Inter- and intra-rater agreement of static posture analysis using a mobile application

Utility of a Neuromuscular Activation Exercise Protocol on Surgeon Posture

BACKGROUND

Surgeons are at risk for musculoskeletal disorders from ergonomic strain in the operating room. These deficits may stem from neuromuscular control deficits. Neuromuscular activation exercises (NMEs) may strengthen the brain-muscle connection. This study aimed to assess the utility of a surgeon-oriented NME protocol on posture.

METHODS

Surgeons, operating room staff, and medical students completed a professionally established NME routine. An electronic application, PostureScreen®, assessed participants' posture. A long-term cohort was assessed before and after a 2 to 6-week routine. A short-term cohort was assessed immediately before and after completion. All participants additionally completed a postintervention survey.

RESULTS

After intervention, the short-term cohort (n = 47) had significantly reduced frontal and sagittal postural deviation (P < 0.05). A significant decrease in effective head weight was additionally demonstrated with decreased neck flexion and increased cerebral-cervical symmetry (P < 0.05).The long-term cohort (n = 6) showed a significant postintervention decrease in lateral and anterior shoulder translation (P < 0.05). Total anterior translational deviations demonstrated trend-level decrease (P = 0.078). This demonstrates that after intervention, participants' shoulders were more centered with the spine as opposed to shifted right or left. Survey results showed participants favored exercises that immediately brought relief of tension.

CONCLUSIONS

A decrease in postural deviations associated with NME in both cohorts demonstrates NME as a potential mechanism to protect surgeon musculoskeletal health and improve well-being. Survey results demonstrate areas of refinement for NME protocol design.

Two Methods of Forward Head Posture Assessment: Radiography vs. Posture and Their Clinical Comparison

Background: Forward head posture (FHP) and altered cervical lordotic curvatures are common spine displacements often associated with neck pain and disability. Two primary categories for determining FHP exist: radiographic and postural measurements. Methods: This study investigated the correlation between the craniovertebral angle (CVA), the radiographically measured C2-C7 sagittal vertical axis (SVA), and cervical lordosis (absolute rotation angle: ARA C2-C7) in a sample of participants with chronic myofascial pain (CMP). In 120 participants, we performed both a postural measurement of the CVA and a lateral cervical radiograph, where the C2-C7 SVA and ARA C2-C7 were measured. A linear-regression R2 value to assess the correlation between the CVA, C2-C7 SVA, and ARA C2-C7 was sought. Results: A statistically significant weak linear fit was identified (Spearman's r = 0.549; R2 = 0.30, p < 0.001) between the CVA and C2-C7 SVA, having considerable variation between the two measures. A statistically significant linear fit (very weak) was identified for the lordosis ARA C2-C7 and the CVA: Spearman's r = 0.524; R2 = 0.275; p < 0.001. A value of 50° for the CVA corresponded to a value of 20 mm for the C2-C7 SVA on an X-ray. Conclusion: While the CVA and radiographic C2-C7 SVA are weakly correlated in an individual, they seem to represent different aspects of sagittal cervical balance. The CVA cannot replace radiographically measured cervical lordosis. We recommend that more emphasis be given to radiographic measures of sagittal cervical alignment than the CVA when considering patient interventions.

Comparison of the Effects of Two Different Exercise Programs on Lower Limb Functions, Posture, and Physical Activity in Office Workers Working at Home and in Office Alternately: A Randomized Controlled Trial

OBJECTIVE

The aim of this study was to compare the effects of online functional exercises and posture exercises on lower limb functions, posture, and physical activity in office workers working at home and in office alternately during the COVID-19 pandemic.

DESIGN

Forty individuals were included in the study and were randomized into two groups: group I (functional exercise group, 20 participants) and group II (posture exercise group, 20 participants). The exercises programs were performed online for 2 days/in a week/8 wk. Lower limb functions, posture, and physical activity were evaluated before and after the exercise program.

RESULT

Significant improvement was obtained in lower limb functions (muscular endurance, balance, and functional capacity), posture, and physical activity in group I, while significant improvement was obtained in balance and functional capacity in group II after treatment. The change in scores of lower limb functions, posture, and physical activity after treatment was statistically superior in group I compared with group II ( P < 0.05).

CONCLUSIONS

It was found that both online exercise programs provided effective results in office workers working at home and in office alternately due to the COVID-19 pandemic, but the functional exercise program had superior effects on lower limb functions, posture, and physical activity compared with the posture exercise program.

Correlation between scapular alignment and upper extremity function in children with hemiparetic cerebral palsy

OBJECTIVES

To investigate the relationship between scapular alignment and upper extremity function.

METHODS

Eighty-five children (63 boys and 22 girls) with spastic hemiplegic cerebral palsy aged 3 to 6 years were included in the study. Scapular upward rotation was assessed using Postural Zone software, and upper extremity function was assessed using the Pediatric Arm Function Test.

RESULTS

There was a significant difference (p = .0001) in the degree of upward scapular rotation between less affected and affected sides (-41.78 ± 4.87 and -26.42 ± 6.34, respectively). There was a significant difference (p = .0001) between the function of the upper extremity of the affected side and the less affected sides (48.15 ± 14.37, 62.1 ± 6.62, respectively). Pearson Correlation Coefficient (r) was calculated, and there was a strong negative significant correlation between the degree of scapular upward rotation of the affected side, a unilateral score of the affected side, and the total score of the Pediatric Arm Function Test (r = -0.976, p = .0001 and r = -0.973, p = .0001, respectively). The correlation between symmetry index and total score of the Pediatric Arm Function Test was a strong positive significant correlation (r = 0.946, p = .0001).

CONCLUSION

The degree of upward scapular rotation was less on the affected side. Scapular alignment and symmetry may contribute to upper extremity function in children with hemiplegic cerebral palsy. Clinically, correction of scapular deviations may be considered in the rehabilitation program for children with hemiplegic cerebral palsy. This study suggests further experimental studies to find the cause and effect.

Are Rotations and Translations of Head Posture Related to Gait and Jump Parameters?

This study assessed the relationship between head posture displacements and biomechanical parameters during gait and jumping. One hundred male and female students (20 ± 3 yrs) were assessed via the PostureScreen Mobile® app to quantify postural displacements of head rotations and translations including: (1) the cranio-vertebral angle (CVA) (°), (2) anterior head translation (AHT) (cm), (3) lateral head translation in the coronal plane (cm), and (4) lateral head side bending (°). Biomechanical parameters during gait and jumping were measured using the G-Walk sensor. The assessed gait spatiotemporal parameters were cadence (steps/min), speed (m/s), symmetry index, % left and right stride length (% height), and right and left propulsion index. The pelvic movement parameters were (1) tilt symmetry index, (2) tilt left and right range, (3) obliquity symmetry index, (4) obliquity left and right range, (5) rotation symmetry index, and (6) rotation left and right range. The jump parameters measured were (1) flight height (cm), (2) take off force (kN), (3) impact Force (kN), (4) take off speed (m/s), (5) peak speed (m/s), (6) average speed concentric phase (m/s), (7) maximum concentric power (kW), (8) average concentric power (kW) during the counter movement jump (CMJ), and (9) CMJ with arms thrust (CMJAT). At a significance level of p ≤ 0.001, moderate-to-high correlations (0.4 < r < 0.8) were found between CVA, AHT, lateral translation head, and all the gait and jump parameters. Weak correlations (0.2 < r < 0.4) were ascertained for lateral head bending and all the gait and jump parameters except for gait symmetry index and pelvic symmetry index, where moderate correlations were identified (0.4 < r < 0.6). The findings indicate moderate-to-high correlations between specific head posture displacements, such as CVA, lateral head translation and AHT with the various gait and jump parameters. These findings highlight the importance of considering head posture in the assessment and optimization of movement patterns during gait and jumping. Our findings contribute to the existing body of knowledge and may have implications for clinical practice and sports performance training. Further research is warranted to elucidate the underlying mechanisms and establish causality in these relationships, which could potentially lead to the development of targeted interventions for improving movement patterns and preventing injuries.

Translational and Rotational Postural Aberrations Are Related to Pulmonary Functions and Skill-Related Physical Fitness Components in Collegiate Athletes

This study assessed the relationship between body posture displacements, cardiopulmonary exercise testing (CPET), and skill-related physical fitness tests. One hundred male (60%) and female collegiate athletes (22.2 ± 4 yrs) with normal body mass indexes (BMI up to 24.9) were assessed via the PostureScreen Mobile^® app to quantify postural displacements such as head, thorax, and pelvis rotations and translations. CPET and physical performance tests, including the agility t-test, vertical jump test, stork static balance test (SSBT), and dynamic Y-balance test (YBT), were performed. Spearman correlation (r) and p-values are reported. The postural parameters were found to have moderate-to-high associations with the CPET and agility test, moderate correlations with the vertical jump test and SSBT (head and pelvic postures only), and weak correlations with the YBT. As the postural parameters were more asymmetric, both the CPET and performance skills scores were worse. For example: (1) a medium positive correlation was found between cranio-vertebral angle (CVA) and the vertical jump test (r = 0.54; p-value < 0.001) and SSBT (r = 0.57; p-value < 0.001), while a strong negative correlation was found between CVA and the agility test (r = -0.86; p-value < 0.001). (2) A strong positive correlation was found between CVA and oxygen uptake efficiency slope, load watts VO2 at VT, VO2/kg, and load watts at the respiratory compensation point (RCP) (r = 0.65 and r = 0.71; p < 0.001). Conversely, a significant negative correlation was found between CVA and VE/VO2 at VT (r = -0.61; p < 0.001). Postural rotations and translations of the head, thorax, and pelvis were statistically correlated with the physical performance skills and CPET in the young collegiate athletes. There were moderate-to-high associations with cardiopulmonary functions and the agility tests, moderate correlations with the vertical jump test, and weak correlations with the YBT. Postural alignment may be important for optimal physical performance and optimal cardiopulmonary function. Further research is necessary to elucidate the reasons for these correlations found in our sample of young and healthy athletes.

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.

Comparing body posture and postural control in children with intellectual disability and dyslexia to typically developing children using technology‑based assessments

Background/Aims

Children with intellectual disability and dyslexia have poor academic and behavioural skills related to social participation, as well as poor motor skills compared to typically developing children. Most training programmes for these children focus on the academic and behavioural aspects of special education, overlooking musculoskeletal and motor development needs. The aim of this study was to investigate body posture and postural control in children with intellectual disability and dyslexia compared to typically developing children using technology-based assessments.

Methods

A total of 77 children (36 with dyslexia, 21 with intellectual disability and 20 typically developing children) took part in the study. The PostureScreen Mobile app was used to evaluate body posture and the Fizyosoft Balance System was used to assess postural control.

Results

Significant postural differences were observed in children with intellectual disability when compared to typically developing children. Head, shoulder and knee translations in the sagittal plane were significantly higher in children with intellectual disability than typically developing children. Centre of pressure velocities were significantly higher in children with dyslexia. Centre of pressure displacements showed non-significant differences in the children with dyslexia compared to the children with intellectual disability and typically developing children.

Conclusions

The present study found that children with dyslexia had poor postural control and children with intellectual disability had poor quality of posture compared to typically developing children. The authors believe that motor and physical assessments with objective outcome measurements should be conducted for children with dyslexia and intellectual disability to help improve their motor development.

Assessment of Forward Head Posture and Ergonomics in Young IT Professionals - Reasons to Worry?

BACKGROUND

 Prolonged computer use and poor ergonomics among IT professionals are considered risk factors for musculoskeletal disorders. This research aims to analyze the degree of forward head posture and workplace ergonomics in young IT professionals to assess the risk for a neck disability. Methods: A prospective study was carried out by assessing the sitting posture at work, neck disability in the cervical region, quality of life, physical activity, and ergonomics of the workspace in 73 young IT professionals (32.56±5.46 years). Results: The score for the cervical functional disability index (NDI) showed a mild neck disability (8.19±7.51). The craniovertebral angle has an average value of 32.01±11.46, corresponding to a light forward head posture, and it positively correlated with age and work experience and negatively correlated with ROSA (r=0.24, p<0.05). The NDI positively correlated with physical activity (r =00.32 p<0.05) and with ROSA (r= 0.24, p<0.05). Conclusions: In IT professionals, neck disability is associated with the lack of workspace ergonomics and the amount of physical activity. Forward head posture correlated with age, work experience, and poor workspace ergonomics. According to our findings, there are real concerns about the influence of head posture and workplace ergonomics on health among IT professionals. We consider that it is necessary to adopt preventive measures to address neck disability and improve workspace ergonomics.

Measurement of Lower Extremity Alignment Using a Smartphone Application

Identification of lower extremity misalignment requires radiation exposure and complex imaging. We developed and tested a smartphone application to facilitate quick identification of misalignment using photographs. Lower extremity alignment was measured by two independent researchers using a proprietary smartphone application and conventional radiographs. The results were compared between the methods and evaluators for interrater and intrarater reliability. Ninety datasets were obtained from 45 patients, with 90 lower extremity alignment angles measured via radiographs and the smartphone application. The intrarater reliability of the hip–knee–ankle angle (HKAA), measured twice by evaluator A using the radiographic imaging program, was 0.985, whereas that measured by evaluator B was 0.995. The intrarater reliability of the predicted lower extremity alignment angle (PLEAA) measured using the smartphone application was 0.970 and 0.968 for evaluators A and B, respectively. Thus, all results showed excellent reliability. In validity analysis, the correlation between PLEAA and HKAA measured twice by evaluators A and B was analyzed using Pearson’s correlation coefficient. HKAA (A) and PLEAA (A) had a positive correlation coefficient of 0.608 (p < 0.01), whereas HKAA (B) and PLEAA (B) had a positive correlation coefficient of 0.627 (p < 0.01). Thus, our smartphone application can facilitate for self-diagnosis of lower extremity misalignment.

A computer vision-based mobile tool for assessing human posture: A validation study

BACKGROUND AND OBJECTIVE

Non-invasive methods for postural assessment are tools used for tracking and monitoring the progression of postural deviations. Different computer-based methods have been used to assess human posture, including mobile applications based on images and sensors. However, such solutions still require manual identification of anatomical points. This study aims to present and validate the NLMeasurer, a mobile application for postural assessment. This application takes advantage of the PoseNet, a solution based on computer vision and machine learning used to estimate human pose and identify anatomical points. From the identified points, NLMeasurer calculates postural measures.

METHODS

Twenty participants were photographed in front view while using surface markers over anatomical landmarks. Then, the surface markers were removed, and new photos were taken. The photos were analyzed by two examiners, and six postural measurements were computed with NLMeasurer and a validated biophotogrammetry software. One-sample t-test and Bland Altman procedure were used to assess agreement between the methods, and Intraclass Correlation Coefficient (ICC) was used to assess inter- and intra-rater reliability.

RESULTS

Postural measurements calculated using the NLMeasurer were in agreement with the biophotogrammetry software. Furthermore, there was good inter- and intra-rater reliability for most photos without surface markers.

CONCLUSIONS

NLMeasurer demonstrated to be a valid tool method to assess postural measurements in the frontal view. The use of surface markers on specific anatomical landmarks (i.e., ears, iliac spines and ankles) can facilitate the digital identification of these landmarks and improve the reliability of the postural measurements performed with NLMeasurer.

A mobile application tool for standing posture analysis: development, validity, and reliability

Background

Using mobile application for postural assessments has been drawing a rising interest due to widespread use of smartphones. Although there are some mobile applications in use, validated mobile tools for accurate postural assessment are still warranted.

Aims

This study aimed to develop Fizyoprint mobile application tool to assess standing posture and investigate the validity and reliability of the application in young adults.

Methods

A convenience sample of 20 young adults (12 men and 8 women with a mean age of 21.3 ± 2.2 years) and 2 physiotherapists as raters participated in the study. The participant’s digital images were obtained from the anterior, posterior, and right lateral sides. The raters selected the anatomic reference points by using digital markers in the app screen, and the Fizyoprint application, with Turkish language option, calculated a total of 26 posture variables, including 11 distance and 15 angle variables. Each participant was assessed twice (1-week interval) by 2 raters with Fizyoprint. Inter- and intra-rater reliabilities were estimated using the intraclass correlation coefficient. The BioTonix™ posture analysis system was used for validation.

Results

A total of 80.7% (21 variables) indicated acceptable to excellent intra-rater reliability results. A total of 57.7% (15 variables) were found to be acceptable to excellent for inter-rater measurements. The results confirmed the validity of the Fizyoprint application for testing the standing posture.

Conclusions

Fizyoprint application is a new, valid, free mobile tool with acceptable concordance with BioTonix™ postural analysis system for assessing standing posture. Further studies are warranted to test the current application in different populations and musculoskeletal conditions.

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

This was a longitudinal observational study. Eligible participants were adult patients who had an indication of orthognathic surgery (bilateral sagittal split osteotomy of the maxilla and/or mandible, can be associated or not with genioplasty). Thirty-five patients were evaluated from the orthognathic surgery group (OSG) and control group (CG). Measurements in OSG were performed at 3 time points: preoperative orthognathic surgery (P0), first postoperative month (P1), and second postoperative month (P2). Static posture was evaluated using the PostureScreen Mobile (PostureCo Inc, Trinity, Fla) application in 4 views.

RESULTS

Patients with Angle Class II malocclusion in the OSG evidenced a tendency to a left hip translation at P1 with a significant difference at P2 in the anterior view (P = 0.052). In the right lateral view, patients with Angle Class II malocclusion in the OSG at P1 presented an accentuated anterior shoulder translation when compared with CG (P <0.001). At P1, patients with Angle Class II malocclusion in the OSG showed a significant anterior knee translation compared with the CG and OSG at P0 and P2 (P <0.001 for all). Patients in the OSG with Angle Class III malocclusion presented an average posterior head translation in the right lateral view at P1 when compared with those in the CG and OSG at P0, who presented an anterior translation (P = 0.0008).

CONCLUSIONS

These findings suggest a realignment of static posture in the first 2 months after orthognathic surgery.

A Multidomain Approach to Assessing the Convergent and Concurrent Validity of a Mobile Application When Compared to Conventional Methods of Determining Body Composition

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.

Psychometric Proprieties of a Mobile Application to Measure the Craniovertebral Angle a Validation and Reliability Study

The aim of this study was to assess the psychometric properties of the mobile application forward head posture in terms of validity, inter- and intra-rater reliability, minimum detectable change, sensitivity, and specificity to measure craniovertebral angle. In total, 44 subjects (mean age 23.30 ± 4.44 years) were evaluated in the standing position with markers on the tragus and cutaneous prominence of seventh cervical vertebra (C7). We had two experienced and trained physiotherapists assess cervical posture using the mobile application forward head posture and photogrammetry. Intraclass correlation coefficients were used to determine validity and reliability. A contingency table was made to determine sensitivity and specificity. Intra-rater reliability of the mobile application forward head posture had an intraclass correlation coefficient of 0.88. The inter-rater reliability generated an intraclass correlation coefficient of 0.83 to 0.89. Criterion validity data were above 0.82. The minimum detectable change was 4.96° for intra-rater and 5.52° for inter-rater reliability. The smartphone application exhibited 94.4% sensitivity and 84.6% specificity. The smartphone application forward head posture is a valid and reliable tool to measure craniovertebral angle in a standing position and, therefore, could be a useful assessment tool in clinical practice.

Mobile Applications for Assessing Human Posture: A Systematic Literature Review

Smartphones are increasingly incorporated with features such as sensors and high resolution cameras that empower their capabilities, enabling their use for varied activities including human posture assessments. Previous reviews have discussed methods used in postural assessment but none of them focused exclusively on mobile applications. This paper systematically reviews mobile applications proposed for analyzing human posture based on alignment of the body in the sagittal and coronal plane. The main digital libraries were searched, 26 articles published between 2010 and 2020 were selected, and 13 mobile applications were identified, classified and discussed. Results showed that the use of mobile applications to assist with posture assessment have been demonstrated to be reliable, and this can contribute to clinical practice of health professionals, especially the assessment and reassessment phases of treatments, despite some variations when compared to traditional methods. Moreover, in the case of image-based applications, we highlight the advantage that measurements can be taken with the assessor at a certain distance with respect to the patient’s position, which is an important function for assessments performed in pandemic times such as the outbreak of COVID-19.

Can human posture and range of motion be measured automatically by smart mobile applications?

Human posture and Range of Motion (ROM) are important components of a physical assessment and, from the collected data, it is possible to identify postural deviations such as scoliosis or joint and muscle limitations, hence identifying risks of more serious injuries. Posture assessment and ROM measures are also necessary metrics to monitor the effect of treatments used in the motor rehabilitation of patients, as well as to monitor their clinical progress. These evaluation processes are more frequently performed through visual inspection and manual palpation, which are simple and low cost methods. These methods, however, can be optimized with the use of tools such as photogrammetry and goniometry. Mobile solutions have also been developed to help health professionals to capture more objective data and with less risk of bias. Although there are already several systems proposed for assessing human posture and ROM in the literature, they have not been able to automatically identify and mark Anatomical and Segment Points (ASPs). The hypothesis presented here considers the development of a mobile application for automatic identification of ASPs by using machine learning algorithms and computer vision models associated with technologies embedded in smartphones. From ASPs identification, it will be possible to identify changes in postural alignment and ROM. In this context, our view is that an application derived from the hypothesis will serve as an additional tool to assist in the physical assessment process and, consequently, in the diagnosis of disorders related to postural and movement changes.

The effect of a novel thoracolumbar brace on spinal alignment in Parkinson's disease: a pilot study

[Purpose] Individuals with Parkinson’s disease (PD) experience postural dysfunction, which can contribute to pain and an increased risk for falls. One method with limited research for addressing postural dysfunction is bracing. The objective of this pilot study was to establish the immediate impact of a novel thoracolumbar brace on postural alignment in individuals with PD. [Participants and Methods] This study utilized a single-participant randomized A-B design. Participants were included if they had a diagnosis of PD were 50–80 years of age, reported difficulty with posture, but were able to ambulate within their home and the community. Ten kinematic assessments of posture were completed in each phase. The primary outcome measure was postural alignment at the neck, trunk, and hip/knee. An analysis of postural stability and experience wearing the brace was also completed. [Results] Nine out of ten participants demonstrated at least one statistically significant change in a posture variable, but postural stability was variable across participants. [Conclusion] This pilot study demonstrated that the brace functioned as expected bringing postural alignment into a more neutral or extended position at the trunk and hip/knee. Further research on the long-term effect of the brace needs to be completed to determine its clinical value.

Use of Mobile Applications to Collect Data in Sport, Health, and Exercise Science: A Narrative Review

Peart, DJ, Balsalobre-Fernández, C, and Shaw, MP. Use of mobile applications to collect data in sport, health, and exercise science: A narrative review. J Strength Cond Res 33(4): 1167-1177, 2019-Mobile devices are ubiquitous in the population, and most have the capacity to download applications (apps). Some apps have been developed to collect physiological, kinanthropometric, and performance data; however, the validity and reliability of such data is often unknown. An appraisal of such apps is warranted, as mobile apps may offer an alternative method of data collection for practitioners and athletes with money, time, and space constraints. This article identifies and critically reviews the commercially available apps that have been tested in the scientific literature, finding evidence to support the measurement of the resting heart through photoplethysmography, heart rate variability, range of motion, barbell velocity, vertical jump, mechanical variables during running, and distances covered during walking, jogging, and running. The specific apps with evidence, along with reported measurement errors are summarized in the review. Although mobile apps may have the potential to collect data in the field, athletes and practitioners should exercise caution when implementing them into practice as not all apps have support from the literature, and the performance of a number of apps have only been tested on 1 device.

Validity and Reliability of Standing Posture Measurements Using a Mobile Application

OBJECTIVE

The purpose of this study was to evaluate the validity and reliability of standing posture assessments in asymptomatic men using the PostureScreen Mobile (PSM) iOS application.

METHODS

The standing posture of 50 asymptomatic male participants (24.04 ± 1.81 years) was measured during 3 trials on the same day. The following 10 measurements using the PSM app were compared to the criterion VICON 3-dimensional analysis: from the frontal plane, shift and tilt of the head, shoulders, and hips; and from the sagittal plane, shift of the head, shoulders, hips, and knees. We used Bayesian methods to analyze the data.

RESULTS

Compared with the VICON measurements, PSM assessments of head tilt, shoulder tilt and shift, and hip tilt and shift in the frontal plane were biased. In the sagittal plane, PSM measurements of shoulder, hip, and knee shift were biased. Only head shift in the frontal and sagittal planes were comparable between the VICON and the PSM. The VICON and PSM had similar intraclass correlations in 6 of 10 measurements. The PSM assessments of head shift and tilt and shoulder tilt in the sagittal plane were significantly less reliable than with VICON.

CONCLUSION

The use of the PSM app introduced significant bias in postural measurements in the frontal and sagittal plane. Until further research reports additional validity and reliability data of the PSM app, we suggest caution in the use of PSM app when highly accurate postural assessments are necessary.

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.

The acceptance of the clinical photographic posture assessment tool (CPPAT)

BACKGROUND

There is a lack of evidence-based quantitative clinical methods to adequately assess posture. Our team developed a clinical photographic posture assessment tool (CPPAT) and implemented this tool in clinical practice to standardize posture assessment. The objectives were to determine the level of acceptance of the CPPAT and to document predictors as well as facilitators of and barriers to the acceptance of this tool by clinicians doing posture re-education.

METHODS

This is a prospective study focussing on technology acceptance. Thirty-two clinician participants (physical therapists and sport therapists) received a 3-5 h training workshop explaining how to use the CPPAT. Over a three-month trial, they recorded time-on-task for a complete posture evaluation (photo - and photo-processing). Subsequently, participants rated their acceptance of the tool and commented on facilitators and barriers of the clinical method.

RESULTS

Twenty-three clinician participants completed the trial. They took 22 (mean) ± 10 min (SD) for photo acquisition and 36 min ± 19 min for photo-processing. Acceptance of the CPPAT was high. Perceived ease of use was an indirect predictor of intention to use, mediated by perceived usefulness. Analysis time was an indirect predictor, mediated by perceived usefulness, and a marginally significant direct predictor. Principal facilitators were objective measurements, visualization, utility, and ease of use. Barriers were time to do a complete analysis of posture, quality of human-computer interaction, non-automation of posture index calculation and photo transfer, and lack of versatility.

CONCLUSION

The CPPAT is perceived as useful and easy to use by clinicians and may facilitate the quantitative analysis of posture. Adapting the user-interface and functionality to quantify posture may facilitate a wider adoption of the tool.

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.

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 posture mobile application has demonstrated strong rater reliability and preliminary evidence of construct validity. This application may have utility in clinical and research settings.

Difference between tablet methods and paper questionnaire methods of conducting a survey with community-dwelling elderly

[Purpose] This study aimed to develop a tablet app that emulates paper questionnaires used in clinical care, and to verify the difference between the utility of tablet survey methods and paper questionnaire methods with elderly people. [Subjects and Methods] A tablet app was developed in the Java language. A questionnaire was provided to 30 community-dwelling elderly people. The subjects were randomly allocated to the group responding on the tablet (tablet group) or that responding to a paper-based questionnaire (questionnaire group). Assessed items included response time to questions, whether or not they had queries regarding the survey, and data input time. For the tablet group, a questionnaire was conducted regarding the operability of the tablet. [Results] There was no difference in response time between the two groups. Significantly more people in the tablet group had queries regarding the survey. Data input time was 426 seconds for the tablet group and 1268 seconds for the questionnaire group. In the survey regarding tablet operability, there were no negative opinions about the visibility of the screen. [Conclusion] Tablets can be used with elderly people to shorten the data input time. The present findings suggested that tablet surveys could be effective for a large-scale investigation.