Reliability of the craniocervical posture assessment: visual and angular measurements using photographs and radiographs

J Manipulative Physiol Ther. Nov-Dec 2013;36(9):619-25. doi: 10.1016/j.jmpt.2013.09.002. Epub 2013 Oct 18.


Objective: The purposes of this study were to determine the intrarater and interrater reliability of the craniocervical posture in a sagittal view using quantitative measurements on photographs and radiographs and to determine the agreement of the visual assessment of posture between raters.

Methods: One photograph and 1 radiograph of the sagittal craniocervical posture were simultaneously taken from 39 healthy female subjects. Three angles were measured on the photographs and 10 angles on the radiographs of 22 subjects using Alcimage software (Alcimage; Uberlândia, MG, Brazil). Two repeated measurements were performed by 2 raters. The measurements were compared within and between raters to test the intrarater and interrater reliability, respectively. Intraclass correlation coefficient and SEM were used. κ Agreement was calculated for the visual assessment of 39 subjects using photographs and radiographs between 2 raters.

Results: Good to excellent intrarater and interrater intraclass correlation coefficient values were found on both photographs and radiographs. Interrater SEM was large and clinically significant for cervical lordosis photogrammetry and for 1 angle measuring cervical lordosis on radiographs. Interrater κ agreement for the visual assessment using photographs was poor (κ = 0.37).

Conclusion: The raters were reliable to measure angles in photographs and radiographs to quantify craniocervical posture with exception of 2 angles measuring lordosis of the cervical spine when compared between raters. The visual assessment of posture between raters was not reliable.

Keywords: Head; Neck; Photogrammetry; Posture; Radiography; Reliability of Results.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cervical Atlas / diagnostic imaging
  • Cervical Atlas / physiology
  • Cervical Vertebrae / diagnostic imaging*
  • Cervical Vertebrae / physiology*
  • Female
  • Healthy Volunteers
  • Humans
  • Observer Variation
  • Photogrammetry / methods*
  • Photography / methods
  • Posture / physiology*
  • Radiography
  • Range of Motion, Articular / physiology
  • Reference Values
  • Reproducibility of Results
  • Skull / diagnostic imaging*
  • Skull / physiology