Quantitative measurements of forward head in college-aged students: A conformational study of intra-rater and inter-rater reliability of a novel Posture Measuring Device.

Introduction: Medical professionals frequently encounter forward head postures (FHP) in the treatment of cervical spine pain. In the clinical setting, FHP measurements are often described subjectively using the phrase, "patient demonstrates forward head posture." There are reliable tools that can objectively measure FHP, but they are not frequently used in the clinical setting on a regular basis because the tools are unavailable, inconvenient or overly time-consuming. The objective of this study was to confirm if FHP can be reliably measured using a novel posture-measuring device. The Posture Measuring Device (PMD) was designed to quickly obtain objective measurements of FHP in the outpatient clinical setting. A pilot study demonstrated good to excellent reliability in intra-rater (test-retest) measurements and good interrater reliability using two first-year Doctor of Physical Therapy Students as raters. This study is to confirm that the PMD is able to provide intra-rater and interrater reliability using two physical therapists and two second-year Doctor of Physical Therapy students to obtain FHP measurements.

Methods: Twenty-three college-aged subjects were measured individually using a PMD by a panel of four raters consisting of two physical therapists and two second-year physical therapy students to develop interrater reliability. Each rater measured each subject twice on two separate occasions to obtain a measure of intra-rater (relative) reliability.

Results: Pearson Correlations demonstrate high intra-rater correlation with inconsistent interrater correlation. The average measured Intraclass Correlation Coefficient (ICC) was .822 with a 95% confidence interval indicating a high degree of reliability between the eight measurements performed on each subject. Cronbach's alpha results confirm the ICC findings of strong correlation among the eight raters (α = 0.87).

Discussion And Conclusion: Objective measurement of forward head posture is valuable to document and monitor patient response to treatment. This study identifies a convenient and time-efficient method for measuring forward head in the clinical setting. The PMD demonstrated a high degree of reliability in intra-rater measurements of FHP.