Design and Validation of the Observational Static Posture Assessment Tool (OSPAT): A Psychometric Study

doi:10.21203/rs.3.rs-4821933/v1

Download PDF

Research Article

Design and Validation of the Observational Static Posture Assessment Tool (OSPAT): A Psychometric Study

https://doi.org/10.21203/rs.3.rs-4821933/v1

This work is licensed under a CC BY 4.0 License

You are reading this latest preprint version

Background

Postural assessment is important for several reasons, poor posture can lead to a range of musculoskeletal issues. Posture plays a crucial role in biomechanics and movement efficiency and also impacts an individual's appearance, confidence, and overall well-being. Existing visual assessment tools have not kept pace with the latest scientific Approaches and paradigm shifts in our understanding of the holistic assessment. This study aims to address this gap by designing and validating a new observational tool for observational postural assessment that integrates current scientific insight and best practices in musculoskeletal health.

Methods

This is a cross-sectional design including recruiting both qualitative and quantitates methods to develop and test psychometric properties of the Observational Static Posture Assessment Tool (OSPAT). To establish the validity of the OSPAT, we employed Lawshe's Content Validity Ratio (CVR) and Content Validity Index (CVI) through a collaborative process involving consultation with 12 experts. To test the reliability, 28 raters utilized the OSPAT on a sample of 80 individuals. Each practitioner rated the presence of postural deviations including Upper Crossed Syndrome, Sway Back Posture, Lower Crossed Syndrome, Genu Recurvatum, Scoliosis, Genu Varum, Genu Valgum, and Foot Pronation Syndrome in each subject using a 6-point scale of severity. We employed Kappa coefficients (κ) to assess both intra-rater and inter-rater reliability.

Results

The analysis for OSPAT validity showed overall CVR and CVI, (0.70 and CVI > 79) index, respectively. The results for OSPAT reliability revealed good intra-rater and inter-rater agreement, with κ values of 0.68 and 0.53, respectively.

Conclusions

The OSPAT showed promise for valid and reliable observational static postural assessment, overcoming the limitations of segmental evaluation by taking a holistic approach to postural assessment and considering the body as an interconnected system.

Body

Alignment

Corrective exercises

Posture is a critical factor in determining the alignment of body segments at any given moment [1]. It is a major public health concern for individuals across different age groups, including children, adolescents, and adults, as it can have a significant impact on the development of musculoskeletal disorders [2]. Prolonged periods of sitting, especially during various activities at school, home, and work, can increase the risk of individuals adopting improper postures. This can result in the development of muscular imbalances and the onset of postural abnormalities [1]. Postural misalignments can result in muscle weakness and tightness, leading to a decreased range of motion in the joints. This can ultimately contribute to the development of musculoskeletal injuries and hinder daily activities, impacting the overall quality of life [1, 3]. It is essential for clinicians and practitioners to possess the necessary skills to identify postural misalignments in order to prevent the progression and development of musculoskeletal issues and their associated complications. Various methods can be used to assess postural alignment, including visual observation [4, 5], goniometry [5, 6], Radiography [6], photogrammetry [5, 6], and Optical motion capture system [6, 7], with the latter being considered the most reliable due to its advanced technology. However, technology-based methods have their own set of implications in their analysis, such as the need for techniques that are simple and non-invasive, provide quick and accurate data, and address ethical concerns related to the use of images while protecting the interests of the subjects.

Extensive research has shown that visual assessment tools are commonly utilized in evaluating posture across diverse populations [5, 6, 8]. Visual assessment enables practitioners to conduct a comprehensive assessment of their patients' musculoskeletal system in a quick, cost-effective, and non-invasive manner [8–11]. One of the most commonly utilized tools for visual assessment screening is the New York Posture Rating (NYPR) scale. The NYPR scale was first introduced in 1958 as part of a series of evaluations [12]. A revised version of the NYPR, which included a reduced number of items and an updated scoring system, was later incorporated into the Health Fitness Instructors Handbook by Howley and Franks from the University of the State of New York, Bureau of Physical Education [13]. The 1958 publication by NYPR provides a detailed compilation of three figure drawings for each of the 13 body alignment segments that collectively influence overall postural alignment. These segments include posterior views of the head, shoulders, spine, hips, feet, and arches, as well as lateral (left side) views of the neck, chest, shoulders, upper back, trunk, abdomen, and lower back. Each drawing is accompanied by brief verbal descriptions that highlight the visual cues serving as reference points for scoring. In the original version, a scoring system of 5 (indicating correct posture), 3 (representing slight deviation), or 1 (pronounced deviation) was utilized to assess each body segment (Fig. 1).

****Figure 1 near here****

The NYPR versions have been noted to have validity concerns, including the lack of items for assessing knee abnormalities and plantar arch. In contrast to the segmented approach of NYPR, Janda contends that the locomotor system of the human body cannot be adequately assessed and treated by concentrating on individual segments. Instead, he advocates for viewing and evaluating the body as a cohesive system. According to Janda, it is essential to consider the entire body as a unified entity during assessment, as all segments is interconnected through muscular and joint chains. By evaluating the body holistically, practitioners may avoid overlooking the root causes of musculoskeletal disorders [14]. Moreover, to the best of the authors' knowledge, there has been no study conducted to evaluate the reliability and validity of the NYPR scale.

As a result, a new observational posture assessment tool was to be created to tackle the aforementioned concerns, with the aim of improving upon the existing NYPR scale by integrating new rating criteria to enhance its reliability and validity. The outcomes of the study are anticipated to enhance posture rating techniques in clinical environments and foster a deeper comprehension of posture-related concerns.

A multiphase, cross-sectional, qualitative field study was used for developing and psychometric testing of the Observational Static Posture Assessment Tool (OSPAT).

Developing the OSPAT

Selecting the Posture Assessment Indices

The selection of posture indices in the study was based on their clinical relevance [15]. This means that the chosen posture indices were considered to be meaningful and important in the context of assessing posture-related issues or abnormalities. By selecting posture indices that are clinically relevant, researchers aimed to ensure that the posture assessment tool accurately captures and evaluates postural characteristics that are known to be significant indicators of health, function, or potential musculoskeletal problems. Prioritizing posture indices based on their clinical relevance enhances the validity and utility of the posture assessment tool in clinical settings, as it ensures that the tool can effectively address and evaluate postural issues that are of practical importance to healthcare professionals and patients.

The selection of posture indices in the study was also guided by their ability to assess posture changes across all body segments regarding the janda approach [14], This criterion emphasizes the importance of capturing and evaluating postural alignment and deviations not only in specific body regions but across all body segments comprehensively. By considering posture indices that can assess posture changes across multiple body segments, the posture assessment tool developed in the study aims to provide a holistic and global evaluation of an individual's posture. This approach allows for a thorough assessment of postural alignment, symmetry, and potential deviations throughout the entire body, rather than focusing on isolated regions or segments.

The incorporation of posture indices that cover various body segments enhances the tool's ability to capture complex postural changes and abnormalities that may involve multiple regions. This comprehensive assessment can contribute to a more complete understanding of an individual's postural profile and facilitate targeted interventions or treatments based on a thorough evaluation of posture across all body segments.

Also ensuring the validity and reliability of the tool based on the Tyson and DeSouza's content validity study [16] and a high level of intra-rater reliability (intra-class correlation coefficient > 0.70) [11].

To select Indices for developing the OSPAT, The New York Posture Rating Scale (NYPRC) was targeted as the basis for this review, as it is a widely used tool. A thorough literature review was conducted to discuss the importance of posture rating, existing posture rating charts, and the limitations of the NYPRC.

OSPAT Validity Assessment

A panel of 12 experts evaluated the tool to determine its validity. To assess the validity of the developed tool, Lawshe's Content Validity Ratio (CVR) and Content Validity Index (CVI) were employed [17].

Content Validity Ratio (CVR)

In the calculation of the Content Validity Ratio (CVR), the collective input of all panelists regarding the importance of the tested knowledge or skill was considered. The CVR was calculated based on the ratings provided by the experts. According to Lawshe's CVR table, for a panel of a minimum of 12 experts, each item should yield a calculated CVR value exceeding 0.56 to be considered valid [17]. Panelists were asked to rate each item on a scale of 1 to 3, where 1 signifies "not necessary," 2 indicates "useful but not essential," and 3 represents "essential" importance [18].

Content Validity Index (CVI)

The Content Validity Index (CVI) was determined by panel members who assessed the clarity and relevance of the instrument items. They rated each item on a 4-point ordinal scale (1: not relevant, 2: somewhat relevant, 3: quite relevant, 4: highly relevant). The CVI was calculated by dividing the number of experts who rated the item as relevant or clear (rating 3 or 4) by the total number of content experts, providing an indication of the item's content validity [19].

****Figure 2 near here****

OSPAT Reliability Assessment

To evaluate the reliability of the newly developed Observational Static Posture Assessment Tool (OSPAT), a group of raters was trained to utilize the tool for assessing static posture in study participants. Both inter-rater reliability and intra-rater reliability were assessed to determine the consistency and reproducibility of posture assessments using OSPAT.

Inter-rater reliability was evaluated by calculating intraclass correlation coefficients (ICCs) among different raters who independently assessed the static posture of the study participants using OSPAT. ICCs provide a statistical measure of agreement between multiple raters in their assessments of the same set of posture measurements. High ICC values indicate good agreement among raters in their evaluations of posture deviations and abnormalities.

Intra-rater reliability was assessed by calculating ICCs for repeated assessments conducted by the same rater on the same set of study participants. This analysis examines the consistency of posture assessments performed by individual raters over time and helps determine the reliability of the OSPAT tool in producing consistent results when used by the same rater on multiple occasions.

Raters

A group of 28 experts specializing in musculoskeletal health and posture assessment participated as raters in the research study [20]. The raters selected had varying years of experience and expertise in assessing posture and musculoskeletal alignment. Each rater was tasked with assigning a severity score on a scale from 0 to 5 to indicate posture devotions including Upper Crossed Syndrome (UCS), Sway Back Posture (SBP), Lower Crossed Syndrome (LCS), Genu Recurvatum (GR), Scoliosis (SC), Genu Varum (GVR), Genu Valgum (GVG), and Foot Pronation Syndrome (FPS) of the study participants. The severity scoring system was designed to capture the extent of deviation from ideal posture, with 0 indicating no observable deviation and scores of 1 to 5 representing increasing levels of abnormality. A score of 1 indicated a minimal deviation, while scores of 4 or 5 indicated more severe abnormalities in posture that were readily apparent to the raters.

Participants

A total of 80 participants, aged between 18 and 25 years, were purposefully selected to participate in the research study. The inclusion criteria required participants to be within the specified age range to ensure a relatively homogeneous sample in terms of musculoskeletal development and postural alignment characteristics within the age group of interest.

Exclusion criteria were put in place to ensure the exclusion of individuals who may have factors influencing musculoskeletal alignment that could confound the assessment of static posture. Participants with a history of previous spinal surgery, osteoporosis, major congenital anomalies affecting posture, previous spinal fractures, rheumatological conditions impacting musculoskeletal health, leg length discrepancy, or neurologic conditions that could affect posture were excluded from the study.

Posture Assessment

The method of photography was employed to assess static posture in a research study. Images were captured from three different views – front, side, and back to analyze body posture. To do so, Participants were instructed to wear minimal clothing to ensure clear visibility of their posture and were asked to stand naturally with their hands by their sides in their usual stance.

.The camera was set up on a tripod at 4 meters distance and angle to capture high-resolution images of the subject's posture from each view. The camera height and alignment were carefully adjusted to ensure accurate image capture. Using a Panasonic Lumix camera photographs were taken of the individual standing in a natural and relaxed posture with their arms positioned by their sides. The images were then randomized and anonymized for evaluation.

Data Analysis

ICC values were used to determine the consistency and reliability of ratings among raters for both inter-rater and intra-rater assessments [21]. The statistical methods employed in the study included the calculation of Kappa coefficients (κ) to evaluate both intra-rater and inter-rater reliability. The interpretation of κ values in this research study followed established conventions in the literature, where values significantly below 0.5 indicate weak agreement. The interpretations used in this study are as follows:

Poor agreement: κ < 0.40
Fair agreement: κ = 0.40–0.59
Good agreement: κ = 0.60–0.79
Excellent agreement: κ ≥ 0.80

Intra-rater reliability was assessed by comparing each examiner's initial assessment of a subject with their subsequent assessment of the same subject. On the other hand, inter-rater reliability was evaluated by comparing the initial assessments made by all examiners. This involved comparing each examiner's evaluation of a subject with that of every other examiner.

****Figure 3 near here****

Demographic information of the participants is presented in Table 1.

Table 1

Demographic Characteristic of Participants
Variable	Mean ± SD
Age (yr)	20.4 ± 5.3
Height (cm)	176.8 ± 4.5
Weight (kg)	77.8 ± 5

****Table 1 near here****

In the study, all 28 raters had experience ranging from 1 to 15 years of practice, with each group having an equal distribution of years of experience. This ensured a diverse range of expertise levels among the raters, allowing for comprehensive and varied assessments of static posture using the Observational Static Posture Assessment Tool (OSPAT).

The results of the Kappa coefficient analysis indicated good intrarater and interrater agreement for each individual item assessed using the OSPAT tool, as well as for the overall questionnaire. The Kappa coefficient values of 0.68 and 0.53 demonstrated a substantial level of agreement among raters in their assessments of posture abnormalities and deviations.

A Kappa coefficient of 0.68 for intrarater agreement signifies a substantial level of agreement among the same rater's repeated assessments of posture items over time. This level of agreement indicates that the raters were consistent in their evaluations when assessing the same set of posture measurements on different occasions.

Similarly, a Kappa coefficient of 0.53 for interrater agreement indicates a moderate level of agreement among different raters when assessing posture using the OSPAT tool. This level of agreement suggests that there was a consistent understanding and interpretation of posture assessments among the diverse group of raters with varying levels of experience.

These results highlight the reliability and consistency of the OSPAT tool in facilitating accurate and reproducible assessments of static posture, as evidenced by the good intrarater and interrater agreement demonstrated through the Kappa coefficient analysis (Table 2).

Table 2

Mean Intrarater and Interrater Kappa Coefficients for each item of questionnaire
Items	Intrarater (95% CI)	Description*	Interrater (95% CI)	Description*
Item 1 (UCS)	0.55 (0.14–0.83)	Fair	0.50 (0.10–0.63)	Fair
Item 2 (SBP)	0.53 (0.19–0.79)	Fair	0.48 (0.06–0.73)	Fair
Item 3 (LCS)	0.61 (0.10–0.73)	Good	0.53 (0.23–0.73)	Fair
Item 4 (GR)	0.80 (0.04–0.92)	Excellent	0.61 (0.23–0.91)	Good
Item 5 (SC)	0.76 (0.16–0.87)	Good	0.52 (0.13–0.63)	Fair
Item 6 (GVR)	0.90 (0.11–0.93)	Excellent	0.70 (0.08–0.67)	Good
Item 7 (GVG)	0.60 (0.20–0.85)	Good	0.45 (0.13–0.63)	Fair
Item 8 (FPS)	0.69 (0.10–0.75)	Good	0.52 (0.11–0.73)	Fair
Overall	0.68 (0.02–0.71)	Good	0.53 (0.06–0.72)	Fair
*Descriptor according to Altman et al (1990) interpretation of Kappa.
Upper Crossed Syndrome (UCS), Sway Back Posture (SBP), Lower Crossed Syndrome (LCS), Genu Recurvatum (GR), Scoliosis (SC), Genu Varum (GVR), Genu Valgum (GVG), Foot Pronation Syndrome (FPS)

****Table 2 near here****

The CVR results for each item and overall tools are displayed in Table 3. Also CVI results indicated that all items had a score above 0.79, considered as high content validity [22]. It suggests that the items included in the OSPAT tool were deemed relevant and clear by the group of raters who participated in the assessment. The high CVI scores reflect the consensus among the raters regarding the appropriateness and accuracy of the items included in the posture assessment tool.

Table 3

Values of Content Validity Ratio (CVR)
Items	CVR
Item 1 (UCS)	0.58
Item 2 (SBP)	0.62
Item 3 (LCS)	0.76
Item 4 (GR)	0.82
Item 5 (SC)	0.73
Item 6 (GVR)	0.89
Item 7 (GVG)	0.67
Item 8 (FPS)	0.57
Overall	0.70
Upper Crossed Syndrome (UCS), Sway Back Posture (SBP), Lower Crossed Syndrome (LCS), Genu Recurvatum (GR), Scoliosis (SC), Genu Varum (GVR), Genu Valgum (GVG), Foot Pronation Syndrome (FPS)

****Table 3 near here****

This study aimed to enhance the NYPR scale by developing an observational posture assessment tool and validating its use in clinical settings. The results showed good levels of intrarater and interrater agreement across the newly developed indices, with Kappa coefficients (κ) of 0.68 and 0.53, respectively. These values indicate good agreement levels, with the intrarater agreement considered substantial and the interrater agreement falling within the category of fair agreement based on conventional interpretations. In addition to the agreement metrics, the validity assessment results revealed favorable overall Content Validity Ratio (CVR) of 0.70 and Content Validity Index (CVI) greater than 0.79. These validity indicators suggest that the revised observational posture assessment tool is credible and appropriate for assessing posture visually. The high levels of agreement and validity observed in the study support the tool's potential utility in clinical settings, where rapid, non-invasive, and accurate assessments are crucial for effective diagnosis and treatment planning. Furthermore, the tool demonstrates reliability and validity across clinicians with varying levels of experience, indicating its applicability in diverse clinical settings.

When assessing posture, a key concept is to focus on the kinetic chain, which refers to the interconnected series of joints and muscles that work together to produce movement. By examining the alignment and function of the entire kinetic chain, rather than just isolated segments, clinicians can gain a more comprehensive understanding of how posture is influenced by the body's movement patterns and muscle imbalances [14].

One important framework for understanding posture and movement patterns is the concept of upper and lower cross syndromes, originally proposed by Czech neurologist Vladimir Janda. Upper cross syndrome typically involves tightness and weakness in specific muscle groups in the upper body, leading to rounded shoulders, forward head posture, and an increased cervical curve. Lower cross syndrome, on the other hand, is characterized by imbalances in the muscles of the lower back, hips, and legs, resulting in an anterior pelvic tilt, increased lumbar curve, and potentially knee and foot issues [14].

The new observational posture assessment tool aligns with Janda's perspective on posture and movement patterns, moving away from the limitations of segmental evaluation [14]. By taking a holistic approach to postural assessment and considering the body as an interconnected system, clinicians can develop more effective interventions and preventive measures to address postural misalignments and musculoskeletal disorders. This comprehensive view allows for a deeper understanding of the underlying causes of postural issues, enabling clinicians to tailor interventions that target the root of the problem rather than just addressing the symptoms.

In the present study, the reliability of the newly developed observational posture assessment tool was found to be comparable to or potentially even better than similar research studies, often demonstrating greater consistency in ratings. For instance, earlier studies like Watson and Mac Donncha [23] achieved slightly higher intra-rater reliability, but they had fewer raters, which could impact the generalizability of their findings. On the other hand, studies like the one by Fedorak et al. [20] that did not have specific rating guidelines reported lower reliability, underscoring the importance of having clear and standardized protocols in place for reliable assessments.

Given the high cost and potential side effects associated with invasive methods of postural assessment, it is advisable to explore alternative tools or instruments that are more cost-effective and safer to use [24]. Observational assessment emerges as a favorable option in this regard, as it offers prompt and precise outcomes without the risk of side effects such as radiation exposure [25]. Additionally, observational assessment methods do not pose any significant risks to the individual undergoing evaluation.

Furthermore, the present study has shown that the observational assessment tool demonstrated robust reliability and validity, establishing it as effective instruments for postural assessment purposes. It provides accurate and consistent results, making it a valuable asset in clinical practice for evaluating and monitoring posture-related conditions.

The development of the enhanced observational posture assessment tool has significant implications for clinical practice, offering a practical and effective solution for clinicians to identify postural misalignments and potential musculoskeletal disorders in their patients. This holistic approach may lead to more effective interventions and preventive measures, ultimately improving patient outcomes.

It is important to recognize the limitations of the study, despite its promising results. The sample size of 80 subjects and the specific age range of 18 to 25 years may restrict the generalizability of the findings. Including a broader demographic in future research studies would be beneficial to ensure that the results can be applied to a more diverse population. Furthermore, the study's reliance on clinician assessment for observational ratings may introduce a subjective bias that could affect the accuracy and consistency of the results. Developing objective measures to complement the observational assessments could help to mitigate this limitation and provide more reliable and consistent data.

The study's contribution to the field of postural assessment is significant, offering a reliable and validated tool that can enhance clinical practice. The revised observational assessment tool not only improves upon the NYPR scale but also provides a foundation for future research to build upon, with the ultimate goal of advancing our understanding and management of posture-related health concerns. The adoption of observational assessment tools for postural evaluation offers a safe, cost-effective, and reliable means of assessing posture with precision and efficiency.

OSPAT

Observational Static Posture Assessment Tool

CVR

Content Validity Ratio

CVI

Content Validity Index

NYPR

New York Posture Rating

NYPRC

New York Posture Rating Scale

ICCs

Intraclass Correlation Coefficients

UCS

Upper Crossed Syndrome

SBP

Sway Back Posture

LCS

Lower Crossed Syndrome

Genu Recurvatum

Scoliosis

GVR

Genu Varum

GVG

Genu Valgum

FPS

Foot Pronation Syndrome

Ethics approval and consent to participate

The Ethics Committee affirmed the research protocol of Sport Sciences Research Institute (Code: IR.SSRC.REC.1403.062). In addition, before beginning the research process, all participants in this study provided informed consent.

Consent for publication

Not applicable.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Competing interests

The authors declare that they have no competing interests.

Funding

This article is based on a research project that was carried out with the financial support of the research and funding of Sport Sciences Research Institute. Tehran. Iran. Research Projects Unit with project no. 11.3462.

Authors' contributions

Conceptualization, HA and MS; Methodology, HA, MS, SM and MB; Investigation, all authors; Writing – Original Draft, all authors; Writing – Review & Editing, all authors; Funding Acquisition, HA; Resources, HA; Supervision, HA.

Acknowledgements

The authors would like to acknowledge the participants of this study for their time and efforts.

Sahrmann S, Azevedo DC, Dillen LV. Diagnosis and treatment of movement system impairment syndromes. Braz J Phys Ther. 2017;21:391–99.
Adamczewska K, Wiernicka M, Malchrowicz-Mośko E, Małecka J, Lewandowski J. The Angle of Trunk Rotation in School Children: A Study from an Idiopathic Scoliosis Screening. Prevalence and Optimal Age Screening Value. Int J Environ Res Public Health. 2019;16.
Haddad JM, Rietdyk S, Claxton LJ, Huber JE. Task-dependent postural control throughout the lifespan. Exerc Sport Sci Rev. 2013;41:123–32.
McRoberts LB, Cloud RM, Black CM. Evaluation of the New York Posture Rating Chart for Assessing Changes in Postural Alignment in a Garment Study. Cloth Text Res J. 2013;31:81–96.
Singla D, Veqar Z. Methods of postural assessment used for sports persons. J Clin Diagn Res. 2014;8:Le01–4.
Xing Q, Hong R, Shen Y, Shen Y. Design and validation of depth camera-based static posture assessment system. iScience. 2023;26:107974.
Trovato B, Roggio F, Sortino M, Zanghì M, Petrigna L, Giuffrida R et al. Postural Evaluation in Young Healthy Adults through a Digital and Reproducible Method. J Funct Morphol Kinesiol. 2022;7.
Alves ME, Marinho DA, Carneiro DN, Alves J, Forte P, Nevill AM et al. A Visual Scan Analysis Protocol for Postural Assessment at School in Young Students. Int J Environ Res Public Health. 2020;17.
Aitken AW. Reliability of visual assessment of forward head posture in standing 2009.
Moran R, Ljubotenski E. Reliability of visual assessment for lumbar curves in standing: Does clinical experience matter? Int J Osteopath Med. 2006;9:42.
Fortin C, Feldman DE, Cheriet F, Gravel D, Gauthier F, Labelle H. Reliability of a quantitative clinical posture assessment tool among persons with idiopathic scoliosis. Physiotherapy. 2012;98:64–75.
Education NYBoP. The New York State Physical Fitness Test for Boys and Girls. Grades 4–12: A Manual for Teachers of Physical Education. University of the State of New York, Bureau of physical education; 1958.
Howley ET, Franks BD. Health fitness instructor’s handbook. 2nd ed. Champaign: Human Kinetics; 1992.
Page P, Frank CC, Lardner R. Assessment and Treatment of Muscle Imbalance: The Janda Approach. Human Kinetics; 2010.
Kendall FP, McCreary EK, Provance PG, Rodgers MM, Romani WA. Muscles: testing and function with posture and pain. Lippincott Williams & Wilkins Baltimore, MD; 2005.
Tyson SF, DeSouza LH. A clinical model for the assessment of posture and balance in people with stroke. Disabil Rehabil. 2003;25:120–6.
Lawshe CH. A quantitative approach to content validity. Pers Psychol. 1975;28:563–75.
Gilbert GE, Prion S. Making sense of methods and measurement: Lawshe's content validity index. Clin Simul Nurs. 2016;12:530–31.
Zamanzadeh V, Ghahramanian A, Rassouli M, Abbaszadeh A, Alavi-Majd H, Nikanfar A-R. Design and implementation content validity study: development of an instrument for measuring patient-centered communication. J Caring Sci. 2015;4:165.
Fedorak C, Ashworth N, Marshall J, Paull H. Reliability of the visual assessment of cervical and lumbar lordosis: how good are we? Spine. 2003;28:1857–59.
Altman DG. Practical statistics for medical research. Chapman and Hall/CRC; 1990.
Tilden VP, Nelson CA, May BA. Use of qualitative methods to enhance content validity. Nurs Res. 1990;39:172–5.
Watson A, Mac Donncha C. A reliable technique for the assessment of posture: assessment criteria for aspects of posture. J Sports Med Phys Fit. 2000;40:260.
Smith A, O'Sullivan P, Straker L. Classification of sagittal thoraco-lumbo-pelvic alignment of the adolescent spine in standing and its relationship to low back pain. Spine. 2008;33:2101–07.
Petermann XB, Meereis ECW. Postural body: a systematic review about assessment methods. Man Ther Posturology Rehabil J. 2016:1–9.

No competing interests reported.

Download PDF

Reviews received at journal
09 Sep, 2024
Reviewers agreed at journal
09 Sep, 2024
Reviewers invited by journal
02 Sep, 2024
Editor invited by journal
31 Jul, 2024
Editor assigned by journal
30 Jul, 2024
Submission checks completed at journal
30 Jul, 2024
First submitted to journal
29 Jul, 2024

You are reading this latest preprint version

Design and Validation of the Observational Static Posture Assessment Tool (OSPAT): A Psychometric Study

Status:

Version 1

Abstract

Background

Methods

Results

Conclusions

Figures

Background

Methods

Developing the OSPAT

Selecting the Posture Assessment Indices

OSPAT Validity Assessment

Content Validity Ratio (CVR)

Content Validity Index (CVI)

OSPAT Reliability Assessment

Raters

Participants

Posture Assessment

Data Analysis

Results

Discussion

Conclusions

Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1