Reliability and validity of non-radiographic methods of thoracic kyphosis measurement: a systematic review.
BACKGROUND
A wide array of instruments are available for non-invasive thoracic kyphosis measurement. Guidelines for selecting outcome measures for use in clinical and research practice recommend that properties such as validity and reliability are considered. This systematic review reports on the reliability and validity of non-invasive methods for measuring thoracic kyphosis.


METHODS
A systematic search of 11 electronic databases located studies assessing reliability and/or validity of non-invasive thoracic kyphosis measurement techniques. Two independent reviewers used a critical appraisal tool to assess the quality of retrieved studies. Data was extracted by the primary reviewer. The results were synthesized qualitatively using a level of evidence approach.


RESULTS
27 studies satisfied the eligibility criteria and were included in the review. The reliability, validity and both reliability and validity were investigated by sixteen, two and nine studies respectively. 17/27 studies were deemed to be of high quality. In total, 15 methods of thoracic kyphosis were evaluated in retrieved studies. All investigated methods showed high (ICC ≥ .7) to very high (ICC ≥ .9) levels of reliability. The validity of the methods ranged from low to very high.


CONCLUSIONS
The strongest levels of evidence for reliability exists in support of the Debrunner kyphometer, Spinal Mouse and Flexicurve index, and for validity supports the arcometer and Flexicurve index. Further reliability and validity studies are required to strengthen the level of evidence for the remaining methods of measurement. This should be addressed by future research.
Department of Clinical Therapies, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland. Electronic address: evabarrett@live.ie.
Eva
E
Barrett
Department of Clinical Therapies, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.
Karen
K
McCreesh
Musculoskeletal Services, Health at the Stowe, Central London Community Healthcare, NHS Trust, 260 Harrow Road, London W2 5ES, UK; Department of Allied Health Professions and Midwifery, School of Health and Social Work, Wright Building, College Lane Campus, University of Hertfordshire, Hatfield, AL10 9AB, Hertfordshire, UK.
Jeremy
J
Lewis
D019937:Diagnostic Techniques and Procedures / Q000295:instrumentation*; D019317:Evidence-Based Medicine; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D007738:Kyphosis / Q000175:diagnosis*; D008297:Male; D009983:Orthopedic Equipment; D010808:Physical Examination / Q000379:methods*; D013902:Radiography, Thoracic; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
Measurement; Reliability; Thoracic kyphosis; Validity