Effect of body shape on tragus-to-wall distance in the normal population

Forward flexed posture: reliability and determinants of tragus-to-wall measurement

INTRODUCTION

Forward flexed posture is an impairment in body structure commonly seen among older adults and those with pathologies such as ankylosing spondylitis and osteoporosis. Accurate measurement of forward flexed posture is important as it is related to pain, mobility limitations, and falls. Our purpose was to examine the reliability and determinants of forward flexed posture as indicated by tragus-to-wall (TTW) distance.

METHODS

Twenty healthy younger and 20 healthy older adults were included in this secondary analysis of data from a neck strength study. Measurements included the linear distance of TTW standing naturally and with neck retraction, age, gender, body mass index (BMI), and neck retraction strength. Measurements were performed initially by 2 investigators and by the primary investigator 1 week later. Intraclass correlation coefficients (ICCs) (model 3,1) described relative reliability and Bland-Altman plots characterized absolute reliability. A mixed general linear model examined the determinants for TTW distance.

RESULTS

Good inter-rater (ICC = 0.811-0.878) and test-retest reliability (ICC = 0.853-0.862) were found in both positions. Bland-Altman plots showed that absolute limits of agreement ranged from - 1.9 to +3.8 cm for inter-rater reliability and -2.4 to +2.6 cm for test-retest reliability. Analysis of TTW determinants demonstrated significant differences between neck positions, dichotomous age groups, and BMI groups (p ≤ 0.001). There was no significant difference based on neck strength.

CONCLUSIONS

Our results indicate that TTW distance, measured using a standardized procedure, is a reliable method of quantifying forward flexed posture. TTW distance is greater in relaxed standing, older individuals, and those with greater BMI.

Tragus-to-wall: A systematic review of procedures, measurements obtained, and clinimetric properties

OBJECTIVE

Our purpose was to summarize the literature on the applicability, procedures for performing, and clinimetric findings related to the measurement of tragus-to-wall (TTW) distance.

METHOD

Pubmed, Scopus, and CINAHL databases were systematically searched using the key words "tragus" AND "wall". Articles were examined for information on the participants whose TTW distance was measured, the procedures used for measuring TTW, and findings regarding TTW distances measured and the clinimetric properties of the measurements.

RESULTS

Thirty-nine articles were identified that described use of the TTW test. Most used the test with patients with ankylosing spondylitis. We found evidence for the convergent and known groups validity and reliability of the TTW measurements. Limited support for the responsiveness of TTW measurements was found. Two studies provided normative reference values.

CONCLUSIONS

The TTW test is a simple objective indicator of forward flexed posture supported by research on its validity and reliability. More specific information on responsiveness and age-specific norms would increase the value of this nonspecific postural indicator.

Inclinometric measurement of kyphotic curvature: Description and clinimetric properties

BACKGROUND

Hyperkyphosis is associated with physical impairments, activity limitations, and reduced quality of life. Therefore, a simple, reliable, responsive, and valid clinical measure of dorsal kyphosis would be valuable to clinicians.

OBJECTIVE

To describe a novel procedure for measuring kyphotic curvature-the inclinometric kyphosis measure (IKM)-and provide an estimation of reliability, responsiveness, and validity.

METHODS

During 2 sessions spaced days apart, we used a bubble inclinometer to measure dorsal kyphosis in 68 patients receiving outpatient physical therapy. We also documented occiput-to-wall status and tragus-to-wall distance.

RESULTS

Intra-rater reliability of the IKM was supported by intra-class correlation coefficients (ICC_3,1) of 0.94 and 0.91 for relaxed and cued conditions, respectively. Responsiveness, as indicated by minimal detectable change, was 8.0 and 10.0 degrees under relaxed and cued conditions, respectively. Validity was supported by significant correlations between the IKM and tragus-to-wall and by differences in the IKM between: 1) relaxed and cued conditions; 2) patients who could and could not touch occiput to the wall; and 3) patients who were older versus younger than 50 years of age.

CONCLUSIONS

The IKM is a simple, reliable, responsive, and valid method for assessing posture in patients with musculoskeletal conditions.