title: Clinical measurements of cervical lordosis using flexirule and inclinometer methods in individuals with and without cervical spine dysfunction: A reliability and validity study.
abstract: OBJECTIVE
  The purposes of this study were to determine the reliability and validity of two clinical measurements of cervical lordosis and to compare these measurements of individuals with cervical spine symptoms to those of asymptomatic individuals.
  
  
  METHODS
  Fifty-seven participants were recruited for the study: 18 following cervical fusion, 20 with neck pain and no surgery, and 19 with no neck pain. Cervical lordosis was measured using a flexible ruler (flexirule) and a modified bubble inclinometer. Intertester and intratester reliability were calculated for both methods. Validity was assessed by correlating measurements taken using both methods to Cobb angles between C2 and C7 on lateral view radiography of the participants in the cervical fusion and the neck pain groups.
  
  
  RESULTS
  Intraclass correlation coefficients (ICCs) revealed good intratester reliability for both methods. Intertester reliability was fair for the flexirule method but good for the inclinometer method. Pearson correlations with radiographic angles were poor for both methods. ANOVAs showed no significant difference in cervical lordosis measurements between asymptomatic and symptomatic groups.
  
  
  CONCLUSIONS
  Although both the flexirule and inclinometer methods are reliable, neither method correlated with the Cobb angle on the radiography, suggesting these methods may measure different aspects of cervical spine alignment.
authors.affiliation: Texas Spine and Joint Hospital, Tyler, TX, USA.
authors.forename: Carol
authors.initials: C
authors.lastname: McFarland
authors.affiliation: School of Physical Therapy, Texas Woman's University, Dallas, TX, USA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Wang-Price
authors.affiliation: Parkland Health & Hospital System, Dallas, TX, USA.
authors.forename: Shanan
authors.initials: S
authors.lastname: Richard
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008141:Lordosis / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000000981:diagnostic imaging*; D010808:Physical Examination; D011859:Radiography; D015203:Reproducibility of Results; D013123:Spinal Fusion / Q000379:methods
keywords: Cervical spine; Cobb angle; inclinometer; posture; sagittal alignment