title: Reliability of the craniocervical posture assessment: visual and angular measurements using photographs and radiographs.
abstract: OBJECTIVE
  The purposes of this study were to determine the intrarater and interrater reliability of the craniocervical posture in a sagittal view using quantitative measurements on photographs and radiographs and to determine the agreement of the visual assessment of posture between raters.
  
  
  METHODS
  One photograph and 1 radiograph of the sagittal craniocervical posture were simultaneously taken from 39 healthy female subjects. Three angles were measured on the photographs and 10 angles on the radiographs of 22 subjects using Alcimage software (Alcimage; Uberlândia, MG, Brazil). Two repeated measurements were performed by 2 raters. The measurements were compared within and between raters to test the intrarater and interrater reliability, respectively. Intraclass correlation coefficient and SEM were used. κ Agreement was calculated for the visual assessment of 39 subjects using photographs and radiographs between 2 raters.
  
  
  RESULTS
  Good to excellent intrarater and interrater intraclass correlation coefficient values were found on both photographs and radiographs. Interrater SEM was large and clinically significant for cervical lordosis photogrammetry and for 1 angle measuring cervical lordosis on radiographs. Interrater κ agreement for the visual assessment using photographs was poor (κ = 0.37).
  
  
  CONCLUSIONS
  The raters were reliable to measure angles in photographs and radiographs to quantify craniocervical posture with exception of 2 angles measuring lordosis of the cervical spine when compared between raters. The visual assessment of posture between raters was not reliable.
authors.affiliation: Assistant Professor, Department of Physical Therapy, Nicole Wertheim College of Nursing & Health Sciences, Florida International University, Miami, FL. Electronic address: igadotti@fiu.edu.
authors.forename: Inae C
authors.initials: IC
authors.lastname: Gadotti
authors.forename: Susan
authors.initials: S
authors.lastname: Armijo-Olivo
authors.forename: Anelise
authors.initials: A
authors.lastname: Silveira
authors.forename: David
authors.initials: D
authors.lastname: Magee
mesh_terms: D000328:Adult; D001270:Cervical Atlas / Q000000981:diagnostic imaging / Q000502:physiology; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000502:physiology*; D005260:Female; D064368:Healthy Volunteers; D006801:Humans; D015588:Observer Variation; D010780:Photogrammetry / Q000379:methods*; D010781:Photography / Q000379:methods; D011187:Posture / Q000502:physiology*; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D012016:Reference Values; D015203:Reproducibility of Results; D012886:Skull / Q000000981:diagnostic imaging* / Q000502:physiology
keywords: Head; Neck; Photogrammetry; Posture; Radiography; Reliability of Results