The Test-retest Reliability of a Body Posture Literacy Questionnaire Among Polish Teachers From Different Educational Levels

The Test-retest Reliability of a Body Posture Literacy Questionnaire Among Polish Teachers From Different Educational Levels | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Test-retest Reliability of a Body Posture Literacy Questionnaire Among Polish Teachers From Different Educational Levels Marta Kinga Labecka, Agnieszka Jankowicz-Szymańska, Magdalena Plandowska, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4221930/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract To develop a reliable and valid Teachers’ Body Posture Literacy Questionnaire (TBPLQ) to examine their body posture knowledge. The tool was based on a Parents Body Posture Literacy Questionnaire (PBPLQ) and modified and validated through discussion with experts which were conducted in two rounds. Corrective gymnastics, physiotherapy, ergonomics, physical education (PE) experts and doctoral and postdoctoral scholars evaluated content validity. Test-retest repeatability was tested using Cohen's kappa coefficient. The study used a convenience sample of 195 teachers from 3 different educational levels: PE, kindergarten, and primary education in two rounds of test-retest. The initial round encompassed 95 participants, with pre-test and post-test procedures applied using the original TBPLQ. Subsequently, the second round involved 100 participants and followed a similar approach, incorporating modifications to the TBPLQ based on the reliability outcomes observed in the first round. The results of the first-round test–retest TBPLQ reliability, with 95 samples resulted in an overall reliability of 0.77 (range 0.02 to 1). This indicated that the questionnaire still lacks sufficient reliability. Consequently, after the necessary amendments and modifications, the questionnaire’s reliability was tested for the second time with 100 samples. Notably, the overall reliability of 0.82 (ranging from 0.50 to 1) was established for the TBPLQ indicating that 87.5% of the questionnaire items achieved reliability scores within the substantial and almost perfect range and only 12.5% of the items attained moderate reliability scores. The questionnaire is a new self-report measure, reliable and relevant to effectively evaluating teachers' literacy in postural health that can be applicable in both research and practical contexts, extending its use to larger and more diverse populations. child posture knowledge ergonomics school teachers physical education Figures Figure 1 Figure 2 Figure 3 Introduction Postural defects, deemed a contemporary pandemic and societal issue (Kolarová et al., 2019 ), affect 60–80% of children (Klimkiewicz-Wszelaki et al., 2019 ). Causes include congenital or acquired defects, exogenous factors (physical activity, eating habits, body position), and endogenous factors affecting general health (Modrzejewska & Malec, 2017 ). Noteworthy environmental factors involve prolonged sitting in classrooms, poor posture, inadequate furniture (Murphy et al., 2004 ), and the manner of carrying school backpacks (Minghelli et al., 2021 ). In particular, an inappropriate lifestyle and insufficient physical activity stand out as common causes (Skorupka & Asienkiewicz, 2014 ). Given the risk of body posture defects at every child development stage, preventive measures are vital. Early diagnosis, especially in children under 15, is crucial for skeletal modifications and easier postural correction (Mitova, 2015 ). Untreated poor posture can lead to body static impairments, musculoskeletal disorders, pain, increased healthcare costs, and mental symptoms (Domljan et al., 2010 ; Hagner et al., 2010 ). Untimely correction significantly impacts life quality (Kędra et al., 2021 ). The situation highlights the need for systematic diagnosis of children's locomotor apparatus development during early school years and preventive actions from early childhood (Kowalski et al., 2013 ). Preventive actions should include effective screening tests (Lipkin et al., 2020 ; Moment et al.). Supporting child development extends beyond parents to those shaping the child's environment (Office, 2020 ). Family doctors, pediatricians, nurses, and especially teachers should pay attention to a child’s body posture (Antczak-Komoterska & Lewińska, 2022 ). Primary education teachers play a crucial role as the first three years of schooling contribute to posture deterioration (Gesell, 2021 ; Nichele et al., 2016 ). They have the opportunity to observe changes and ensure a correct working environment. Teachers should shape correct sitting habits and posture (Gao et al., 2021 ). Physical Education, as a fundamental component of engaging in physical culture, significantly contributes to molding the character of young individuals. In this context, it is crucial for educators to acknowledge that PE facilitates holistic development, instills a sense of joy through physical effort, and supports overall health maintenance (Ruzimbaevich & Ruzimbaev, 2021 ). PE teachers also contribute significantly to preventing body posture defects (Khakimovich & Rozmatovich, 2022 ). To the best of the researcher's knowledge, no scientific studies exist on educational teachers' knowledge regarding recognition, prevention, correction, and the causes of body posture defects. Therefore, it is necessary to know about pro-health activities and the role of correct body posture and how to create it, as well as appropriate motivation for this type of action, skills, and actual preventive actions. As a result, this study aims to develop a valid and reliable questionnaire examining the level of teachers' literacy in postural health, including postural defeat recognition in pupils and its probable causes and solutions to prevent or correct it. Material and Methods This research included four phases. Phase 1 was from February to March 2023 and involved creating a questionnaire based on the Parents Body Posture Literacy Questionnaire (PBPLQ) (Labecka et al., 2023 ) and adjusted by expert consultation. Phase 2 was conducted in April 2023. The questionnaire was translated into Polish. Phase 3 was conducted in August 2023, as a first-round reliability (pilot reliability). Phase 4 was a survey to test the questionnaire’s reliability of the questionnaire in November 2023 as a second-round reliability. This was done after revisions were made by the international committee of experts to the English version of the questionnaire based on the results of the first-round reliability study (Fig. 1 ). The study was conducted by the Declaration of Helsinki and approved by the Ethics Committee of Jozef Pilsudski University of Physical Education in Warsaw (protocol code 01–07/2023, date of approval 18 February 2023). Participation in the study was voluntary. Respondents provided informed consent, and data privacy and confidentiality were assured by treating the data aggregately and coding the names. Insert Fig. 1 near here Questionnaire development The questionnaire was based on the pool of items from previous questionnaires (Labecka et al., 2023 ; Rajabi et al., 2023 ). The majority of questions were obtained from the Parents Body Posture Literacy Questionnaire (PBPLQ) (Labecka et al., 2023 ). This questionnaire was chosen because it had high reliability and was relevant in assessing postural knowledge. In addition, it was scientific and was prepared according to rigorous questionnaire development procedures. A committee of six experts in postural health (doctoral and postdoctoral scholars, physiotherapists, physical education teachers, and instructors of corrective gymnastics/exercises) evaluated the draft questionnaire in English for content validity. Based on literature from postural health and discussions between experts, questions were removed or reworded and new ones were added. Because the draft questionnaire was aimed at parents, the questions were modified to be appropriate for other audiences including teachers. The initial question pool contained 36 items divided into 3 sections: postural abnormality, postural ergonomics, and sociodemographic data. The experts individually wondered which questions were most important and assessed the questionnaire independently. Then they discussed together the formulation of the questions and answers, as well as the structure and format of the questionnaire in face-to-face and online meetings. A brainstorming session was conducted. The committee of experts was international, so discussions were conducted in English. Through multiple exchanges of information and revision of feedback, the elements of the Delphi method (McPherson et al., 2018 ) transformed the experts' opinions into a group consensus. Final recommendations were taken from the arguments most widely accepted by the participants and always to improve the questionnaire. The original questionnaire was developed in English. The pool of questions turned out to be much larger than the final number of items that were included in the PBPLQ model questionnaire. After determining the preliminary version of the questionnaire, it was translated from English into Polish using the guidelines recommended by Oxford University Innovation to ensure appropriate standards (Wild et al., 2005 ). Forward translation by two independent translators (Polish native speakers), discussion between ‘forward’ translators and the Polish research team, backward translation by two independent translators (English native speakers), and a review by a physiotherapist established the final Polish version of the questionnaire. Reliability Analysis The first round of test–retest reliability as pilot reliability was conducted twice, with approximately 1 week between the first and second administration of the questionnaire to obtain information on how the BPLQT questionnaire was working, whether it was feasible to use it in a real-world setting and to complete it in a reasonable amount of time, assessing its ease of understanding, its acceptability and evaluating the initial test–retest reliability of the questionnaire. At that time, the respondents were not allowed to see the answers they gave when the questionnaire was first administered. The authors chose the interval between questionnaire administrations based on the concept that the time should be long enough that respondents would not remember previously selected answers, but short enough that the acquisition of new knowledge was unlikely (Parmenter & Wardle, 2000 ). The questionnaire was administered to 95 teachers of both sexes and of different ages. Respondents were recruited from all school types (kindergarten, primary, secondary, and high school) in in various cities of Poland through various channels (e-mails, Facebook posts, etc.) where information with a link to an online preliminary version of the questionnaire was provided. Electronic questionnaires were checked by the researcher from backstage and invalid questionnaires would be eliminated. Respondents were invited to give opinions about the questionnaire, their difficulties in understanding the questions and answers, and comment on other aspects. Due to slight test–retest reliability results in some questions, and opinions of the experts and participants, the questionnaire was modified. Finally, the experts decided to carry out the test–retest again to check the reliability of the modified questionnaire. A second round of test–retest reliability was performed with 100 newly enrolled teachers who were unfamiliar with the content and structure of the questionnaire. The rules for conducting the test–retest remained unchanged (as in the first round). Statistical Analysis Data were analyzed using Microsoft Excel and were presented as the range, mean, or n (%). Cohen's kappa coefficient was applied to evaluate the test–retest reliability (data from the same rater at two different points in time). Values ≤ 0 indicating no agreement, 0.01–0.20 as none to slight, 0.21–0.40 as fair, 0.41– 0.60 as moderate, 0.61–0.80 as substantial, and 0.81–1.00 as almost perfect agreement (McHugh, 2012 ). To ensure the content validity of the questionnaire, experts from various disciplines and different international institutions reviewed and agreed upon the questionnaire's content coverage. Results Questionnaire development The initial questionnaire was determined and formed based on previous questionnaires for parents and a total of 41 items. Based on the opinions of experts, in the first part of the questionnaire (postural abnormality), a fourth column was added containing graphics presenting corrective exercises of the abnormality. Also, in the third column (causes of the abnormality) an answer that is a combination of two or three correct answers was added (e.g. 1&2 or 1,2,3). In the second part of the questionnaire (postural ergonomics), in the second column, the 'All of the above' option was added. The third part of the questionnaire was significantly modified (the question pool has been increased from 20 to 25 items) to include teachers' socio-demographics, professional data, and educational status. Reliability Analysis Table 1 presents the socio-demographic and professional characteristics of the teachers. Ninety-five teachers completed the first questionnaire administered (I round), where the majority were female (76.8%). Respondents ranged in age from 26 to 58 years (38.20 ± 10.97) from different educational levels with over 10 years of work experience (11.59 ± 10.49). It was necessary to modify some questions and sub-questions to improve them based on respondents' comments. Table 1 Socio-demographic and professional characteristics of questionnaire respondents. Item I round II round n % n % Sex Female 73 76.8 58 58.0 Male 22 23.2 42 42.0 Age (years) ≤ 35 20 21.1 59 59.0 36–45 47 49.5 32 32.0 ≥ 46 28 29.4 9 9.0 Education level Kindergarten 33 34.7 32 32.0 Primary school 30 31.6 29 29.0 Physical education 32 33.7 39 39.0 Work experience ≤ 10 19 20.0 42 42.0 11–20 55 57.9 39 39.0 ≥ 21 21 22.1 19 19.0 n – number of participants; %- percent The 100 teachers filled out the modified version of the questionnaire (II round) where the majority were female (58.0%). Respondents ranged in age from 25 to 48 years (30.24 ± 8.57) from different educational levels with under 10 years of work experience (8.54 ± 6.46). There was no adjustment to the questionnaire after the second-round reliability study as it seemed that the modifications of the questionnaire (content and graphics) after the second round were effective and in line with expert group expectations. Insert Table 1 near here Table 2 presented the Cohen's kappa coefficient results for all items in the teachers' groups included in the study. After the first round of reliability (95 teachers out of 108), the reliability scores spanned a range from 0.02 to 1.00 overall, 0.74 for the postural abnormality questions and 0.80 for the postural ergonomics questions. In the first part of the questionnaire (postural abnormality items), sub-item 2 from question 1 (Cohen's kappa = 0.02), sub-item 2 from question 2 (Cohen's kappa = 0.37), sub-item 3 from question 5 (Cohen's kappa = 0.54), and sub-item 3 from question 8 (Cohen's kappa = 0.46) obtained slight reliability scores. In the 2 sections, sub-item 1 from question 9 (Cohen's kappa = 0.53), sub-item 2 from question 11 (Cohen's kappa = 0.55), and sub-item 1 from question 13 (Cohen's kappa = 0.59) displayed moderate reliability. After analyzing the respondents' answers, the researchers observed was a lack of clarity resulting in multiple interpretations of selected questions, so modifications in the questionnaire were required. In the first part of the questionnaire, in column 3, the causes of abnormalities were reformulated into statements describing the abnormalities; in column 4, the answer "I don't know" was added, in column 2, in questions 1,2, the names of the abnormalities were changed; in column 3, in questions 5,8, statements describing the abnormalities were modified. The second part of the questionnaire (postural ergonomics items) remained unchanged. In the third part of the questionnaire (socio-demographic and professional characteristics), 1 question about external and internal factors affecting body posture was deleted, and question number 13 was modified. Finally, the total number of questions has changed (from 41 to 40). Table 2 Data describing the reliability of questionnaire items. Question/item (Postural abnormality) Sub-item1 (Recognition of abnormalities) Sub-item2 (Naming of the abnormality) Sub-item3 (causes of the abnormality) Sub-item4 (corrective exercise for the abnormality) Items average (range, mean) 1 round 2 round 1 round 2 round 1 round 2 round 1 round 2 round 1 round 2 round 1 Forwarded head 1 1 0.02 0.82 0.70 0.67 0.83 0.68 0.02–0.83 (0.64) 0.67-1 (0.79) 2 Thoracic Kyphosis 1 1 0.37 0.69 0.80 0.73 0.81 0.56 0.37–0.81 (0.75) 0.56-1 (0.75) 3 Lumbar Lordosis 0.85 1 0.83 0.81 0.83 0.52 0.83 0.67 0.83–0.85 (0.84) 0.52-1 (0.75) 4 Scoliosis 0.90 1 0.78 1 0.62 1 0.74 0.89 0.62–0.90 (0.76) 0.89-1 (0.97) 5 Geno Varum 0.75 1 0.64 0.74 0.54 0.73 0.73 0.76 0.54–0.75 (0.67) 0.73-1 (0.81) 6 Geno Valgum 0.91 1 0.85 0.5 0.82 0.79 0.61 0.7 0.61–0.91 (0.80) 0.50-1 (0.75) 7 Feet abnormalities 0.73 0.81 0.66 0.81 0.64 0.55 0.68 0.76 0.64–0.73 (0.67) 0.55–0.81 (0.73) 8 Toe abnormalities 1 1 0.85 0.95 0.46 1 0.71 0.75 0.46-1 (0.76) 0.46-1 (0.92) Sub-items average 0.73-1.00 (0.89) 0.81-1 (0.98) 0.02–0.85 (0.63) 0.50-1 (0.79) 0.46–0.83 (0.68) 0.52-1 (0.75) 0.61–0.83 (0.74) 0.56–0.89 (0.72) Total = 0.74 Total = 0.81 Postural Ergonomics Questions/items Sub-item1 kappa value (Recognition) Sub-item2 kappa value (Mechanism) 1 round 2 round 1 round 2 round 1 round 2 round 9 Sitting posture on the floor while playing 0.53 0.7 0.77 0.84 0.53–0.77 (0.65) 0.70–0.84 (0.77) 10 Lifting and carrying postures 0.83 1 0.78 0.5 0.78–0.83 (0.81) 0.50-1 (0.75) 11 Working with correct posture while working with computer 1 1 0.55 0.6 0.55-1 (0.78) 0.60-1 (0.8) 12 Walking posture 1 1 0.78 0.7 0.78-1 (0.89) 0.70-1 (0.85) 13 Smart phone using posture 0.59 1 0.70 0.73 0.59–0.70 (0.65) 0.73-1 (0.86) 14 Writing posture 1 1 0.85 0.58 0.85-1 (0.93) 0.58-1 (0.79) 15 Back pack carrying posture 1 1 0.78 0.97 0.78-1 (0.90) 0.97-1 (0. 98) 16 Sleeping posture 0.76 0.81 0.80 0.89 0.78–0.80 (0.78) 0.81–0.89 (0.85) Sub-items average 0.53-1.00 (0.84) 0.55–0.85 (0.75) Total = 0.80 Total = 0.83 Over all 16 items 0.77 0.82 Data presented as range and mean; n – number of participant In the second round of reliability of TBPLQ, (100 teachers out of 118) were assessed using 16 questions with 48 sub-questions, 32 sub-questions related to postural abnormalities, and 16 sub-questions related to postural ergonomics. The overall reliability (16 questions) of the TBPLQ was demonstrated as 0.82 (range 0.46 to 1.00), with 54.1% demonstrating almost perfect reliability (range 0.81 to 1.00), 31.2% demonstrating substantial reliability (range 0.61 to 0.80) and 14.6% demonstrating moderate reliability (range 0.41 to 0.60). More detailed results regarding reliability for postural abnormalities and postural ergonomics are presented in Table 2 . Insert Table 2 near here Final questionnaire After refinements and modifications were made as a result of the validation process and the first round of reliability tests, the final questionnaire (validated Polish version, and English version) was formulated [Supplementary material]. The second round of reliability of TBPLQ indicated a substantial improvement. The first and second round reliability test comparison is provided in Figs. 2 and 3 . Finally, the questionnaire took the form of a self-administered document that was easy to complete and not time-consuming; it consisted of three parts (40 questions – including 8 questions for postural abnormality with 32 sub-items, 8 questions for postural ergonomics with 16 sub-items, and 24 questions about socio-demographics, professional data, and educational status). Insert Figs. 2 and 3 near here Discussion The primary aim of this study was to assess the test–retest reliability of a self-reporting questionnaire designed to evaluate the level of teachers' literacy in postural health, encompassing aspects such as recognition, naming, describing, selecting an appropriate corrective exercise for postural abnormalities, and the ergonomics of daily activities. The results of the first-round test retest TBPLQ reliability resulted in overall substantial reliability. However, some questionnaire items showed slight to moderate reliability, which indicated that the questionnaire still lacked sufficient reliability. Upon closer examination of sub-items 9 and 13, it became apparent that these sub-items contained misleading and ambiguous elements. For example, in the first sub-item of item 9, variations in graphic patterns (some depicting a child and others an adult) were identified. Similarly, the first sub-items of item 13 presented graphics with striking similarities, making it challenging to select the correct response. It is important to note that certain refinements were necessary to enhance reliability and to address the observed discrepancies between expected and actual outcomes, so specific modifications to the final questionnaire were made. These adjustments included the redesign of specific items and their sub-items based on experts’ and participants’ opinions. Consequently, after the necessary amendments and modifications, the questionnaire’s reliability was tested for the second time. Notably, overall almost perfect agreement reliability was established for the TBPLQ indicating that 87.5% of the questionnaire items achieved reliability scores within a range of substantial to almost perfect, and only 12.5% of the items attained moderate reliability scores. This nuanced assessment aligns with the findings of a recently published study (Rajabi et al., 2023 ). Owing to the development of modern civilization, it seems reasonable to pay attention to the position of the body adopted by children during various everyday activities. School should be the first environment for preventing postural issues, which involves eliminating factors that negatively affect the development of the child's body (Skorupka & Asienkiewicz, 2014 ). The school is responsible for creating such conditions for the functioning of the child within it, which will prevent the formation and spread of body posture defects. One of the tools in these activities is conducting active education among school principals, teachers, and parents, as well as children and youth. It should be obvious that posture defects should be detected as early as possible; however, information and educational activities undertaken in the field of postural defects prevention have not been fully effective (Office, 2020 ). There may be several reasons for the lack of effectiveness of educational activities: difficulties in reaching recipients, or financial problems. However, attention should also be paid to the substantive preparation of early school and preschool education teachers, as well as teachers of other subjects to conduct education in this area, as it is currently not done adequately. In this regard, one of the obstacles to assessing the level of theoretical and practical abilities of teachers regarding students' postural abnormalities is the absence of a comprehensive yet simple and practical questionnaire. Such a tool is needed to examine and evaluate the literacy of teachers in common body posture abnormalities among students in schools. So, the current questionnaire, called TBPLQ, is addressed to PE, kindergarten, and primary education teachers: people who, at various stages of education, are particularly responsible for caring for the quality of the body posture of children and youth and for developing in children and youth the care for the quality of body posture and healthy lifestyle. The study has two limitations: technical terminology and sample size. Despite our conscientious efforts to simplify the terminology used in the questionnaire, it is worth noting that the incorporation of technical and medical language relating to postural abnormalities may inadvertently have led to responses that were less reliable. Although our study adhered to the standard recommendation of utilizing a minimum of 100 participants for a robust reliability estimate (as consistent with our sample size), it is important to acknowledge that this represents the bare minimum necessary to achieve reliable outcomes. In contrast, the study's strengths are rigorous questionnaire development involving multiple rounds of pretests, meticulous item selection, extensive expert reviews to ensure the content validity and clarity of the questionnaire; and comprehensive content discussion of all the issues of the questionnaire. The results of the research, which will be carried out with the use of the questionnaire, will not only help to assess teachers' literacy about postural health but will also enable the preparation of a package of ergonomics and other recommendations for educational institutions in these fields. It will also be possible to prepare an auxiliary package (brochures, electronic materials) supplementing teachers' knowledge, or workshops to improve their practical skills. The findings will complement evidence-based knowledge that takes into account the social and health needs of different society groups. Conclusions The Teachers’ Body Posture Literacy Questionnaire (TBPLQ) demonstrated commendable overall reliability, encompassing substantial and almost perfect scores, signifying its potential to assess teachers' knowledge of postural health in school-age students effectively. The TBPLQ is a newly established self-report questionnaire, proven to be both valid and reliable, making it suitable for application in both research and practical settings. Its adaptability extends its utility to broader and more diverse populations. Declarations Acknowledgments The authors would like to show gratitude to Mr. Piotr Tabor from Jozef Pilsudski University of Physical Education in Warsaw who helped collect the survey for the second round of pretest. Declaration of interest statement The authors report there are no competing interests to declare. Funding This work was supported by the Ministry of Education and Science in the years 2023-2024 under the University Research Project at Józef Piłsudski University of Physical Education in Warsaw ‘The knowledge of teachers about the prevention, correction, and defects of body posture in children’ [280/R/PRO/2023; date 2023/02/28]. References Antczak-Komoterska, A., & Lewińska, A. (2022). 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Labecka","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDElEQVRIiWNgGAWjYPACCwYDBgZmBoYKBgb2BgYGCaCQDB7ljGA1EC1nGBh4DkC08BCnhbGNCC267WefP/jBICFvzt782ODnPLvEHgbmg7d5GO7g1GJ2Jt2wsYdBwnBnzzHjxN5tyUAtbMnWPAzPcGs5kMbYwMMgwbjhRg7zAd5tzLn7GXjMpHkYDuPWcv4ZY+MfBgn7DfffMB/8O6c+t4eB/xt+LTfSGJuBtiRuuMHDnMzbcBiohYeNgJZnjLNlDCSSd/akGRvLHDte38PMZmw5xwCPX86nMXx8U2Fju5398GPJNzXVxjzszQ9vvKm4I4dLCwQYIHOYwSIH8OvABsjQMgpGwSgYBcMVAAAuo1Ev1TLqxQAAAABJRU5ErkJggg==","orcid":"","institution":"Department of Rehabilitation, Jozef Pilsudski University of Physical Education in Warsaw, Poland","correspondingAuthor":true,"prefix":"","firstName":"Marta","middleName":"Kinga","lastName":"Labecka","suffix":""},{"id":287849858,"identity":"b0705cdd-1581-4279-b470-b2e2b1202c38","order_by":1,"name":"Agnieszka Jankowicz-Szymańska","email":"","orcid":"","institution":"University of Applied Sciences in Tarnow, Faculty of Health Sciences, Department of Physiotherapy, Tarnow, Poland","correspondingAuthor":false,"prefix":"","firstName":"Agnieszka","middleName":"","lastName":"Jankowicz-Szymańska","suffix":""},{"id":287850094,"identity":"c24f03b0-5138-43ae-b511-7f24cc8557b0","order_by":2,"name":"Magdalena Plandowska","email":"","orcid":"","institution":"Faculty of Physical Education and Health in Biala Podlaska, Jozef Pilsudski University of Physical Education in Warsaw, Biala Podlaska, Poland","correspondingAuthor":false,"prefix":"","firstName":"Magdalena","middleName":"","lastName":"Plandowska","suffix":""},{"id":287850095,"identity":"496ebe4c-7c24-416e-b618-842f532843e6","order_by":3,"name":"Elżbieta Olszewska","email":"","orcid":"","institution":"Józef Piłsudski Academy of Physical Education in Warsaw, Poland","correspondingAuthor":false,"prefix":"","firstName":"Elżbieta","middleName":"","lastName":"Olszewska","suffix":""},{"id":287850096,"identity":"9c6538e6-cb2e-49ec-a5ee-2d4f7a2f7719","order_by":4,"name":"Reza Rajabi","email":"","orcid":"","institution":"Health and Sport Medicine Department, Faculty of Physical Education and Sport Sciences, University of Tehran, Iran","correspondingAuthor":false,"prefix":"","firstName":"Reza","middleName":"","lastName":"Rajabi","suffix":""}],"badges":[],"createdAt":"2024-04-05 09:20:11","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-4221930/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4221930/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":54314615,"identity":"086964be-104e-4972-ba15-4f8ba108c4f0","added_by":"auto","created_at":"2024-04-08 17:36:36","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":48917,"visible":true,"origin":"","legend":"\u003cp\u003ePhases of developing the Teachers’ Body Posture Literacy Questionnaire (TBPLQ).\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4221930/v1/d6af45d4c7ceae8ad898d1d8.png"},{"id":54313541,"identity":"5f21a9e2-ef89-43ca-ba35-f231b8a60590","added_by":"auto","created_at":"2024-04-08 17:28:36","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":13751,"visible":true,"origin":"","legend":"\u003cp\u003eItem by item reliability improvement of the TBPLQ.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4221930/v1/45a77c91fdab4898abe49ca1.png"},{"id":54313543,"identity":"0e39e2c2-d2c5-4ecf-9c58-2b016dc36582","added_by":"auto","created_at":"2024-04-08 17:28:36","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":9348,"visible":true,"origin":"","legend":"\u003cp\u003eOverall Reliability Improvement of TBPLQ.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4221930/v1/71af2f02df2518bf201b4042.png"},{"id":54315474,"identity":"fe121fad-4854-4f40-9a3a-37b7c9a8a6ad","added_by":"auto","created_at":"2024-04-08 17:44:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":513617,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4221930/v1/b7fb22d2-eec8-4143-b3d2-c1a8cf40854b.pdf"},{"id":54313544,"identity":"38c57ccc-15af-4e84-b77d-97ad4b75a4ad","added_by":"auto","created_at":"2024-04-08 17:28:36","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":7894002,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarymaterials.docx","url":"https://assets-eu.researchsquare.com/files/rs-4221930/v1/ec09e4d9dbecb9ebd4cf4a7a.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eThe Test-retest Reliability of a Body Posture Literacy Questionnaire Among Polish Teachers From Different Educational Levels\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePostural defects, deemed a contemporary pandemic and societal issue (Kolarov\u0026aacute; et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), affect 60\u0026ndash;80% of children (Klimkiewicz-Wszelaki et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Causes include congenital or acquired defects, exogenous factors (physical activity, eating habits, body position), and endogenous factors affecting general health (Modrzejewska \u0026amp; Malec, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Noteworthy environmental factors involve prolonged sitting in classrooms, poor posture, inadequate furniture (Murphy et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2004\u003c/span\u003e), and the manner of carrying school backpacks (Minghelli et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). In particular, an inappropriate lifestyle and insufficient physical activity stand out as common causes (Skorupka \u0026amp; Asienkiewicz, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGiven the risk of body posture defects at every child development stage, preventive measures are vital. Early diagnosis, especially in children under 15, is crucial for skeletal modifications and easier postural correction (Mitova, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Untreated poor posture can lead to body static impairments, musculoskeletal disorders, pain, increased healthcare costs, and mental symptoms (Domljan et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Hagner et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Untimely correction significantly impacts life quality (Kędra et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe situation highlights the need for systematic diagnosis of children's locomotor apparatus development during early school years and preventive actions from early childhood (Kowalski et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Preventive actions should include effective screening tests (Lipkin et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Moment et al.).\u003c/p\u003e \u003cp\u003eSupporting child development extends beyond parents to those shaping the child's environment (Office, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Family doctors, pediatricians, nurses, and especially teachers should pay attention to a child\u0026rsquo;s body posture (Antczak-Komoterska \u0026amp; Lewińska, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Primary education teachers play a crucial role as the first three years of schooling contribute to posture deterioration (Gesell, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Nichele et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). They have the opportunity to observe changes and ensure a correct working environment. Teachers should shape correct sitting habits and posture (Gao et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Physical Education, as a fundamental component of engaging in physical culture, significantly contributes to molding the character of young individuals. In this context, it is crucial for educators to acknowledge that PE facilitates holistic development, instills a sense of joy through physical effort, and supports overall health maintenance (Ruzimbaevich \u0026amp; Ruzimbaev, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). PE teachers also contribute significantly to preventing body posture defects (Khakimovich \u0026amp; Rozmatovich, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo the best of the researcher's knowledge, no scientific studies exist on educational teachers' knowledge regarding recognition, prevention, correction, and the causes of body posture defects. Therefore, it is necessary to know about pro-health activities and the role of correct body posture and how to create it, as well as appropriate motivation for this type of action, skills, and actual preventive actions. As a result, this study aims to develop a valid and reliable questionnaire examining the level of teachers' literacy in postural health, including postural defeat recognition in pupils and its probable causes and solutions to prevent or correct it.\u003c/p\u003e"},{"header":"Material and Methods","content":"\u003cp\u003eThis research included four phases. Phase 1 was from February to March 2023 and involved creating a questionnaire based on the Parents Body Posture Literacy Questionnaire (PBPLQ) (Labecka et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) and adjusted by expert consultation. Phase 2 was conducted in April 2023. The questionnaire was translated into Polish. Phase 3 was conducted in August 2023, as a first-round reliability (pilot reliability). Phase 4 was a survey to test the questionnaire\u0026rsquo;s reliability of the questionnaire in November 2023 as a second-round reliability. This was done after revisions were made by the international committee of experts to the English version of the questionnaire based on the results of the first-round reliability study (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e The study was conducted by the Declaration of Helsinki and approved by the Ethics Committee of Jozef Pilsudski University of Physical Education in Warsaw (protocol code 01\u0026ndash;07/2023, date of approval 18 February 2023). Participation in the study was voluntary. Respondents provided informed consent, and data privacy and confidentiality were assured by treating the data aggregately and coding the names.\u003c/p\u003e \u003cp\u003eInsert Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e near here\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eQuestionnaire development\u003c/h2\u003e \u003cp\u003eThe questionnaire was based on the pool of items from previous questionnaires (Labecka et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Rajabi et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). The majority of questions were obtained from the Parents Body Posture Literacy Questionnaire (PBPLQ) (Labecka et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). This questionnaire was chosen because it had high reliability and was relevant in assessing postural knowledge. In addition, it was scientific and was prepared according to rigorous questionnaire development procedures.\u003c/p\u003e \u003cp\u003eA committee of six experts in postural health (doctoral and postdoctoral scholars, physiotherapists, physical education teachers, and instructors of corrective gymnastics/exercises) evaluated the draft questionnaire in English for content validity. Based on literature from postural health and discussions between experts, questions were removed or reworded and new ones were added. Because the draft questionnaire was aimed at parents, the questions were modified to be appropriate for other audiences including teachers. The initial question pool contained 36 items divided into 3 sections: postural abnormality, postural ergonomics, and sociodemographic data. The experts individually wondered which questions were most important and assessed the questionnaire independently. Then they discussed together the formulation of the questions and answers, as well as the structure and format of the questionnaire in face-to-face and online meetings. A brainstorming session was conducted. The committee of experts was international, so discussions were conducted in English. Through multiple exchanges of information and revision of feedback, the elements of the Delphi method (McPherson et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) transformed the experts' opinions into a group consensus. Final recommendations were taken from the arguments most widely accepted by the participants and always to improve the questionnaire. The original questionnaire was developed in English. The pool of questions turned out to be much larger than the final number of items that were included in the PBPLQ model questionnaire.\u003c/p\u003e \u003cp\u003eAfter determining the preliminary version of the questionnaire, it was translated from English into Polish using the guidelines recommended by Oxford University Innovation to ensure appropriate standards (Wild et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2005\u003c/span\u003e). Forward translation by two independent translators (Polish native speakers), discussion between \u0026lsquo;forward\u0026rsquo; translators and the Polish research team, backward translation by two independent translators (English native speakers), and a review by a physiotherapist established the final Polish version of the questionnaire.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eReliability Analysis\u003c/h2\u003e \u003cp\u003eThe first round of test\u0026ndash;retest reliability as pilot reliability was conducted twice, with approximately 1 week between the first and second administration of the questionnaire to obtain information on how the BPLQT questionnaire was working, whether it was feasible to use it in a real-world setting and to complete it in a reasonable amount of time, assessing its ease of understanding, its acceptability and evaluating the initial test\u0026ndash;retest reliability of the questionnaire. At that time, the respondents were not allowed to see the answers they gave when the questionnaire was first administered. The authors chose the interval between questionnaire administrations based on the concept that the time should be long enough that respondents would not remember previously selected answers, but short enough that the acquisition of new knowledge was unlikely (Parmenter \u0026amp; Wardle, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2000\u003c/span\u003e). The questionnaire was administered to 95 teachers of both sexes and of different ages. Respondents were recruited from all school types (kindergarten, primary, secondary, and high school) in in various cities of Poland through various channels (e-mails, Facebook posts, etc.) where information with a link to an online preliminary version of the questionnaire was provided. Electronic questionnaires were checked by the researcher from backstage and invalid questionnaires would be eliminated. Respondents were invited to give opinions about the questionnaire, their difficulties in understanding the questions and answers, and comment on other aspects. Due to slight test\u0026ndash;retest reliability results in some questions, and opinions of the experts and participants, the questionnaire was modified. Finally, the experts decided to carry out the test\u0026ndash;retest again to check the reliability of the modified questionnaire. A second round of test\u0026ndash;retest reliability was performed with 100 newly enrolled teachers who were unfamiliar with the content and structure of the questionnaire. The rules for conducting the test\u0026ndash;retest remained unchanged (as in the first round).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using Microsoft Excel and were presented as the range, mean, or n (%). Cohen's kappa coefficient was applied to evaluate the test\u0026ndash;retest reliability (data from the same rater at two different points in time). Values\u0026thinsp;\u0026le;\u0026thinsp;0 indicating no agreement, 0.01\u0026ndash;0.20 as none to slight, 0.21\u0026ndash;0.40 as fair, 0.41\u0026ndash; 0.60 as moderate, 0.61\u0026ndash;0.80 as substantial, and 0.81\u0026ndash;1.00 as almost perfect agreement (McHugh, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). To ensure the content validity of the questionnaire, experts from various disciplines and different international institutions reviewed and agreed upon the questionnaire's content coverage.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003eQuestionnaire development\u003c/h2\u003e\n \u003cp\u003eThe initial questionnaire was determined and formed based on previous questionnaires for parents and a total of 41 items. Based on the opinions of experts, in the first part of the questionnaire (postural abnormality), a fourth column was added containing graphics presenting corrective exercises of the abnormality. Also, in the third column (causes of the abnormality) an answer that is a combination of two or three correct answers was added (e.g. 1\u0026amp;2 or 1,2,3). In the second part of the questionnaire (postural ergonomics), in the second column, the \u0026apos;All of the above\u0026apos; option was added. The third part of the questionnaire was significantly modified (the question pool has been increased from 20 to 25 items) to include teachers\u0026apos; socio-demographics, professional data, and educational status.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eReliability Analysis\u003c/h2\u003e\n \u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e presents the socio-demographic and professional characteristics of the teachers. Ninety-five teachers completed the first questionnaire administered (I round), where the majority were female (76.8%). Respondents ranged in age from 26 to 58 years (38.20\u0026thinsp;\u0026plusmn;\u0026thinsp;10.97) from different educational levels with over 10 years of work experience (11.59\u0026thinsp;\u0026plusmn;\u0026thinsp;10.49). It was necessary to modify some questions and sub-questions to improve them based on respondents\u0026apos; comments.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSocio-demographic and professional characteristics of questionnaire respondents.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eI round\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eII round\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36\u0026ndash;45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eEducation level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKindergarten\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePhysical education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eWork experience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u0026ndash;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003en \u0026ndash; number of participants; %- percent\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eThe 100 teachers filled out the modified version of the questionnaire (II round) where the majority were female (58.0%). Respondents ranged in age from 25 to 48 years (30.24\u0026thinsp;\u0026plusmn;\u0026thinsp;8.57) from different educational levels with under 10 years of work experience (8.54\u0026thinsp;\u0026plusmn;\u0026thinsp;6.46). There was no adjustment to the questionnaire after the second-round reliability study as it seemed that the modifications of the questionnaire (content and graphics) after the second round were effective and in line with expert group expectations.\u003c/p\u003e\n \u003cp\u003eInsert Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e near here\u003c/p\u003e\n \u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e presented the Cohen\u0026apos;s kappa coefficient results for all items in the teachers\u0026apos; groups included in the study. After the first round of reliability (95 teachers out of 108), the reliability scores spanned a range from 0.02 to 1.00 overall, 0.74 for the postural abnormality questions and 0.80 for the postural ergonomics questions. In the first part of the questionnaire (postural abnormality items), sub-item 2 from question 1 (Cohen\u0026apos;s kappa\u0026thinsp;=\u0026thinsp;0.02), sub-item 2 from question 2 (Cohen\u0026apos;s kappa\u0026thinsp;=\u0026thinsp;0.37), sub-item 3 from question 5 (Cohen\u0026apos;s kappa\u0026thinsp;=\u0026thinsp;0.54), and sub-item 3 from question 8 (Cohen\u0026apos;s kappa\u0026thinsp;=\u0026thinsp;0.46) obtained slight reliability scores. In the 2 sections, sub-item 1 from question 9 (Cohen\u0026apos;s kappa\u0026thinsp;=\u0026thinsp;0.53), sub-item 2 from question 11 (Cohen\u0026apos;s kappa\u0026thinsp;=\u0026thinsp;0.55), and sub-item 1 from question 13 (Cohen\u0026apos;s kappa\u0026thinsp;=\u0026thinsp;0.59) displayed moderate reliability. After analyzing the respondents\u0026apos; answers, the researchers observed was a lack of clarity resulting in multiple interpretations of selected questions, so modifications in the questionnaire were required. In the first part of the questionnaire, in column 3, the causes of abnormalities were reformulated into statements describing the abnormalities; in column 4, the answer \u0026quot;I don\u0026apos;t know\u0026quot; was added, in column 2, in questions 1,2, the names of the abnormalities were changed; in column 3, in questions 5,8, statements describing the abnormalities were modified. The second part of the questionnaire (postural ergonomics items) remained unchanged. In the third part of the questionnaire (socio-demographic and professional characteristics), 1 question about external and internal factors affecting body posture was deleted, and question number 13 was modified. Finally, the total number of questions has changed (from 41 to 40).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eData describing the reliability of questionnaire items.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"12\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eQuestion/item\u003c/p\u003e\n \u003cp\u003e(Postural abnormality)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eSub-item1\u003c/p\u003e\n \u003cp\u003e(Recognition of abnormalities)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eSub-item2\u003c/p\u003e\n \u003cp\u003e(Naming of the abnormality)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eSub-item3\u003c/p\u003e\n \u003cp\u003e(causes of the abnormality)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eSub-item4\u003c/p\u003e\n \u003cp\u003e(corrective exercise for the abnormality)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eItems average (range, mean)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 round\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 round\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 round\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 round\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 round\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 round\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 round\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 round\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 round\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 round\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eForwarded head\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.02\u0026ndash;0.83 (0.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.67-1 (0.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThoracic Kyphosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.37\u0026ndash;0.81 (0.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.56-1 (0.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLumbar Lordosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.83\u0026ndash;0.85 (0.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.52-1 (0.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eScoliosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.62\u0026ndash;0.90 (0.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.89-1 (0.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGeno Varum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.54\u0026ndash;0.75 (0.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.73-1 (0.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGeno Valgum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.61\u0026ndash;0.91 (0.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.50-1 (0.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFeet abnormalities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.64\u0026ndash;0.73 (0.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.55\u0026ndash;0.81 (0.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eToe abnormalities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.46-1 (0.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.46-1 (0.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSub-items average\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.73-1.00 (0.89)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.81-1 (0.98)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.02\u0026ndash;0.85 (0.63)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.50-1 (0.79)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.46\u0026ndash;0.83 (0.68)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.52-1 (0.75)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.61\u0026ndash;0.83 (0.74)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.56\u0026ndash;0.89 (0.72)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026thinsp;=\u0026thinsp;0.74\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026thinsp;=\u0026thinsp;0.81\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePostural Ergonomics\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eQuestions/items\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eSub-item1\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ekappa value\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Recognition)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eSub-item2\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ekappa value (Mechanism)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1 round\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 round\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e1 round\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e2 round\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 round\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 round\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSitting posture on the floor while playing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.53\u0026ndash;0.77 (0.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.70\u0026ndash;0.84 (0.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLifting and carrying postures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.78\u0026ndash;0.83 (0.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.50-1 (0.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWorking with correct posture while working with computer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.55-1 (0.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.60-1 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWalking posture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.78-1 (0.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.70-1 (0.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSmart phone using posture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.59\u0026ndash;0.70 (0.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.73-1 (0.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWriting posture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.85-1 (0.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.58-1 (0.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBack pack carrying posture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.78-1 (0.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.97-1 (0. 98)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSleeping posture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.78\u0026ndash;0.80 (0.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.81\u0026ndash;0.89 (0.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSub-items average\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.53-1.00 (0.84)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.55\u0026ndash;0.85 (0.75)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026thinsp;=\u0026thinsp;0.80\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026thinsp;=\u0026thinsp;0.83\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"9\"\u003e\n \u003cp\u003e\u003cstrong\u003eOver all 16 items\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.77\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.82\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"12\"\u003eData presented as range and mean; n \u0026ndash; number of participant\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eIn the second round of reliability of TBPLQ, (100 teachers out of 118) were assessed using 16 questions with 48 sub-questions, 32 sub-questions related to postural abnormalities, and 16 sub-questions related to postural ergonomics. The overall reliability (16 questions) of the TBPLQ was demonstrated as 0.82 (range 0.46 to 1.00), with 54.1% demonstrating almost perfect reliability (range 0.81 to 1.00), 31.2% demonstrating substantial reliability (range 0.61 to 0.80) and 14.6% demonstrating moderate reliability (range 0.41 to 0.60). More detailed results regarding reliability for postural abnormalities and postural ergonomics are presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n \u003cp\u003eInsert Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e near here\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n \u003ch2\u003eFinal questionnaire\u003c/h2\u003e\n \u003cp\u003eAfter refinements and modifications were made as a result of the validation process and the first round of reliability tests, the final questionnaire (validated Polish version, and English version) was formulated [Supplementary material]. The second round of reliability of TBPLQ indicated a substantial improvement. The first and second round reliability test comparison is provided in Figs. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e. Finally, the questionnaire took the form of a self-administered document that was easy to complete and not time-consuming; it consisted of three parts (40 questions \u0026ndash; including 8 questions for postural abnormality with 32 sub-items, 8 questions for postural ergonomics with 16 sub-items, and 24 questions about socio-demographics, professional data, and educational status).\u003c/p\u003e\n \u003cp\u003eInsert Figs. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e near here\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe primary aim of this study was to assess the test\u0026ndash;retest reliability of a self-reporting questionnaire designed to evaluate the level of teachers' literacy in postural health, encompassing aspects such as recognition, naming, describing, selecting an appropriate corrective exercise for postural abnormalities, and the ergonomics of daily activities.\u003c/p\u003e \u003cp\u003eThe results of the first-round test retest TBPLQ reliability resulted in overall substantial reliability. However, some questionnaire items showed slight to moderate reliability, which indicated that the questionnaire still lacked sufficient reliability. Upon closer examination of sub-items 9 and 13, it became apparent that these sub-items contained misleading and ambiguous elements. For example, in the first sub-item of item 9, variations in graphic patterns (some depicting a child and others an adult) were identified. Similarly, the first sub-items of item 13 presented graphics with striking similarities, making it challenging to select the correct response. It is important to note that certain refinements were necessary to enhance reliability and to address the observed discrepancies between expected and actual outcomes, so specific modifications to the final questionnaire were made. These adjustments included the redesign of specific items and their sub-items based on experts\u0026rsquo; and participants\u0026rsquo; opinions. Consequently, after the necessary amendments and modifications, the questionnaire\u0026rsquo;s reliability was tested for the second time. Notably, overall almost perfect agreement reliability was established for the TBPLQ indicating that 87.5% of the questionnaire items achieved reliability scores within a range of substantial to almost perfect, and only 12.5% of the items attained moderate reliability scores. This nuanced assessment aligns with the findings of a recently published study (Rajabi et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOwing to the development of modern civilization, it seems reasonable to pay attention to the position of the body adopted by children during various everyday activities. School should be the first environment for preventing postural issues, which involves eliminating factors that negatively affect the development of the child's body (Skorupka \u0026amp; Asienkiewicz, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). The school is responsible for creating such conditions for the functioning of the child within it, which will prevent the formation and spread of body posture defects. One of the tools in these activities is conducting active education among school principals, teachers, and parents, as well as children and youth. It should be obvious that posture defects should be detected as early as possible; however, information and educational activities undertaken in the field of postural defects prevention have not been fully effective (Office, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). There may be several reasons for the lack of effectiveness of educational activities: difficulties in reaching recipients, or financial problems. However, attention should also be paid to the substantive preparation of early school and preschool education teachers, as well as teachers of other subjects to conduct education in this area, as it is currently not done adequately. In this regard, one of the obstacles to assessing the level of theoretical and practical abilities of teachers regarding students' postural abnormalities is the absence of a comprehensive yet simple and practical questionnaire. Such a tool is needed to examine and evaluate the literacy of teachers in common body posture abnormalities among students in schools. So, the current questionnaire, called TBPLQ, is addressed to PE, kindergarten, and primary education teachers: people who, at various stages of education, are particularly responsible for caring for the quality of the body posture of children and youth and for developing in children and youth the care for the quality of body posture and healthy lifestyle.\u003c/p\u003e \u003cp\u003eThe study has two limitations: technical terminology and sample size. Despite our conscientious efforts to simplify the terminology used in the questionnaire, it is worth noting that the incorporation of technical and medical language relating to postural abnormalities may inadvertently have led to responses that were less reliable. Although our study adhered to the standard recommendation of utilizing a minimum of 100 participants for a robust reliability estimate (as consistent with our sample size), it is important to acknowledge that this represents the bare minimum necessary to achieve reliable outcomes.\u003c/p\u003e \u003cp\u003eIn contrast, the study's strengths are rigorous questionnaire development involving multiple rounds of pretests, meticulous item selection, extensive expert reviews to ensure the content validity and clarity of the questionnaire; and comprehensive content discussion of all the issues of the questionnaire.\u003c/p\u003e \u003cp\u003eThe results of the research, which will be carried out with the use of the questionnaire, will not only help to assess teachers' literacy about postural health but will also enable the preparation of a package of ergonomics and other recommendations for educational institutions in these fields. It will also be possible to prepare an auxiliary package (brochures, electronic materials) supplementing teachers' knowledge, or workshops to improve their practical skills. The findings will complement evidence-based knowledge that takes into account the social and health needs of different society groups.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe Teachers\u0026rsquo; Body Posture Literacy Questionnaire (TBPLQ) demonstrated commendable overall reliability, encompassing substantial and almost perfect scores, signifying its potential to assess teachers' knowledge of postural health in school-age students effectively. The TBPLQ is a newly established self-report questionnaire, proven to be both valid and reliable, making it suitable for application in both research and practical settings. Its adaptability extends its utility to broader and more diverse populations.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to show gratitude to Mr. Piotr Tabor from Jozef Pilsudski University of Physical Education in Warsaw who helped collect the survey for the second round of pretest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of interest statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors report there are no competing interests to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Ministry of Education and Science in the years 2023-2024 under the University Research Project at Józef Piłsudski University of Physical Education in Warsaw ‘The knowledge of teachers about the prevention, correction, and defects of body posture in children’ [280/R/PRO/2023; date 2023/02/28].\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAntczak-Komoterska, A., \u0026amp; Lewińska, A. 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Reliability of a self-report questionnaire to assess parents\u0026rsquo; postural knowledge. \u003cem\u003eBiomedical Human Kinetics\u003c/em\u003e,\u003cem\u003e\u0026nbsp;15\u003c/em\u003e(1), 194-200.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eRuzimbaevich, N. A., \u0026amp; Ruzimbaev, M. A. (2021). Methodological methods of teaching children for movement activities in the process of physical education classes. \u003cem\u003eWeb of Scientist: International Scientific Research Journal\u003c/em\u003e,\u003cem\u003e\u0026nbsp;2\u003c/em\u003e(04), 313-322.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSkorupka, E., \u0026amp; Asienkiewicz, R. (2014).\u0026nbsp;Funkcja szkoły w zapobieganiu wad postawy ciała u dzieci.\u0026nbsp;\u003cem\u003eRocznik Lubuski\u003c/em\u003e,\u003cem\u003e\u0026nbsp;40\u003c/em\u003e(2), 177-187.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eWild, D., Grove, A., Martin, M., Eremenco, S., McElroy, S., Verjee-Lorenz, A., \u0026amp; Erikson, P. (2005). Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: report of the ISPOR task force for translation and cultural adaptation. \u003cem\u003eValue in health\u003c/em\u003e,\u003cem\u003e\u0026nbsp;8\u003c/em\u003e(2), 94-104. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"child, posture, knowledge, ergonomics, school teachers, physical education","lastPublishedDoi":"10.21203/rs.3.rs-4221930/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4221930/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eTo develop a reliable and valid Teachers\u0026rsquo; Body Posture Literacy Questionnaire (TBPLQ) to examine their body posture knowledge. The tool was based on a Parents Body Posture Literacy Questionnaire (PBPLQ) and modified and validated through discussion with experts which were conducted in two rounds. Corrective gymnastics, physiotherapy, ergonomics, physical education (PE) experts and doctoral and postdoctoral scholars evaluated content validity. Test-retest repeatability was tested using Cohen's kappa coefficient. The study used a convenience sample of 195 teachers from 3 different educational levels: PE, kindergarten, and primary education in two rounds of test-retest. The initial round encompassed 95 participants, with pre-test and post-test procedures applied using the original TBPLQ. Subsequently, the second round involved 100 participants and followed a similar approach, incorporating modifications to the TBPLQ based on the reliability outcomes observed in the first round. The results of the first-round test\u0026ndash;retest TBPLQ reliability, with 95 samples resulted in an overall reliability of 0.77 (range 0.02 to 1). This indicated that the questionnaire still lacks sufficient reliability. Consequently, after the necessary amendments and modifications, the questionnaire\u0026rsquo;s reliability was tested for the second time with 100 samples. Notably, the overall reliability of 0.82 (ranging from 0.50 to 1) was established for the TBPLQ indicating that 87.5% of the questionnaire items achieved reliability scores within the substantial and almost perfect range and only 12.5% of the items attained moderate reliability scores. The questionnaire is a new self-report measure, reliable and relevant to effectively evaluating teachers' literacy in postural health that can be applicable in both research and practical contexts, extending its use to larger and more diverse populations.\u003c/p\u003e","manuscriptTitle":"The Test-retest Reliability of a Body Posture Literacy Questionnaire Among Polish Teachers From Different Educational Levels","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-08 17:28:31","doi":"10.21203/rs.3.rs-4221930/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6dddc0fa-5589-46a8-88a2-50df51e938b5","owner":[],"postedDate":"April 8th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-04-08T17:28:31+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-08 17:28:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4221930","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4221930","identity":"rs-4221930","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}