Original research
Photogrammetric Assessment of Upper Body Posture Using Postural Angles: A Literature Review

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Abstract

Objective

The purpose of this paper was to review the literature regarding the measurement properties of various angles used for postural assessment of the head, neck, shoulder, and thorax and to discuss the utility of these measures.

Methods

The inclusion criteria for this literature review were use of postural angles to assess posture, measurement of upper body posture, and research studies conducted in last 3 decades that had free full-text available online entirely in the English language. The exclusion criteria were review articles; studies involving subjects having obesity, visual problems, any history of surgery, respiratory, cardiovascular, neurologic, or congenital pathology or disease; and research studies in which postural angles were measured with respect to vertical only. The following databases were searched: PubMed Central, PubMed, ResearchGate, Springer Link, ScienceDirect, Google Scholar and Scielo through February 20, 2016.

Results

A total of 21 studies that were found to be best suited to explain the craniovertebral (CV) angle, sagittal head tilt, sagittal shoulder-C7 angle, coronal head tilt, coronal shoulder angle, and thoracic kyphosis angle were included in this review. Craniovertebral angle, sagittal head tilt, sagittal shoulder-C7 angle, coronal head tilt, and coronal shoulder angle possess moderate to high intrarater reliability. Craniovertebral angle, sagittal head tilt, sagittal shoulder-C7 angle and thoracic kyphosis angle possess high interrater reliability (except for sagittal head tilt when measured using the goniometer). Craniovertebral angle, sagittal head tilt, and sagittal shoulder-C7 angle have been proved to be valid measures of posture when compared with similar angles measured on radiographs. None of the studies reported intrarater reliability of thoracic kyphosis angle, interrater reliability of coronal head tilt and coronal shoulder angle, and validity of coronal angles and thoracic kyphosis angle.

Conclusions

We found several reliable methods to measure the postures of the head, neck, shoulder, and thoracic regions by measuring the CV angle, sagittal head tilt, sagittal shoulder-C7 angle, and thoracic kyphosis angle, respectively. Standardization of methods for angular measurement is recommended so that there is uniformity among studies regarding camera height, participant-camera distance, and type of software to generate normative data for postural angles.

Introduction

Postural angles are variables that can be measured to quantify posture. These are different from linear measurements, which express postural deviations as distances between 2 bony landmarks.1 Comparisons between 2 different values of a particular angle have yielded significant information regarding posture in many studies,2, 3, 4, 5 as normative values for postural angles of the sagittal plane do not exist in the literature.6 Quantitative data obtained with postural angles can be used to evaluate and monitor the changes that occur during the rehabilitation process by comparing the previous and present values of an angle.

Measurement of various postural angles by using goniometry, photography, photogrammetry, and radiography has been reported in the literature. Photogrammetry is the most widely used method for noninvasive measurement of postural measures, as it eliminates the risk of exposure to harmful radiation encountered with the radiographic method,7 and it does not require printing of photographs. Photogrammetry quantifies postural assessment by measuring linear distances and angles (formed between lines produced through body markers and horizontal or vertical lines) on digital photographs by using software specifically designed for this purpose.7, 8 Goniometry, which uses a handheld goniometer, has a disadvantage when used to record values for postural angles, since it becomes difficult to read the goniometer while the goniometer’s arm is held by the therapist in a horizontal manner.1

There are a number of different postural angles routinely used by the authors in a clinical setting for patients presenting with biomechanical faults. The objective of this study was to review the measurement properties of various angles used for postural assessment of the head, neck, shoulder, and thorax and to discuss the utility of these measures.

Section snippets

Methods

A literature review was performed using the following keywords: head, posture, shoulder, kyphosis, and photogrammetry; PubMed Central, PubMed, ResearchGate, Springer Link, ScienceDirect, Google Scholar, and Scielo, in addition to other sources, were searched through February 20, 2016. The keywords were used individually and in various combinations to search for papers. No additional terms were used while searching. Because of their prior clinical experience, the authors were particularly

Results

A formal record of studies obtained, accepted, and rejected after database searching was not kept. A total of 21 papers were selected by using the keywords and the inclusion and exclusion criteria. Table 19, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21 summarizes the various studies that were included in this review and in which postural angles were measured. The various postural angles that can be measured for the upper body are listed below:

  • 1

    Craniovertebral angle10, 14, 19, 20: Where a line

Discussion

This review aimed to verify the measurement properties and the utility of certain angles used for the assessment of posture of the head, neck, shoulder, and thoracic regions. To our knowledge, this review is first of its kind to highlight the quality and usage of postural angles for the assessment of upper body posture.

Several examples from the literature may help illustrate how these various postural angles can be used. Lau et al.10 used the Electronic Head Posture Instrument (EHPI) to

Conclusions

The CV angle, sagittal head tilt, sagittal shoulder-C7 angle, and thoracic kyphosis angle provide reliable and easy assessment of head, neck, shoulder and thoracic regions, respectively, in the sagittal plane. However, only subsequent values of a particular angle can be compared to ascertain changes in posture. Nonuniformity found in studies regarding methods used to obtain values of angles precludes the availability of normative data for postural angles in different populations; hence, some

Funding Sources and Conflicts of Interest

No funding sources or conflicts of interest were reported for this study.

Contributorship Information

Concept development (provided idea for the research): D.S., Z.V.

Design (planned the methods to generate the results): D.S., M.E.H.

Supervision (provided oversight, responsible for organization and implementation, writing of the manuscript): Z.V., D.S.

Data collection/processing (responsible for experiments, patient management, organization, or reporting data): D.S., M.E.H.

Analysis/interpretation (responsible for statistical analysis, evaluation, and presentation of the results): D.S., Z.V., M.E.H.

References (21)

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