Validity and reliability of qualitative and quantitative postural assessment in adults with cervical pain

Abstract

Introduction: Neck pain (NP) is among the top-five cause disabilities worldwide. Neck posture is associated to NP, though the validity and reliability of postural assessment for decision-making remains poorly investigated. Objective: To describe the validity and reliability of visual inspection in adults with and without NP for decision-making. Methods: A cross-sectional, observational, controlled, single-blinded study was conducted. Participants were allocated into symptomatic NP (n=30) or asymptomatic group (n=30) for postural analysis using photogrammetry. Physiotherapists were allocated as experienced (ER; n=6) or novice raters (NR; n=6) depending on their time since undergraduate. Postural assessment was performed by visual inspection of participants’ images to indicate the presence of postural misalignment, NP, and referral to physiotherapy intervention. Results: Symptomatic participants showed NP intensity of 38±20 mm, a high frequency of chronic NP (93%), low risk for developing chronic pain and disability associated with psychosocial factors (47%), and high NDI score (22±8 vs. 4±4). Validity (Cohen’s ) to identify the participants’ group by reporting the presence of NP was poor for both ER (=-0.033 [-0.100; 0.200]) and NR raters (=0.010 [-0.333; 0.133]). Interrater reliability (Light’s ) was poor in both ER and NR for reporting postural misalignment (=-0.046, 95%CI=[-0.086; 0.005]; =-0.001, 95%CI=[-0.045; 0.055], respectively), presence of NP (=0.010, 95%CI=[-0.061; 0.089]; =0.016, 95%CI=[-0.034; 0.082]), and referral to intervention (=0.001, 95%CI=[-0.040; 0.046]; =0.003, 95%CI=[-0.048; 0.072], respectively). Conclusion: Visual inspection to perform clinical decision-making in young NP adults is not valid or reliable across experienced or novice raters.