adults.
SUBJECTS AND METHODS: Pictures of subjects were taken in three standing positions. Two raters independently digitized the static standing posture image twice. The app calculated posture variables, including sagittal and coronal plane translations and angulations. Intra- and inter-rater reliability were calculated using the appropriate ICC models for complete agreement. Construct validity was determined through comparison of known groups using repeated measures ANOVA.
RESULTS: Intra-rater reliability ranged from 0.71 to 0.99. Inter-rater reliability was good to excellent for all translations. ICCs were stronger for translations versus angulations. The construct validity analysis found that the app was able to detect the change in the four variables selected.
CONCLUSION: The PostureScreen mobile application has demonstrated strong rater reliability and preliminary evidence of construct validity. This application may have utility in clinical and research settings.
J Phys Ther Sci. 2018 Jan;30(1):31-36
[Abstract] Determining body composition via mobile application may circumvent limitations of conventional methods. However, the accuracy of many technologies remains unknown. This investigation assessed the convergent and concurrent validity of a mobile application (LS) that employs 2-dimensional digital photography (LS2D) and 3-dimensional photonic scanning (LS3D). Measures of body composition including circumferences, waist-to-hip ratio (WHR), and body fat percentage (BF%) were obtained from 240 healthy adults using LS and a diverse set of conventional methods-Gulick tape, bioelectrical impedance analysis (BIA), and skinfolds. Convergent validity was consistently high-indicating these methods vary proportionally and can thus reliably detect changes despite individual measurement differences. The span of the Limits of Agreement (LoA) using LS were comparable to the LoA between conventional methods. LS3D exhibited high agreement relative to Gulick tape in the measurement of WHR, despite poor agreement with individual waist and hip circumferences. In BF%, LS2D exhibited high agreement with BIA and skinfold methods, whereas LS3D demonstrated low agreement. Interestingly, the low inferred bias between LS3D and DXA using existing data suggests that LS3D may have high agreement with dual-energy x-ray absorptiometry. Overall, the suitability of LS2D and LS3D to replace conventional methods must be based on an individual user’s criteria.
Sensors (Basel). 2020 Nov; 20(21): 6165.
PostureScreen as an Outcome Assessment Tool
Are Rotations and Translations of Head Posture Related to Gait and Jump Parameters?
CONCLUSION: We identified statistically significant relationships between various gait and jump functional performance measures and 3D head posture displacements. Our results indicate that studies focusing exclusively on the sagittal plane alignment are not sufficient to capture all possible correlations existing between 3D posture and performance measures; thus, it is recommended that 3D postural assessment approaches, which are now easily performed due to recent advancements in technology, are routinely used for studies evaluating relationships between static body posture and functional performance measures. Head postures as assessed as translations and rotations relative to neutral alignment, have important implications to performance parameters related to gait and jumping. Future studies are needed to further understand these relationships.
J. Clin. Med. 2023, 12, 6211. https://doi.org/10.3390/jcm12196211
Translational & Rotational Postural Aberrations are related to Pulmonary Functions and Skill-Related Physical Fitness Components in Collegiate Athletes
CONCLUSIONS:
Posture parameters, in terms of rotations and translations of the head, thorax, and pelvis, were statistically correlated with physical performance skills and cardiopulmonary function. There were moderate-to-high associations with the cardiopulmonary exercise tests and agility tests, moderate correlations with the vertical jump test, and weak correlations with the YBT. Specifically, we identified several key postures of the head (forward head, lateral translation, and lateral bending), thoracic spine (increased kyphosis and anterior translation), and pelvis (flexion/extension, anterior translation, lateral translation, and lateral bending) that have an influence on athletic skills and cardiopulmonary exercise tests. These specific postures should be considered in future interventional trials as outcome assessments that might influence human performance. Further research is necessary to elucidate the reasons for the correlations found in our sample of young and healthy athletes.
J Clin Med. 2023 Jul 11;12(14):4618. doi: 10.3390/jcm12144618
Is PostureScreen® Mobile app an accurate tool for dentists to evaluate the correlation between malocclusion and posture?
OBJECTIVE: To determine whether PostureScreen® Mobile app is a useful, simple tool that is accessible for dentists to evaluate the correlation between malocclusion and posture.
METHODS: Twenty-nine subjects underwent static and dynamic dental occlusion examinations and a postural exam with PostureScreen® Mobile app, a photographic method. The subjects were divided into groups depending on their static and dynamic occlusion features. The postural parameters were then compared between these groups.
RESULTS: Statistically significant differences (p < 0.05) for some postural parameters were obtained for Angle Class 1 vs. 2 and 3 and for the passive interference group and active premature contacts group during left lateral movement. There were no statistically significant differences regarding protrusion and right lateral movement.
DISCUSSION: Dental occlusion anomalies and posture pathological modifications can be inter-related. PostureScreen® Mobile app might represent a useful tool in the early diagnosis of dental occlusion pathology.
Cranio. 2018 Sep 10:1-7.
Vertebral Malalignment among Male Dentists with Work-related Musculoskeletal Pain in the United Arab Emirates.
AIM: Musculoskeletal pain (MSP) is a highly prevalent and debilitating disorder among dentists, often leading to early retirement. Poor ergonomics in the dental practice not only causes MSP, but can also lead to postural deviations as a result of an imbalance in muscle function. The aim of this study was to observe the relationship between MSP and vertebral deviations among male dentists in the United Arab Emirates (UAE).
MATERIALS AND METHODS: A total of 60 male dentists participated in this cross-sectional study. Standardized Nordic questionnaire (SNQ) was used to record MSP and PostureScreen Mobile® (PSM) application was used to observe postural deviations in the vertebral regions, including the neck, shoulders, upper back, lower back, and hips.
RESULTS: About 83% of participants were suffering from MSP, with the lower back as the most commonly reported region (29%). The pain characteristics reported were chronicity (63%) and dullness (72%). As for postural deviations, the most common site recorded was the neck region (72%). The correlation between the regions of deviation and the regions of pain showed that the shoulder region was more significant than other regions.
CONCLUSION: Musculoskeletal pain and vertebral malalignment are common among practicing dentists, probably because of bad postural habits and lack of awareness. Preventive strategies to minimize the risk of developing these health problems are highly recommended.
CLINICAL SIGNIFICANCE: Work-related MSP (WRMSP) is a significant health problem among dentists and may be linked to the later development of vertebral deviations. Posture screen analysis is a quick, yet objective postural and movement screening tool in which findings can quickly be rendered to prospective dentists, so that custom postural and functional exercises may be correctly practiced.
J Contemp Dent Pract. 2018 Jul 1;19(7):773-777.
Effects of Two Exercise Regimes on Patients with Chiari Malformation Type 1: a Randomized Controlled Trial
This study aims to measure the effects of two different exercise programs on neck pain, proprioception, balance, coordination, posture, and quality of life in patients with Chiari malformation (CM) type 1. Sixteen patients were randomized to two different exercise programs: a tailored exercise protocol for CM (TEP-CM) and cervical spinal stabilization exercises (CSSE). Both exercise programs were implemented by a physiotherapist 3 days a week for 6 weeks. The primary outcome was Neck Disability Index. Secondary outcomes were visual analogue scale for pain, joint position sense error measurement, Berg Balance Scale, Time Up and Go Test, International Coordination Ataxia Rating Scale, PostureScreen Mobile, and Short Form-36. Assessments were done immediately before and after the intervention programs. Both groups showed significant improvement in Neck Disability Index, and some secondary outcome measures (P < 0.05). However, there were no statistical differences in post-intervention changes between the groups (P > 0.05). This is the first study to examine the effects of different exercise programs on symptoms in patients with CM type 1. Our preliminary findings indicate that exercise programs can improve pain, balance, proprioception, posture, coordination, and quality of life in CM type 1. Therefore, exercise should be considered safe, beneficial, and low-cost treatment option for CM type 1 patients without surgical indications.
Cerebellum (2022) https://doi.org/10.1007/s12311-022-01397-1
The preliminary results of physiotherapy scoliosis-specific exercises on spine joint position sense in adolescent idiopathic scoliosis: A randomized controlled trial
Background: It has been observed that there are difficulties in maintaining spinal harmony in the absence of proprioceptive information, which has an important role in achieving postural control in scoliosis. One of the tests used to evaluate proprioceptive mechanisms is joint position reproduction.
Objective(s): The main aim of our study was to investigate the effect of physiotherapy scoliosis-specific exercise (PSSE) on spine joint reposition (JR) sense. The second aim was to determine the effects of PSSE on the angle of trunk rotation (ATR), posture, and deformity perception in adolescent idiopathic scoliosis.
Methods: Twenty-nine patients with adolescent idiopathic scoliosis (mean age 13.79 ± 1.82 years) were randomly allocated to two groups. “Schroth” exercises were applied to the PSSE group for 8 weeks (16 sessions). The control group was placed on the waiting list. Patients’ JR error (dual inclinometer), ATR (scoliometer), posture parameters (PostureScreen Mobile, Posterior Trunk Asymmetry Index, and Anterior Trunk Asymmetry Index), and deformity perception (Walter Reed Visual Assessment Scale [WRVAS]) were assessed at the first session and at the end of 8 weeks.
Results: The initial demographic characteristics, Cobb (thoracal: 19.41 ± 7.03 degrees; lumbar: 20.76 ± 7.24 degrees) and ATR (thoracal: 5.86 ± 3.98 degrees; lumbar: 5.66 ± 3.33 degrees) and clinical test parameters of the groups (JR, posture parameters, and WRVAS) were similar (P > .05). According to the findings, thoracal and lumbar JR error values (P < .05), ATR (P ≤ .001), posture parameters (P ≤ .001), and WRVAS (P = .048) were significantly improved in the PSSE group. Besides, when the groups were compared, a significant difference was found in favor of PSSE except for the deformity perception (P < .05).
Conclusions: Schroth exercises have a positive contribution for improving JR sense of the spine, vertebral rotation, and posture.
Prosthetics and Orthotics International June 7, 2022 – Volume – Issue – 10.1097/PXR.0000000000000136
Body postural realignment in the first 2 months after orthognathic surgery
INTRODUCTION: This study aimed to assess the static posture in patients with Angle Class II and III malocclusions in the first 2 months after orthognathic surgery.
METHODS: Twenty-nine subjects underwent static and dynamic dental occlusion examinations and a postural exam with PostureScreen® Mobile app, a photographic method. The subjects were divided into groups depending on their static and dynamic occlusion features. The postural parameters were then compared between these groups.
RESULTS: Statistically significant differences (p < 0.05) for some postural parameters were obtained for Angle Class 1 vs. 2 and 3 and for the passive interference group and active premature contacts group during left lateral movement. There were no statistically significant differences regarding protrusion and right lateral movement.
DISCUSSION: Dental occlusion anomalies and posture pathological modifications can be inter-related. PostureScreen® Mobile app might represent a useful tool in the early diagnosis of dental occlusion pathology.
Am J Orthod Dentofacial Orthop 2021 Mar;159(3):e281-e290
Reduction of Scheuermann’s deformity and scoliosis using ScoliBrace and a scoliosis specific rehabilitation program: a case report.
{Purpose] There is a paucity of high-quality data pertaining to the conservative management of adult spinal deformity, particularly Scheuermann’s kyphosis. Long-term follow-up data for both treated and untreated Scheuermann’s patients is also lacking. Given that changes in sagittal balance are associated with increased morbidity, and that these changes are increasingly prevalent in the spines of aging populations, it is imperative that potential strategies aimed at reversing or minimizing this type of deformity are explored. As the number of elderly patients in developed countries increases, so does the need for a safe and effective non-surgical management option for patients with spinal deformity/sagittal imbalance. This case study details the influence of ScoliBrace rigid TSLO bracing in combination with a specific rehabilitation program in an adult patient with Kypho-scoliosis. [Participant and Methods] The authors describe a case involving the treatment of a 26-year-old male with Scheuermann’s kyphosis and a lumbar scoliosis. The patient received 12 months of bracing with a supplemental exercise program. The patient was followed for a period of approximately 12 months. Patient progress was assessed using ODI, SRS-22r, NPRS, and radiographic Cobb angle measurements throughout treatment. [Results] The patient presented with an initial ODI score of 18/100, a SRS-22r score of 3.0, and an average NPRS score of 4/10. Initial Cobb angle measurements demonstrated a 79° thoracic kyphosis and a 30° (coronal plane) lumbar scoliosis. At the final assessment, the patient reported an ODI score of 6/100, an SRS-22r score of 3.91, and an average NPRS score of 0/10. The coronal plane Cobb angle measured 63°, and the thoracolumbar scoliosis had reduced to 25°. [Conclusion] The findings from this case study highlight that this type of brace in combination with exercise rehabilitation may be useful for reducing the magnitude of curves and reducing symptoms in patients presenting with adult kypho-scoliosis. Further investigation of this style of treatment is warranted in patients with sagittal plane imbalance.
J Phys Ther Sci. 2019 Feb;31(2):159-165. doi: 10.1589/jpts.31.159. Epub 2019 Feb 7.
A comparison of upper body and limb postures across technology and handheld device use in college students.
[Purpose] People using technology and handheld devices adopt postures of the upper limb and neck that could result in musculoskeletal pathology. Previous research has explored the postures assumed during isolated use of technology devices, such as a smartphone, however a comparison of posture assumed between multiple devices has not been completed. The purpose of this study was to compare the posture of the upper body and limb between handheld devices and technology.
[Participants and Methods] Twenty one healthy college students completed this study. Pictures of participants were taken in a neutral posture and as they performed standard tasks with 3 devices (mobile phone, tablet, laptop). A mobile application calculated sagittal and coronal plane posture variables, which were compared between device conditions with an ANOVA and post-hoc tests.
[Results] Head translation and angulation and shoulder angulation varied significantly between conditions in both planes. Shoulder translation varied significantly between conditions in the sagittal plane. Rib translation varied significantly between conditions in the coronal plane. Tablet use produced postures that were statistically different than the other devices.
[Conclusion] Use of each device altered posture however, frequent, regular use of a tablet may produce greater deleterious effects than regular use of other handheld devices/technology.
J Phys Ther Sci. 2018 Oct;30(10):1293-1300. doi: 10.1589/jpts.30.1293. Epub 2018 Oct 12.
Improving posture to reduce the symptoms of Parkinson’s: a CBP case report with a 21 month follow-up.
[Purpose] To demonstrate the reduction of symptoms related to Parkinson’s disease by improvement in posture. [Participant and Methods] A 59-year-old male patient presented with a prior diagnosis of Parkinson’s. Symptoms included a resting right hand tremor, intermittent ‘freezing episodes’ with gait, mild ataxia with shuffling on toes and bradykinesia assisted with a cane, as well as low back pain and right knee pain. Radiography revealed gross postural and spine deformity. The patient received Chiropractic BioPhysics care including mirror image exercises, spinal traction, spinal adjustments as well as gait rehabilitation. [Results] After 38 treatments over 5 months, the patient had significant improvements in posture alignment as well as gait, balance, hand tremors, low back and knee pains and SF-36 values. A 21 month follow-up revealed the patient had remained essentially well and the initial postural improvements were maintained. [Conclusion] This case demonstrates improvement of various symptoms in a patient with Parkinson’s disease. Since poor posture is a long known clinical manifestation of this disorder, it is proposed that the improvement of posture in these patients may lead to improved outcomes. X-ray use in the diagnosis and management in those with spine deformity is safe and not carcinogenic.
J Phys Ther Sci. 2019 Feb;31(2):153-158. doi: 10.1589/jpts.31.153. Epub 2019 Feb 7.
Physical Exercise and its Role in a Correct Postural Alignment
Summary. This research aims at identifying physical exercise as a game in the physical education lesson on the correct posture of 20 pupils aged 6-9 years. PostureScreen Mobile software has been tested with PostureScreen Mobile software for most subjects (18), particularly chemo, the head, which may lead to deficiencies being installed in the future unless appropriate measures are taken. Thus, for 6 months, subjects were included in a work program, within physical education hours, using motion games and exercises with portable objects. The subjects were tested before and after the application of the work schedules, following the evolution of flexibility at the back (extension). The results recorded at the end of the research showed significant progress in all tests (the motor and those recorded with PostureScreen Mobile), the differences between the initial and final media being statistically significant at a p <0.05, which confirms the validity of our approach. Prophylaxis of physical deficiencies can be accomplished successfully within physical education hours as long as the exercises developed follow the peculiarities of the working group. Abstract. This research aims to identify the effect of physical exercise like dynamic games in physical education class on the correct posture of 20 students aged between 6-9 years. After testing posture through PostureScreen Mobile software, we have been detected in most subjects (18) poor attitudes, especially cyphotic, head forward, issues that could lead to future weaknesses if appropriate measures are taken. Thus, for 6 months, subjects were included in a working program in physical education using dynamic games and exercises with portable objects. Subjects were tested before and after the work programs, aiming at the development of flexibility in the back (extension). The results at the end of the research have shown significant progress in all tests (the test and recorded with PostureScreen Mobile), the initial and final average differences being statistically significant at p <0.05, which confirms the validity of our approach. Prophylaxis of physical deficiencies can be successfully achieved in the physical education class as long as we develop exercises that are specific to the subjects.
Postural problems and pain in patients with juvenile idiopathic arthritis
Background: Juvenile idiopathic arthritis (JIA) is a chronic autoimmune condition of unknown etiology. JIA combine with joint pain and inflammation that affects children who are less 16 years of age and continue more 6 weeks. JIA is a chronic inflammatory disease resulting in joints arthritis, pain and deformities. Disturbances in the posture may occur before deformities in patients with JIA. In some cases, pain can also lead to postural deterioration. Postural control is the ability to maintain equilibrium in a gravitational field by keeping or returning the center of body mass over its base of support.
Objectives: The first purposes of this study was to assessed postural problems in patients with JIA and compared with healthy peers. The other objective was to examine the pain relationship with postural problems.
Methods: 19 patients with JIA aged 5–17 years (13 girls and 6boys) diagnosed according to ILAR classification criteria and 19 healthy controls were enrolled in this cross-sectional study. “PostureScreen Mobile®” was used to evaluate static posture, “11-point Numeric Analogue Scale (NRS)” was used to evaluate the pain (during rest, activity and exercise). The PostureScreen Mobile® an application facilitates the assessment of posture in a variety of settings. Anterior (Head, Shoulders, Ribcage, Hips) and lateral translation (Head, Shoulders, Hips, Knees) were recorded and calculated as a total score for anterior and lateral. For statistical analysis SPSS Version 21.0 program was used.
Results: The mean age and body mass index of patients and healthy control were 10.79±3.59 and 10.68±2.86 years, 17.05±3.88, and 18.50±2.49 kg/m2, respectively. The mean of NRS-rest, activity and exercise scores were 1.18±1.42, 3±2.64 and 1.91±2.02, respectively. As a result of postural assessment for patients and healthy control, the mean of anterior translation scores was significantly higher in patients with JIA than healthy control (p=0.014) (table 1). Two significant correlations with NRS-rest between hip anterior translation (r=0.375, p=0.029) and ribcage anterior translation (r=-0.534, p=0.027) were found.
Correlation between posture and balance in 19-20-year-old Albanian students
Postural control (or balance) can be defined statically as the ability to maintain a base of support with minimal movement, and dynamically as the ability to perform a task while maintaining a stable position (C. J. Winstein, E. R). The development of equilibrium capacities is known to be critical for both the acquisition and the control of motor skills (Massion. J., 1992). Since balance control is an essential component for the optimal functioning of any locomotors system (Winter DA et al., 1990), gait and balance control together needs to be investigated in order to correct inappropriate performance and prevent injury. This study focus was to investigate the correlation between posture and balance changes in normal and healthy adolescent’s (boys and girls). A total of 61 subjects (21 females and 40 males) aged 19-20-year-old students, participated on this study. We have conducted a postural screening, which included digital photography in 4 plans (anterior view, right lateral view, posterior view, left lateral view) and postural evaluation with Posture Screen Mobile program were done, was also performed a set of 4 balance tests BT (Balance Test) a) (Rom EO); b) (Rom EC); c) (SemTanEO); d) (SemTanEC); e) (TanEO); f) (TanEC), on Leonardo Mechanography Platform. Statistical analyses were performed using IBM SPSS Statistics version 2.0. Results shows that generally all subjects have a good balance and orientation level in all tests (with open and closed eyes). Also based on the results we can say that the correlation between posture and balance changes in ages 19-20 it’s really relevant. The posture screening and the analysis of balance are of great importance in studies trying to understand the ageing process. Also differences between genders are of great interest especially if a proper exercise program focused in postural improvement can be implemented.
Journal of Human Sport and Exercise. 2016, 11(Proc1): S245-S250. doi:10.14198/jhse.2016.11.Proc1.16
PostureCo, Inc. software is protected under US Patent No. 8,721,567, US Patent No. 9,788,759, and US Patent No. 9,801,550 with other Patents Pending Internationally