Development of a cost effective three-dimensional posture analysis tool: validity and reliability

BACKGROUND: The lack of clear understanding of the association between sitting posture and adolescent musculoskeletal pain, might reflect invalid and/or unreliable posture measurement instruments. The psychometric properties of any new measurement instrument should be demonstrated prior to use for research or clinical purposes. This paper describes psychometric testing of a new three-dimensional (3D), portable, non-invasive posture analysis tool (3D-PAT), from sequential studies using a mannequin and high school students. METHODS: The first study compared the 3D-(X-, Y- and Z-) coordinates of reflective markers placed on a mannequin using the 3D-PAT, and the Vicon motion analysis system. This study also tested the reliability of taking repeated measures of the 3D-coordinates of the reflective markers. The second study determined the concurrent validity and test-retest reliability of the 3D-PAT measurements of nine sitting postural angles of high school students undertaking a standard computing task. In both studies, concordance correlation coefficients and Intraclass correlation coefficients described test-retest reliability, whilst Pearson product moment correlation coefficients and Bland-Altman plots demonstrated concurrent validity. RESULTS: The 3D-PAT provides reliable and valid 3D measurements of five of the nine postural angles i.e. head flexion, neck flexion, cranio-cervical angle, trunk flexion and head lateral bending in adolescents undertaking a standard task. CONCLUSIONS: The 3D-PAT is appropriate for research and clinical settings to measure five upper quadrant postural angles in three dimensions. As a measurement instrument it can provide further understanding of the relationship between sitting posture, changes to sitting posture and adolescent musculoskeletal pain.