Inter-rater reliability of the evaluation of muscular chains associated with posture alterations in scoliosis.

Carole Fortin,Debbie Ehrmann Feldman,Hubert Labelle,Michelle Houde,Clarice Tanaka

doi:10.1186/1471-2474-13-80

Abstract

BackgroundIn the Global postural re-education (GPR) evaluation, posture alterations are associated with anterior or posterior muscular chain impairments. Our goal was to assess the reliability of the GPR muscular chain evaluation.MethodsDesign: Inter-rater reliability study. Fifty physical therapists (PTs) and two experts trained in GPR assessed the standing posture from photographs of five youths with idiopathic scoliosis using a posture analysis grid with 23 posture indices (PI). The PTs and experts indicated the muscular chain associated with posture alterations. The PTs were also divided into three groups according to their experience in GPR. Experts’ results (after consensus) were used to verify agreement between PTs and experts for muscular chain and posture assessments. We used Kappa coefficients (K) and the percentage of agreement (%A) to assess inter-rater reliability and intra-class coefficients (ICC) for determining agreement between PTs and experts.ResultsFor the muscular chain evaluation, reliability was moderate to substantial for 12 PI for the PTs (%A: 56 to 82; K: 0.42 to 0.76) and perfect for 19 PI for the experts. For posture assessment, reliability was moderate to substantial for 12 PI for the PTs (%A > 60%; K: 0.42 to 0.75) and moderate to perfect for 18 PI for the experts (%A: 80 to 100; K: 0.55 to 1.00). The agreement between PTs and experts was good for most muscular chain evaluations (18 PI; ICC: 0.82 to 0.99) and PI (19 PI; ICC: 0.78 to 1.00).ConclusionsThe GPR muscular chain evaluation has good reliability for most posture indices. GPR evaluation should help guide physical therapists in targeting affected muscles for treatment of abnormal posture patterns.

Highlights

In the Global postural re-education (GPR) evaluation, posture alterations are associated with anterior or posterior muscular chain impairments
The objectives of our study were 1) to determine the inter-rater reliability of the evaluation of muscular chains and their associated posture alterations, from photographs of adolescents presenting with idiopathic scoliosis; 2) to verify the impact of clinical experience on the level of reliability of muscular chain evaluation; and 3) to verify the agreement of posture and muscular chain evaluations observed by physical therapists and two experts instructors in GPR
When physical therapists (PTs) are divided into three groups according to their experience in GPR, the level of reliability for muscular chain evaluation is moderate to substantial for 8 posture indices in Group 1 (≤2 y., K: 0.43 to 0.91), for 8 posture indices in Group 2 (2.5 to 9.5 y., K: 0.40 to 0.73) and for 16 posture indices in Group 3 (≥ 10 y., K: 0.41 to 1.00) (Table 3)

Summary

Introduction

In the Global postural re-education (GPR) evaluation, posture alterations are associated with anterior or posterior muscular chain impairments. Posture alterations can be associated with modifications in muscular moments which can change joint alignment and cause movement impairment syndromes [1]. These impairments can affect functional activities and restrict the active life [2]. Despite the lack of studies linking muscular chain impairments to abnormal posture patterns and dysfunction, it seems that global muscular chain stretching is more effective than analytic muscle stretching to improve function and quality of life for several pathologic conditions including respiratory, musculoskeletal and neurological problems [7,8,9,13,14,15]

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