Intra- and inter-rater reliability of thoracic spine mobility and posture assessments in subjects with thoracic spine pain

Abstract

Background: The thoracic spine (TS) has been neglected in the study of the spine despite its essential role in the stability and posture of the entire spinal complex. Therefore, there is an inevitable need to investigate the reproducibility of different thoracic spinal posture measures used in subjects with TS pain.

Methods: Thirty-two subjects (16 females and 16 males, mean age 39 years) were evaluated by two physiotherapists on the same day to gauge inter-rater reliability and on two consecutive days to gauge intra-rater reliability. TS posture was assessed by observation, and thoracic spine mobility was measured by manual assessment of segmental flexion and extension mobility in a seated position. Additionally, posterior-to-anterior accessory mobility in a prone position was assessed manually. Moreover, cervicothoracic flexion in a seated position, thoracic posture, and thoracic flexion and extension mobility in a standing position were assessed with a tape measure, and flexion and extension mobility in a seated position and TS posture in seated and standing positions were measured with an inclinometer. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), mean difference (MD), Bland-Altman (B&A) plot features and coefficient of repeatability (CR) were calculated.

Results: The mean and standard deviation (SD) of the duration of TS pain was 22 (SD 45) months, with the intensity of pain being rated at 27 (SD 21) mm on a visual analogue scale (VAS). Intra-rater reliability was very strong (ICC ≥ 0.80) for the evaluation of seated and standing upper TS posture, standing whole TS posture and seated lower TS posture with an inclinometer. Moreover, TS posture evaluation with a measuring tape, posture inspection in a seated position, and manual assessment of segmental extension were found to have very strong intra-rater reliability. Inter-rater reliability was very strong for inclinometer measurements of standing and seated upper TS posture as well as standing whole TS posture.

Conclusion: Intra-rater reliability was higher than inter-rater reliability in most of the evaluated measurements. Overall, posture measurements with an inclinometer were more reliable than mobility measurements with the same instrument. The manual assessments can be used reliably when same evaluator performs the examination.

Trial registration: Clinical Trials, NCT01884818. Registered 24 June 2013, https://clinicaltrials.gov/ct2/show/NCT01884818?cond=thoracic+spine&cntry=FI&rank=1.

Keywords: Clinical examination; Inclinometer; Manual therapy; Observation; Pain; Palpation; Reliability; Spine; Tape measure; Thoracic.

Fig. 1

The assessments of the thoracic spine extension with inclinometer in sitting. The assessments were performed in upper thoracic spine (a; Th1), mid-thoracic spine (b; Th6), and lower thoracic spine (c; Th12). Similar measurements were performed in maximum flexion of the thoracic spine. The thoracic spine posture was evaluated in same three locations in sitting and standing while subject maintained his/her typical posture

Fig. 2

Manual assessment of the thoracic spine mobility. Each thoracic spine movement segment of the thoracic spine was palpated in sitting (a-c) and prone (d). In sitting, segmental evaluation started from the neutral position of the segment (a), followed by guided flexion (b) and extension (c) movement while physical therapist palpated the interspinous space to evaluate the mobility of the thoracic spine segment. In prone (d), posterior-anterior pressure was applied to feel the accessory movement of each thoracic spine segment