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Measurement properties of the sagittal craniocervical posture photogrammetry Open Access


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Type of item
Degree grantor
University of Alberta
Author or creator
Gadotti, Inae Caroline
Supervisor and department
Magee, David (Physical Therapy)
Examining committee member and department
Warren, Sharon (Faculty of Rehabilitation Medicine)
Major, Paul (School of Dentistry)
Harrison, Elizabeth (School of Physical Therapy)
Gross, Doug (Physical Therapy)
Thie, Norman (School of Dentistry)
Faculty of Rehabilitation Medicine

Date accepted
Graduation date
Doctor of Philosophy
Degree level
Commonly in clinical settings, the patient’s posture is visually evaluated by the clinician using anatomical landmark references. However, this measurement is subjective and not quantifiable. Photogrammetry to assess posture was thought to be a possible good clinical alternative to the other methods because it is non-invasive, quantifiable, and less expensive. However, more tests were needed to determine its validity. This study tested the reliability and the validity of five angles measuring craniocervical posture using photogrammetry. Radiographs and photographs of the craniocervical posture of 39 healthy-female subjects were taken in a standardized sagittal standing position. Markers were placed on the back of the subject’s neck and ear. A second photograph and radiograph was taken 1 week later using 21 of the 39 subjects to test reliability. The angles were analyzed using Alcimage® software. Intraclass-correlation coefficient and standard error of measurement was used to test the reliability. Concurrent validity was tested using Pearson correlation and regression analysis. Discriminant analysis was used to test the discriminant validity. Sensitivity/specificity and predicted values were also calculated. The results showed that photogrammetry ICC values were good to excellent when assessed by 2 raters (ICC=0.89-0.99). The posture of the subjects was reproducible when tested using radiographs (ICC=0.89-0.98). One rater was reliable in reattaching the markers (ICC=0.71-0.91) and precise in locating the reference spinous processes (87.8%). Craniovertebral angle (CVA) appeared to be valid in measuring the position of the head in relation to the cervical spine (r=0.84) and to be able discriminate subjects with aligned posture, slight forward head posture (SFHP), and forward head posture (FHP) assessed by 1 rater (84.6% correctly classified). Cervical inclination angle (CIA) appears to be valid in discriminating subjects with aligned and FHP (86% and 88% respectively) but moderate to predict the cervical spine inclination. The cervical lordosis angles were not able to discriminate postures and predict the cervical lordosis. CVA and CIA were able to detect postural differences through the sensitivity/specificity and predicted values analysis. This study supports the validation of CVA and CIA to assess craniocervical posture which may improve the ability of the clinician to detect and quantify craniocervical postural alterations.
License granted by Inae Gadotti ( on 2010-06-08T17:05:30Z (GMT): Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of the above terms. The author reserves all other publication and other rights in association with the copyright in the thesis, and except as herein provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.
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