title: Reliability of three landmarking methods for dual inclinometry measurements of lumbar flexion and extension.
abstract: BACKGROUND
  To examine the intra and inter-rater reliability of lumbar flexion and extension measurements attained using three landmarking methods for dual inclinometry.
  
  
  METHODS
  This was a repeated measures reliability study. Convenience sampling was used to obtain forty volunteer subjects. Two assessors measured a series of lumbar flexion and extension movements using the J-Tech™ dual inclinometer. Three different landmarking methods were used: 1) straight palpation of PSIS and L1, 2) palpation of PSIS and the site of the nearest 5 cm interval point closest to L1 and 3) location of PSIS and 15 cm cephalad. Upon landmarking, adhesive tape was used to mark landmarks and the inclinometer was placed on sites for three trials of flexion and extension. Tape was removed and landmarks were relocated by the same assessor (intra-rater) for an additional three trials; and this process was repeated by a second assessor (inter-rater). Reliability was determined using intra-class correlation coefficients.
  
  
  RESULTS
  Reliability within a set of three repetitions was very high (ICCs > 0.90); intra-rater reliability after relocating landmarks was high (ICCs > 0.80); reliability between therapists was moderate to high (0.60 > ICCs < 0.76). Assessment of flexion and extension movements by straight palpation of bony landmarks as in the Straight palpation of PSIS and L1 method (ICC: Flexion 0.60; Extension 0.74) was found to be marginally less reliable than the other two landmarking measurement strategies (ICC: Flexion 0.66; Extension 0.76).
  
  
  CONCLUSIONS
  All three methods of land marking are reliable. We recommend the use of the PSIS to 15 cm cephalad method as used in the modified-modified Schobers test as it is the simplest to perform and aligns with current clinical practice.
authors.affiliation: Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada. jmacderm@uwo.ca.|Department of Surgery, University of Western Ontario, ON N6A 4L6, London, Ontario, Canada. jmacderm@uwo.ca.|Roth - MacFarlane Hand and Upper Limb Center, St. Joseph's Healthcare London, London, Ontario, Canada. jmacderm@uwo.ca.|School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada. jmacderm@uwo.ca.
authors.forename: Joy C
authors.initials: JC
authors.lastname: MacDermid
authors.affiliation: Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada. varumuga@uwo.ca.|Roth - MacFarlane Hand and Upper Limb Center, St. Joseph's Healthcare London, London, Ontario, Canada. varumuga@uwo.ca.
authors.forename: Vanitha
authors.initials: V
authors.lastname: Arumugam
authors.affiliation: Roth - MacFarlane Hand and Upper Limb Center, St. Joseph's Healthcare London, London, Ontario, Canada. joshuaisrael1985@gmail.com.
authors.forename: Joshua I
authors.initials: JI
authors.lastname: Vincent
authors.affiliation: Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada. klpayne@uwo.ca.
authors.forename: Kimberly L
authors.initials: KL
authors.lastname: Payne
authors.affiliation: Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada. Akso@uwo.ca.
authors.forename: Aubrey K
authors.initials: AK
authors.lastname: So
mesh_terms: D000328:Adult; D000368:Aged; D059925:Anatomic Landmarks; D001696:Biomechanical Phenomena; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000033:anatomy & histology* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010173:Palpation / Q000379:methods*; D011237:Predictive Value of Tests; D016059:Range of Motion, Articular; D015203:Reproducibility of Results; D055815:Young Adult