title: Measurement of lumbar lordosis: inter-rater reliability, minimum detectable change and longitudinal variation.
abstract: METHODS
  Repeated measures design to examine reliability and longitudinal variation of lumbar lordosis measurement.
  
  
  OBJECTIVE
  To determine the interrater reliability, minimum detectable change (MDC) and longitudinal variation of the Cobb method for measuring lumbar lordosis using standardized rules.
  
  
  BACKGROUND
  The reliability of the 4-line Cobb method for measuring lumbar lordosis was not examined when standardized rules were instituted for drawing the lines.
  
  
  METHODS
  A random sample of participants was selected from the Pittsburgh clinic of the multicenter Study of Osteoporotic Fractures for radiographic measurement of lumbar lordosis reliability (n=48) and stability (n=109). A standardized version of the 4-line Cobb method was used for all measurements of lordosis. The Intraclass Correlation Coefficient (ICC) was used to calculate interrater reliability for lordosis and to measure the stability of this measure over an approximate 2-year-time period. The standard error of measurement and MDC were calculated for lordosis measurement based on the ICC value.
  
  
  RESULTS
  The interrater reliability coefficient for lumbar lordosis was in the excellent range (ICC=0.98; 95% CI: 0.95, 0.99). The MDC based on measurements between raters was 3.90 degrees. The ICC value for the stability, or reliability from time 1 to time 2, of lordosis measurement over time was 0.81 (95% CI: 0.74, 0.87).
  
  
  CONCLUSIONS
  This study demonstrates that the 4-line Cobb method can be a highly reliable and precise method for measuring lumbar lordosis if standardized procedures are used. The Cobb method has an MDC that is appropriate for clinical use. Also, there is minimal longitudinal variation in lordosis measurements over a 2-year period.
authors.affiliation: Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD 21201, USA. ghicks@som.umaryland.edu
authors.forename: Gregory E
authors.initials: GE
authors.lastname: Hicks
authors.forename: Steven Z
authors.initials: SZ
authors.lastname: George
authors.forename: Michael A
authors.initials: MA
authors.lastname: Nevitt
authors.forename: Jane A
authors.initials: JA
authors.lastname: Cauley
authors.forename: Molly T
authors.initials: MT
authors.lastname: Vogt
mesh_terms: D000368:Aged; D001837:Body Weights and Measures; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008141:Lordosis / Q000000981:diagnostic imaging*; D008159:Lumbar Vertebrae; D015588:Observer Variation; D011859:Radiography; D015203:Reproducibility of Results; D013997:Time Factors