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2012 Annual Conference

October 25–28, 2012

Henry B. Gonzalez Convention Center, San Antonio, TX

2012 TPTA Poster Abstracts


Saturday, October 27, 2012 at 1:00 PM–2:00 PM CDT
Bulletin Board 4B
Presenter's Name - Last Name First

Quiben, Myla

Presenter's Affiliation, City, State

University of Texas Health Science Center at San Antonio, San Antonio, TX


Individuals with increased kyphosis are more likely to have difficulty with functional tasks. While postural examination is integral to physical therapy, the objective examination and documentation of thoracic kyphosis has not been consistently done. Two noninvasive methods for kyphosis measurement, the flexicurve (FC) and tragus to the wall (TW) were compared in this pilot study. While the two methods appear reasonably valid and reliable, little is known about the relationship between the two measures or whether one may be more practical for use as a screening or monitoring tool. The purpose of this pilot study was to determine intra- and interrater reliability, ease of use, and clinical utility of the FC and TW. 


Twenty-eight community-dwelling females aged 50-95 years (mean age 67.7 ± 15.4) participated in the pilot study.


Two raters measured subjects on two different days using both the FC and TW. The selection order of postural measurement and rater was randomized. For both tests, the subject was asked to stand in their “usual best” posture. The FC was molded to the spinal curves; thoracic width was calculated based on the tracing of the FC. For TW, the distance of the tragus from the wall was determined using a digital caliper. Three measurements of each tool were completed and the mean was used for analysis.

Data Analysis

The intraclass correlation coefficient (ICC) was calculated to determine the degree of intrarater and interrater reliability of the thoracic kyphosis measurements using two methods of ICC analysis (ICC 3,1 or ICC 2,1 respectively). Significance was determined by analysis of the F statistic associated with a between-item ANOVA. Level of alpha as based on p<0.05, adjusted using the Bonferroni technique. Data were analyzed with SPSS 19.


Intrarater reliability between the trials of the measurement of kyphosis using the FC was high (0.92-0.93). Interrater reliability for Day 1 and Day 2 was 0.88 and 0.89 respectively. The ICC correlating all FC measurements over both days was 0.85 (95% CI = 0.78-0.92). Intrarater reliability for the TW varied slightly more but was still determined to be good (0.87-0.94). The Day 1 and Day 2 ICC for the interrater reliability was 0.82 and 0.84 respectively. The ICC correlating all TW measurements was 0.80 (95% CI = 0.71-0.89).


The reliability was higher using the FC than the TW; however, both measures exhibited acceptable deviations around the mean and no significant differences between groups.

In spite of standardization of application methods, inconsistencies existed between examiners in palpation of landmarks and alignment of the instruments both on the back and with tragus. Therefore, at least three measurements are advisable. As in prior studies, slight intraindividual and intrasessional postural variations were observed and likely impacted the amount of kyphosis. The FC was less challenging for alignment than measuring TW particularly in participants with a more kyphotic posture.

Clinical Relevance

The clinical measurement and documentation of kyphosis can be accomplished objectively using the FC and TW. Both have good reliability in older females; both are clinically useful as indicators of thoracic curvature, are cost efficient, and are relatively easy to use. The FC was more reproducible than TW and has the advantage of qualitative assessment by way of the visual tracing.


Dr. Myla Quiben, PhD, DPT, PT, GCS, NCS, University of Texas Health Science Center at San Antonio
Dr. Hao Liu, PT, PhD, MD, Physical Therapy, Univeristy of North Texas Health Science Center
Reta Zabel, PT, PhD, GCS, Arkansas