Musculoskeletal Healthcare Professionals' perspectives on objective postural assessment (Expectation and Experience): A UK (Multiprofessional) nationwide survey

Musculoskeletal Healthcare Professionals' perspectives on objective postural assessment (Expectation and Experience): A UK (Multiprofessional) nationwide survey | 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 Musculoskeletal Healthcare Professionals' perspectives on objective postural assessment (Expectation and Experience): A UK (Multiprofessional) nationwide survey Daniel Christopher Martin, Polly McGuigan, Raluca Matei, Gok Kandasamy This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4788633/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 Background: Spinal pain is commonly assessed by physiotherapists, osteopaths and chiropractors in musculoskeletal practice in the UK. Typically, assessment involves some form of visual estimation, but further objective measurement is not preferred due to logistical factors. This study explored the views of physiotherapists, osteopaths, and chiropractors around objective postural assessment and factors that may influence clinical reasoning. Methods: An online, exploratory, ad-hoc, cross-sectional survey was designed to collect data on views around objective postural assessment. The survey was distributed among relevant professional groups. Results : A total of 431 respondents (343 physiotherapists, 43 osteopaths, and 45 chiropractors) took part. As much as 85% of respondents use some form of postural assessment within clinical practice. Most respondents perceived that posture can change and that the changes can be short-term and long-standing. Exercise, education, and behavioural change were perceived as top interventions to change posture. Conclusion: These results provide insights into the current position of MHPs' views within the UK and facilitate conversation regarding the objective measurement of posture in the 21 st century. Posture Assessment Measurement Spinal Pain Survey. Figures Figure 1 HIGHLIGHTS Visual estimation is the predominant method of postural assessment among UK-based MHPs. Clinicians think changes to posture are short and long-term Clinicians perceive there is a link between pain and posture Exercise, education, and activity are perceived to influence posture Introduction Spinal pain is a common occurrence, with prevalence ranging from 28% to 49% in the UK population, maximal prevalence peaking between 41-50 years, and severity continuing to increase with age [1, 2]. Between 24% and 80% of people who experience spinal pain have a recurrent episode later in life [3, 4]. The aetiology of spinal pain can include mechanical, biopsychosocial, co-morbidities and genetic factors, varying in composition for individuals presenting with pain [4]. This multi-factorial nature of spinal pain can make it challenging for musculoskeletal health professionals (MHP) to differentiate between predisposing factors [5, 6]. Although spinal pain has been associated with mechanical factors and spinal disorders, the relationship between spinal disorders and pain remains unclear [7-9]. Forward head posture is believed to be a factor in mechanical neck pain [10, 11], and reduced lumbar lordosis curvature shows a strong relationship to increased spinal pain [12]. Scoliosis or spinal asymmetry can produce spinal pain in youth populations; however, there are no linear relationships between deformity and pain [13, 14]. Whilst posture and pain seem to connect, establishing the relationship's true nature remains elusive. One of the challenges in managing spinal conditions is knowing whether or not spinal position can change, transiently or permanently, and the consequences this will have. Some spinal deformities have increased prevalence in an ageing population [15], and excessive kyphosis is associated with higher mortality [16]. Forward head posture is associated with increased thoracic kyphosis and shoulder protraction [17] and, together with scoliosis, is increasingly linked to spinal pain with age [18], despite studies struggling to dissociate the confounding factors [10, 19]. The critical question that remains is whether an individual's spinal pain can cause changes to structural biomechanics [20]. There remains a debate on this question, and clinicians' views on the topic are influenced by educational background, clinical expertise, and interpretation of the literature on posture [9]. As part of musculoskeletal assessment, MHPs conduct quick and easy objective assessments to confirm a clinical opinion [21]. Once the basic assessment has been completed, other measures are sometimes used to increase the clinician's confidence in the diagnosis, provide accuracy, and produce reviewable measures and educational tools [22]. Currently, clinicians do not have an orthostatic postural measurement tool that is universally accepted and validated; indeed, the area of objective posture assessment is under-researched, particularly in the musculoskeletal clinical environment [23, 24]. Laboratory-based measurements are the most accurate way of assessing objective posture but require complex technology and expertise, which is not feasible in the clinical environment [24] and leads to results that can be deemed clinically irrelevant. Table 1 summarises how objective posture assessment is conducted in clinical and laboratory settings, including the capability to perform 2D/3D analysis and cost implications. Whilst three-dimensional visual estimation is thought to be the predominant measure of orthostatic posture in clinical practice, several studies have modelled orthostatic posture onto two dimensions (coronal and sagittal) and justified this approach through technological inaccessibility of 3D assessment [25, 26]. In recent years, 3D methods have been possible due to the improvement in mobile technology [27]; however, following a review of the literature ( Table 1 ), mobile marker-based reliability and validity of clinical 2D and 3D objective assessment have not been seen in the industry-leading mobile application [28]. Table 1 - insert In addition to the issues around the reliability and validity of current measurement tools, potentially high costs, and an apparent lack of consensus on what should be assessed, little is known about clinicians' actual use of various orthostatic postural assessments and their views around objective postural assessment. As such, this study aimed: (a) to determine MHPs' use of objective orthostatic postural assessment, (b) to describe their views on objective postural assessment, and (c) to determine what key features an application-based objective posture modality would require to measure posture in a clinical environment. Methods This was an exploratory, ad-hoc, cross-sectional study utilising a survey developed on the JISC online surveys platform and distributed through professional interest groups: the iCSP website (professional physiotherapist community); the 'Let's Talk Osteopathy' Facebook page; the General Chiropractic Council administration department; and the lead author's professional network via LinkedIn. Ethical approval was granted by the University of Bath's Research Ethics Approval Committee for Health (EP 22087), and responses were collected over six weeks. The questions used in the survey were informed by previous systematic reviews on posture, for example, the link between posture and pain [9, 10] and consensus among the authors. An initial survey draft was shared with a group of three MHPs (one physiotherapist, one osteopath and one chiropractor) with substantial clinical experience (mean = 24 years musculoskeletal experience) for feedback and review. Then, to test its validity, the lead author piloted a draft survey distributed among eight clinical colleagues with an average of 18 years of musculoskeletal clinical experience. Feedback was collated and presented to the research team. The survey covered two areas: experience and expectations. The first area included five items aimed at clarifying MHPs' experience with posture as an objective measure, while the second area (seven items) focused on exploring MHPs' expectations around objective posture in a clinical context. Of the twelve items, eight were closed questions, and three included a combination of open and closed options, with one question allowing only open responses. Two closed questions included a ranking process to understand which modalities clinicians may prioritise treating postural-related issues, whilst the remainder used a tick box for selection and open inputted through text fields. Input from academic colleagues and clinicians enabled amendments to the survey on the online survey site (Supplementary Material 1). Participant eligibility criteria The survey was open to Chartered Physiotherapists, General Chiropractic Council and General Osteopathic Council registered MHPs with a minimum of one year of clinical experience. Respondents were excluded if they did not confirm a valid registration number for their specific regulatory body. Data Analysis The closed-ended question survey data were downloaded from the Online surveys webpage as frequencies and percentages into an Excel document. Chi squared tests were undertaken to determine the differences between professions and in responses between the different musculoskeletal health professions. Content analysis was conducted on open-ended responses. The lead author took a hybrid (deductive and inductive) approach to coding these responses and organised them into new categories determined by both responses and the closed questions. The Nvivo software package was used for the analysis [39]. The results are presented descriptively in line with SAMPL guidance on descriptive statistics [40] and include relevant categories from the two survey sections. Where responses appeared to differ between professions, the authors tested for statistical significance using Chi-squared test with the level of significance set to p<0,05 using SPSS version 17 (SPSS, IBM, USA). Results A total of 432 respondents completed the survey, but one respondent did not indicate consent so their data were not included, resulting in a sample size 431. A single respondent agreed to the consent for the survey but refused to contribute any responses to any of the questions and is not included in the data analysis. The breakdown of professions represented in the sample is shown in Table 2 . Table 2 Perspectives on posture Objective (a) - The MHPs' use of postural assessment Assessing posture in clinical practice received 429 valid responses. Of the responses, 85% (363/427) said they assessed posture objectively. These included 84% (285/340) of physiotherapists, 88% (38/43) of osteopaths, and 89% (40/45) of chiropractors. The objective assessment of posture among MHPs was multimodal. Out of 430 responses around the main modes of assessment, 78% (336/430) were visual estimation, 9% (38/430) photogrammetry, and 9% (39/430) mobile applications. Physiotherapists (80%, 272/342) and chiropractors (84%, 38/45) were more likely than osteopaths (64%, 27/42) to conduct visual assessments. The results of Fisher's Exact Test (p=0.06) indicate an association approaching significance between the professions. Notably, 22% (95/429) did not objectively measure posture with a similar split on the interprofessional breakdown for physiotherapists (22%, 74/342), chiropractors (18%, 8/45), and osteopaths (31%, 13/42). The difference between the professions was significant, with X 2 = 5.950 and p = 0.05. The 28 responses to the open question on modes of assessment were grouped into 12 categories. Six responses involved photogrammetry; four cases had already selected photogrammetry as an option; therefore, only two responses were added to categories determined by the closed questions. Similarly, the visual estimation data increased by a single response. Other types of posture assessment included X-ray (3/430), tactile methods (6/430) and other video/ software methods (4/430). The usefulness of a tool for grading posture received 429 responses; however, three respondents gave two answers instead of one, such as 'yes/maybe' or 'maybe/no'. The responses for each professional are shown in Fig. 1 . Overall, 29% (125/432) said 'yes', 37% (160/432) 'maybe', and 34% (147/429) 'no' when asked if a posture grading tool would be useful. Interestingly, 49% of chiropractors reported 'yes' compared with 27% of physiotherapists and 23% of osteopaths. Similarly, among those who said 'no', 37% were physiotherapists, 33% osteopaths, and only 16% of chiropractors ( Fig. 1 ). The Fisher's Exact test results were statistically significant with (p=0.011). Objective (b) – MHPs' perspectives on objective posture assessment Postural change Of 431 respondents who answered whether posture can change, 66% (284) responded 'yes definitely', and 31% (133) responded 'maybe'. Nine of the 14 remaining respondents said that standing posture is still part of their assessment. Only 19% of respondents thought changes were long-standing or short-term, not both. The remaining respondents considered the changes to be both long-standing and short-term. The percentage difference between the professions was not significant between professions with X 2 = 0.827 and p = 0.66. Postural management A total of 429 respondents answered the importance of treating posture. Eight respondents provided two responses to the question, suggesting clinical opinions vary on the importance of treating postural asymmetry. The 'sometimes' answer was the most frequent, with a higher percentage of physiotherapists (76%) than chiropractors (67%) and osteopaths (60%). The difference between professions was X 2 = 6.570 and p = 0.04. Table 3 - insert When treating posture, the top five attributes that change posture are Exercise, Education, Behavioural Change, Activity, and Work. Of the 429 respondents, 94% (404) chose the exercise modality, with a subset of 42% most important and another 28% ranking it second most important ( T able 3 ). Education was the second most popular modality to change posture, with 89% (380/429) responses, out of which 46% chose it as most important, and 29% chose it as second most important. The third most popular modality was behavioural change (81%), with an even split of ranked choices. The fourth choice was activity, chosen by 78% of respondents. However, this was ranked lower overall, with 30% choosing it as third and 27% choosing it as fourth. Work as a modality had 49% of responses, with lower ranked responses; 29% mentioned it as their fourth choice and 35% as their fifth choice. Manual therapy as a modality had 40% responses with lower rated responses; 25% opted for it as the fourth choice, and 34% as the fifth choice. The proportion of chiropractors choosing manual therapy (87%) was substantially higher than that of osteopaths (63%) and physiotherapists (30%), The difference between the professions was significant with X 2 = 63.205 and p < 0.001. Some of the other modalities were predominately in the lower ranked options and with fewer responses: Orthotics/ Bracing (24%), Medication (9%), Clothing (9%), Hydrotherapy (7%), Acupuncture (6%), and Electrotherapy (5%). However, psycho-social (18/429), ergonomics (7/429), pain (6/429) and body awareness (5/429) also had sufficient frequencies to warrant further description. In addition, several low-frequency codes described other modes, including taping, surgery, biofeedback, nutrition and footwear. The wider context of posture Much debate continues about the social construct of optimal posture. In response to the question about whether there is an optimal posture, there were 430 responses. Each of the six MHPs recorded two responses, again indicating that opinions vary among clinicians. A total of 62% of Chiropractors (28/45) answered 'yes' or 'maybe' compared to 57% (221/385) of osteopaths and physiotherapists. The difference between the professions was approaching significance with X 2 = 3.597 and p = 0.058. The Osteopaths represented the most likely profession to answer 'maybe', whilst the physiotherapists were most likely to respond 'no'. Of 423 respondents, 65% said there was a link between posture and pain; specifically, 71% were chiropractors, and only 61% were osteopaths. Lastly, respondents were asked about the importance of posture in terms of function versus the aesthetic (visual) aspect. Out of 429 respondents, 75% considered that 'yes', function is more important than visual appearance, and 22% answered 'maybe'. Compared with the other professions, osteopaths displayed a predominance towards the function construct of posture. Objective (c) – Attributes of mobile application for objective postural assessment When asked which attributes could help develop a mobile application, out of 385 responses, 80% were from physiotherapists, 9% from osteopaths, and 10% from chiropractors. Some of the respondents did not give answers for all five attributes. The top 5 attributes listed by frequency were: Ease of use, 89% (95% chiropractors, 91% physiotherapists. and 75% osteopaths) Reliability/validity, 78% (80% physiotherapists, 75% osteopaths, and 73% chiropractors) Time efficiency, 72% (74% physiotherapists, 70% chiropractors, and 53% osteopaths) Low Cost, 64% (68% chiropractors, 65% physiotherapists, and 58% osteopaths) The most common open-text response (12 respondents) suggested no need for a mobile application, with a higher percentage of osteopaths not answering this question compared to the other professions. A separate open question was included to facilitate freedom of expression about potential application attributes. Of 185 respondents, 22% reported they did not want a more objective measure, and 10% were unsure. Other responses (n>2) included patient epidemiology, the ability to link fixed and non-fixed pathologies, review local areas of postural discrepancy, compare with previous data sets, link to clinical reasoning, Beighton Scale, body type, pain score, and kinesiological variables. Discussion What does the paper answer? This is the first study to describe views on posture among UK-based MHPs. It identifies the use of objective orthostatic postural assessment, quantifies the modalities of use within postural assessment and describes the MHPs' views on postural assessment. Asking for input from representatives of three musculoskeletal professions allowed further exploration of differences and similarities in approaches to objective postural assessment. In addition, it identifies features that may provide a solution to greater levels of objectivity within the postural assessment field through a mobile application. Why are MHPs' views on objective postural assessment important? Amongst MHPs, objective postural assessment has been commonplace; however, the proportions of clinicians using it as part of their clinical assessment have been unknown [41]. The results of this survey indicated that 85% of 432 MHPs objectively assess posture as part of their clinical assessment, with a higher percentage of osteopaths and chiropractors than physiotherapists. Differences in teaching/training, understanding of the literature on posture, and clinical experience could potentially and partly explain the different percentages [20, 42]. In addition, clinicians who follow physiotherapist-led literature may be more likely to endorse the narrative showing no clear correlation between posture and lower back pain [43-45]. Clinically, due to different training and literature narratives, physiotherapists could potentially miss predisposing factors and pathologies based on their choice not to review standing posture as part of the musculoskeletal assessment [43, 46]. Interestingly, chiropractors within the UK appear to be less likely to assess posture than Canadian chiropractors [47]. Visual estimation When looking at the specific modalities of postural assessment, osteopaths were less likely to use visual estimation than other professionals. Visual estimation remains the predominant measure of posture despite literature calling it into question [41, 48]. The two main reasons visual estimation should be used as the first line of clinical assessment are usability and clinometry [23]. Although most MHPs use postural assessment, it is unclear why osteopaths are less likely to use visual estimation as a modality. Other clinical objective posture modalities There have been moves towards objective posture measurement from a clinical perspective within the literature [26, 27, 49]. According to this survey, MHPs are more likely to use other objective modalities alongside visual estimation rather than as stand-alone methods, which aligns with the literature [23]. Grading Posture Several studies have attempted to grade posture [50, 51]; however, the need and desire amongst MHPs to use these scales have been questionable. Also, almost half of chiropractors surveyed in this study thought grading posture was beneficial compared to three-quarters of physiotherapists and osteopaths who thought grading was not helpful. The Foot Posture Index is an example of how grading posture can be brought into the clinical environment for localised areas of the body. Still, there are no widely used clinical measures for global body postures [52]. Two of the advantages of such a rating scale are the ability of the scale to work across three dimensions and the validity and reliability of the tool [53, 54]. According to this study's respondents, validity and reliability were two key aspects of an application measuring posture. However, to date, no measure fits these criteria in the objective postural assessment clinical arena. What are the relevance/implications for MHPs? Visual estimation remains the bedrock of objective postural assessment. However, with the advent of technology, there does seem to be an increasing number of MHPs willing to use technology in an attempt to be more objective in this aspect of clinical practice, and this paper suggest the development of an objective postural assessment measure provided it meets the following criteria: Easy to use Reliable and Valid Time efficient Less relevant factors included integration with hardware, two/three-dimensional options, and automatic digitised assessment. It is also noted that even if an application fulfilled the criteria mentioned by most clinicians, a proportion of MHPs would not support or use it. Strengths and Limitations To our knowledge, this is the first survey of musculoskeletal healthcare professionals on objective standing posture. The survey contributes to the debate on objective measurement of posture as a modality for musculoskeletal healthcare practice. Some response differences are unclear, such as the 65 respondents who said they did not routinely use posture in clinical practice, and the 95 who said they do not measure posture. The survey was distributed to UK-based MHPs recruited via professional networks. Although the use of LinkedIn enhanced recruitment and led to a low number of incomplete surveys, it may have led to some sampling bias as some of the respondents were part of the professional network of the lead researcher. Individual perceptions of the terms may have differed. For example, some may consider exercise a form of behavioural change. Given the exploratory nature of this study, we recognise that these results cannot be generalised to all MHPs within the UK; however, our findings provide some insight into the variety of perspectives among MHPs. More robust methodologies are needed to explore this area further. Conclusion The study's findings shed light on the perceptions of different MHPs' concerning objective posture. There is a commonality in how physiotherapists, osteopaths and chiropractors assess their patients; however, several MHPs, as part of their clinical reasoning process, choose not to evaluate posture routinely. While visual estimation is the mainstay of clinical practice, an opportunity to support clinicians with improved objectification remains elusive. This survey's findings also provide insight into how MHPs view posture and what they require from an objective postural mobile application tool. Declarations Ethics Approval and Consent to participate Ethical approval was granted by the University of Bath’s Research Ethics Approval Committee for Health (EP 22087), and all participants provided digitally recorded informed consent. Consent for publication Not applicable Availability of data and materials The datasets used/ or analysed during the current study are available from the corresponding author on reasonable request Competing interests The authors declare that they have no competing interests Funding Not applicable Author’s Contributions D.C.M., G.K., and M.P.M. contributed to the study's concept and design. D.C.M. performed the data interpretation and analysis and drafted the manuscript. D.C.M., R.M., G.K. and M.P.M. took part in interpreting the results, crucially reviewed and revised the manuscript, and approved the final version to be submitted for publication. Acknowledgements Not applicable References Macfarlane GJ, Beasley M, Jones EA, Prescott GJ, Docking R, Keeley P, et al. The prevalence and management of low back pain across adulthood: Results from a population-based cross-sectional study (the MUSICIAN study). Pain. 2012 153(1):27-32. https://doi.org/10.1016/j.pain.2011.08.005 Baskozos G, Hébert HL, Pascal MMV, Themistocleous AC, Macfarlane GJ, Wynick D, et al. Epidemiology of neuropathic pain: An analysis of prevalence and associated factors in UK Biobank. Pain Reports. 2023 8(2):1-11. https://doi.org/10.1097%2FPR9.0000000000001066 Hoy D, Brooks P, Blyth F, Buchbinder R. The Epidemiology of low back pain. Best Practice & Research Clinical Rheumatology 2010 Dec 1;24(6):769-781. https://doi.org/10.1016/j.berh.2010.10.002 Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, et al. What low back pain is and why we need to pay attention. The Lancet 2018 391(10137):2356-2367. https://doi.org/10.1016/S0140-6736(18)30480-X Will JS, Bury DC, Miller JA. Mechanical low back pain. American Family Physician 98(7):421-428. https://www.aafp.org/pubs/afp/issues/2018/1001/p421.html Wilson F, Ardern CL, Hartvigsen J, Dane K, Trompeter K, Trease L, et al. Prevalence and risk factors for back pain in sports: a systematic review with meta-analysis. British Journal of Sports Medicine 2021 55(11): 601-607. https://doi.org/10.1136/bjsports-2020-102537 Izzo R, Popolizio T, D’Aprile P, Muto M. Spinal pain. European Journal of Radiology 2015 84(5): 746-756. https://doi.org/10.1016/j.ejrad.2015.01.018 Yang H, Liu H, Li Z, Zhang K, Wang J, Wang H. et al. Low back pain associated with lumbar disc herniation: role of moderately degenerative disc and annulus fibrous tears. International Journal of Clinical and Experimental Medicine 2015 8(2): 1634-1644. http://www.ncbi.nlm.nih.gov/pmc/articles/pmc4402739/ Swain CTV, Pan F, Owen PJ, Schmidt H, Belavy DL. No consensus on causality of spine postures or physical exposure and low back pain: A systematic review of systematic reviews. Journal of Biomechanics, 2020 102: 1-6. https://doi.org/10.1016/j.jbiomech.2019.08.006 Mahmoud NF, Hassan KA, Abdelmajeed SF, Moustafa IM, Silva AG. The Relationship Between Forward Head Posture and Neck Pain: a Systematic Review and Meta-Analysis. Current Reviews in Musculoskeletal Medicine. 2019 12(4): 562-577. https://doi.org/10.1007/s12178-019-09594-y Balthillaya GM, Parsekar SS, Gangavelli R, Prabhu N, Bhat SN, Rao BK. Effectiveness of posture-correction interventions for mechanical neck pain and posture among people with forward head posture: protocol for a systematic review. BMJ Open, 2022 12(3): e054691. https://doi.org/10.1136/bmjopen-2021-054691 Chun S-W, Lim C-Y, Kim K, Hwang J, Chung SG. The relationships between low back pain and lumbar lordosis: a systematic review and meta-analysis. The Spine Journal, 2017 17(8): 1180-1191. https://doi.org/10.1016/j.spinee.2017.04.034 Théroux J, Le May S, Fortin C, Labelle H. Prevalence and Management of Back Pain in Adolescent Idiopathic Scoliosis Patients: A Retrospective Study. Pain Research and Management, 2015 20(3): 153-157. https://doi.org/10.1155/2015/674354 Balagué F, Pellisé F. Adolescent idiopathic scoliosis and back pain. Scoliosis and Spinal Disorders. 2016 11(1): 27. https://doi.org/10.1186%2Fs13013-016-0086-7 Diebo BG, Shah NV, Pivec R, Naziri Q, Patel A, Post NH, et al. From Static Spinal Alignment to Dynamic Body Balance. JBJS reviews. 2018 6(7): e3. https://doi.org/10.2106/jbjs.rvw.17.00189 Hijikata Y, Kamitani T, Sekiguchi M, Otani K, Konno S-I, Takegami M, et al. Association of kyphotic posture with loss of independence and mortality in a community-based prospective cohort study: the Locomotive Syndrome and Health Outcomes in Aizu Cohort Study (LOHAS). BMJ Open. 2022 12(3): e052421. https://doi.org/10.1136/bmjopen-2021-052421 Singla D., Veqar Z, Association Between Forward Head, Rounded Shoulders, and Increased Thoracic Kyphosis: A Review of the Literature. Journal of Chiropractic Medicine. 2017 16(3): 220-229. https://doi.org/10.1016%2Fj.jcm.2017.03.004 Ames CP, Scheer JK, Lafage V, Smith JS, Bess S, Berven SH, et al. Adult Spinal Deformity: Epidemiology, Health Impact, Evaluation, and Management. Spine Deformity, 2016 4(4): 310-322. https://doi.org/10.1016/j.jspd.2015.12.009 Sarig Bahat H, Levy A., Yona T, The association between forward head posture and non-specific neck pain: A cross-sectional study. Physiotherapy theory and practice. 2023 39(8): 1736–1745. https://doi.org/10.1080/09593985.2022.2044420. Lederman E. The fall of the postural-structural-biomechanical model in manual and physical therapies: Exemplified by lower back pain. Journal of Bodywork and Movement Therapies. 2011 15(2): 131-138. https://doi.org/10.1016/j.jbmt.2011.01.011 Houglum PA, Boyle-Walker KL, Houglum DE. Rehabilitation of Musculoskeletal Injuries. Human Kinetics; 2022 Chartered Society of Physiotherapy (2022) London: CSP https://www.csp.org.uk/professional-clinical/research-evaluation/outcome-experience-measures. Woldendorp KH, Kleinbergen JFE, Boonstra AM, de Schipper AW, Arendzen JH, Reneman MF. Quality and usability of clinical assessments of static standing and sitting posture: A systematic review. Journal of Back and Musculoskeletal Rehabilitation. 2022 35(2): 223-238. https://doi.org/10.3233/bmr-200073 Kandasamy G, Bettany-Saltikov J, Van Schaik P. Posture and Back Shape Measurement Tools: A Narrative Literature Review. Spinal Deformities in Adolescents, Adults and Older Adults: IntechOpen. 2021 https://doi.org/10.5772/intechopen.91803 Lee HJ, Cho HE, Kim M, Chung SY., Park JH. Validity and Reliability of a Non-Radiographic Postural Analysis Device Based on an RGB-Depth Camera Comparing EOS 3D Imaging: A Prospective Observational Study Healthcare. 2023 11(5): 1-11. https://doi.org/10.3390/healthcare11050686 Fortin C, Van Schaik P, Aubin-Fournier J-F, Bettany-Saltikov J, Bernard J-C., Ehrmann Feldman D. (2018) 'The acceptance of the clinical photographic posture assessment tool (CPPAT). BMC Musculoskeletal Disorders. 2018 19(1): 366. https://doi.org/10.1186/s12891-018-2272-7 Moreira R, Teles A, Fialho R, dos Santos TCP, Vasconcelos SS, de Sa I C, et al. Can human posture and range of motion be measured automatically by smart mobile applications? Medical Hypotheses. 2020 142: 1-7. https://doi.org/10.1016/j.mehy.2020.109741 Hopkins BB, Vehrs PR, Fellingham GW, George JD, Hager R, Ridge ST. Validity and Reliability of Standing Posture Measurements Using a Mobile Application. Journal of Manipulative and Physiological Therapeutics. 2019 42(2): 132-140. https://doi.org/10.1016/j.jmpt.2019.02.003 Shin S., Yoo W. Inter-tester Reliability of Lumbar Lordosis Posture Classification Using a Novel Screening Device. Journal of Manipulative and Physiological Therapeutics. 2021 44(1): 35–41. https://doi.org/10.1016/j.jmpt.2019.12.012. Golalizadeh D, Toopchizadeh V, Farshbaf-Khalili A, Salekzamani Y, Dolatkhah N., Pirani A. Faulty posture: Prevalence and its relationship with Body Mass Index and Physical Activity among female adolescents. Biomedical Human Kinetics. 2020 12(1): 25–33. https://doi.org/10.2478/bhk-2020-0004. Dimitriadis Z, Parintas I, Karamitanis G, Abdelmesseh K, Koumantakis GA, Kastrinis A. Reliability and Validity of the Double Inclinometer Method for Assessing Thoracolumbar Joint Position Sense and Range of Movement in Patients with a Recent History of Low Back Pain. Healthcare. 2022 11(105): 1-11. https://doi.org/10.3390/healthcare11010105. Suzuki Y, Kawai H, Kojima M, Shiba Y, Yoshida H, Hirano H. et al. Construct validity of posture as a measure of physical function in elderly individuals: Use of a digitalized inclinometer to assess trunk inclination. Geriatrics & Gerontology International. 2016 16(9): 1068–1073. https://doi.org/10.1111/ggi.12600. Furlanetto TS, Sedrez JA, Candotti CT, Loss JF. Photogrammetry as a tool for the postural evaluation of the spine: A systematic review. World Journal of Orthopedics. 2016 7(2): 136–148. https://doi.org/10.5312/wjo.v7.i2.136. Wu H-D, Liu W, Wong M-S, 2020. Reliability and validity of lateral curvature assessments using clinical ultrasound for the patients with scoliosis: a systematic review. European Spine Journal. 2020 29(4): 717–725. https://doi.org/10.1007/s00586-019-06280-y. Pivotto LR, Navarro IJRL., Candotti CT. Radiography and photogrammetry-based methods of assessing cervical spine posture in the sagittal plane: A systematic review with meta-analysis. Gait & posture. 2021 84(2): 357–367. https://doi.org/10.1016/j.gaitpost.2020.12.033. Park B-KD, Jones MLH, Ebert S, Reed MP. A parametric modeling of adult body shape in a supported seated posture including effects of age. Ergonomics. 2022 65(6): 795–803. https://doi.org/10.1080/00140139.2021.1992020. Labecka MK, Plandowska M, Moiré topography as a screening and diagnostic tool—A systematic review. PloS one. 2021 16(12): 1-15. https://doi.org/10.1371/journal.pone.0260858. Kandasamy G, Bettany-Saltikov J, Van Schaik P. Measurement of Three-Dimensional Back Shape of Normal Adults Using a Novel Three-Dimensional Imaging Mobile Surface Topography System (MSTS): An Intra- and Inter-Rater Reliability Study. Healthcare. 2023 11(23):1-13. https://doi.org/10.3390/healthcare11233099. Lindgren BM, Lundman B, Graneheim UH. Abstraction and interpretation during the qualitative content analysis process. International Journal of Nursing Studies. 2020 108(8): 1-6 https://doi.org/10.1016/j.ijnurstu.2020.103632 Lang TA., Altman DG. Basic statistical reporting for articles published in Biomedical Journals: The "Statistical Analyses and Methods in the Published Literature" or the SAMPL Guidelines. International Journal of Nursing Studies. 2015 52(1): 5-9. https://doi.org/10.1016/j.ijnurstu.2014.09.006 Fedorak C, Ashworth N, Marshall J., Paull H. Reliability of the Visual Assessment of Cervical and Lumbar Lordosis: How Good Are We? Spine. 2003 28(16): 1857-1859. https://doi.org/10.1097/01.brs.0000083281.48923.bd Hohenschurz-Schmidt D, Thomson OP, Rossettini G, Miciak M, Newall D, Roberts L. et al. Avoiding Nocebo and other undesirable effects in chiropractic, osteopathy and physiotherapy: An invitation to reflect Musculoskeletal Science and Practice , 2022 62(10): 1-12. https://doi.org/10.1016/j.msksp.2022.102677 Slater D, Korakakis V, O'Sullivan P, Nolan D., O'Sullivan K. "Sit Up Straight": Time to Re-evaluate. The Journal of Orthopaedic and Sports Physical Therapy. 2019 49(8): 562-564. https://doi.org/10.2519/jospt.2019.0610 O'Sullivan K, O'Sullivan P, O'Sullivan L., Dankaerts W. What do physiotherapists consider to be the best sitting spinal posture? Manual Therapy. 2012 17(5): 432-437. https://doi.org/10.1016/j.math.2012.04.007 Wernli K, O'Sullivan P, Smith A, Campbell A., Kent P. Movement, posture and low back pain. How do they relate? A replicated single‐case design in 12 people with persistent, disabling low back pain. European Journal of Pain. 2020 24(9): 1831-1849. https://doi.org/10.1002/ejp.1631 Williams CA., Lewis L. Mindsets in health professions education: A scoping review. Nurse education today. 2021 100: 1-7. https://doi.org/10.1016/j.nedt.2021.104863. Hinton PM, McLeod R, Broker B, Maclellan CE. Outcome measures and their everyday use in chiropractic practice. The Journal of the Canadian Chiropractic Association. 2010 54(2): 118-131. https://pubmed.ncbi.nlm.nih.gov/20520756 Lang AE., Milosavljevic S. Visual estimation of shoulder posture: accuracy and reliability across five planes of motion. Physical Therapy Reviews. 2019 24(3-4): 118-124. https://doi.org/10.1080/10833196.2019.1637594 Lichota M, Plandowska M, Mil P. The Shape of Anterior-Posterior Curvatures of the Spine in Athletes Practising Selected Sports. Polish Journal of Sport and Tourism. 2011 18(2): 112-116. https://doi.org/10.2478/v10197-011-0009-3 Ludwig O, Dindorf C, Kelm J, Simon S, Nimmrichter F, Fröhlich M. Reference Values for Sagittal Clinical Posture Assessment in People Aged 10 to 69 Years. International Journal of Environmental Research and Public Health. 2023 20(5): 1-16. https://doi.org/10.3390/ijerph20054131 Ludwig O, Hammes A, Kelm J., Schmitt E. Assessment of the posture of adolescents in everyday clinical practice: Intra-rater and inter-rater reliability and validity of a posture index. Journal of Bodywork and Movement Therapies. 2016 20(4): 761-766. https://doi.org/10.1016/j.jbmt.2016.04.004 Redmond AC, Crosbie J., Ouvrier RA. Development and validation of a novel rating system for scoring standing foot posture: The Foot Posture Index. Clinical Biomechanics. 2006 21(1): 89-98. https://doi.org/10.1016/j.clinbiomech.2005.08.002 Terada M, Wittwer AM, Gribble PA. Intra-rater and inter-rater reliability of the five image-based criteria of the foot posture index-6. International Journal of Sports Physical Therapy. 2014 9(2): 187-94. https://pubmed.ncbi.nlm.nih.gov/24790780 Teles A, Fialho R, Baluz R, Santos TC, Moreira R, Goulart-Filho R. et al. Mobile Applications for Assessing Human Posture: A Systematic Literature Review. Electronics, 2020 9(8): 1-24. https://doi.org/10.3390/electronics9081196 Tables Table 1 Measurements of Objective Posture, Setting, Mode, Examples, Costings and Psychometric properties [23, 24, 26] Method of Posture Assessment Clinical or Laboratory Based 2-dimensional (2D) or 3-dimensional (3D) Examples Cost (Low – below £20, Medium - £20-100, High > £100 Psychometric Properties Ruler-based Clinical 2D Fleximeter Low Good reliability for sagittal lumbar posture [29, 30] Inclinometry Clinical 2D Measure App (iPhone)/ Goniometer Low Poor reliability for Joint Position Sense of Spine with Spinal Pain [31], however construct validity shown for assessing function in elderly [32] Visual Estimation Clinical 2D/3D Clinical assessment Low Direct visual observation with raters has been recommended [23] Photogrammetry Clinical/ Laboratory 2D/3D Fortin 2017/ KINECT Low-High Multiple methods make it difficult to determine reliability. Few RCT means validity is problematic too [33] Surface-based markers Clinical/ Laboratory 2D/3D VICON High Gold-standard non-radiographic method, with high validity and reliability [28] Ultrasound Clinical/ Laboratory 3D Lab based High Moderate-level evidence of reliability or validity [34] Radiographic Clinical/ Laboratory 2D/ 3D X-Ray standard or low-dose High Gold-standard assessment of spinal curvature [28, 35] Shape Modelling Clinical/ Laboratory 2D/3D App based High New method, no validation or reliability studies at present in relation to postural assessment [36] Topography Clinical/ Laboratory 2D/3D Lab based High Moderate evidence for reliability and validity [37] Light Based Laboratory 2D/3D PAViR High ICC values 0.70 – 0 .98 for intra and inter-rater reliability [38] Table 2 Number and proportion of respondents by profession Physiotherapist Osteopath Chiropractor Number of participants 343 43 45 Percentage of survey population 80 10 10 Table 3 - Rated attributes most likely to change posture N=429 Respondents = n(%) First Second Third Fourth Fifth Exercise 404 (94%) 168 (42%) 111 (28%) 73 (18%) 33 (8%) 19 (5%) Education 380 (89%) 174 (46%) 110 (29%) 51 (13%) 31 (8%) 14 (4%) Behavioural Change 346 (81%) 70 (20%) 90 (26%) 83 (24%) 62 (18%) 41 (12%) Activity 337 (79%) 33 (8%) 57 (13%) 101 (24%) 89 (21%) 57 (13%) Work 212 (49%) 17 (4%) 23 (5%) 38 (9%) 61 (14%) 73 (17%) Manual Therapy 171 (40%) 23 (5%) 15 (3%) 33 (8%) 43 (10%) 57 (13%) Orthotics/ Bracing 104 (24%) 7 (2%) 16 (4%) 24 (6%) 19 (4%) 38 (9%) Medication 40 (9%) 1 (0%) 1 (0%) 9 (2%) 13 (3%) 16 (4%) Clothing 38 (9%) 1 (0%) 4 (1%) 4 (1%) 7 (2%) 22 (5%) Hydrotherapy 33 (7%) 3 (1%) 6 (1%) 4 (1%) 7 (2%) 13 (3%) Electrotherapy 22 (5%) 0 (0%) 2 (0%) 8 (2%) 3 (1%) 9 (2%) Acupuncture 25 (6%) 1 (0%) 6 (1%) 5 (1%) 1 (0%) 12 (3%) Other 67 (16%) 18 (4%) 8 (2%) 8 (2%) 10 (2%) 25 (6%) File name including file format – Supplementary material 1.docx Title of Data – Example of survey sent to participants Description of Data – All questions included from the original survey File name including file format - Additional file 1.xlsx Title of Data - Raw data from the survey Description of Data The raw data from this file is shown throughout several Excel sheets that display some of the data analysis processes. Additional Declarations No competing interests reported. Supplementary Files SupplementaryMaterial1.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4788633","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":343060793,"identity":"e217fd5d-4051-4c8f-91d2-1fa4d7d999d2","order_by":0,"name":"Daniel Christopher Martin","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwklEQVRIiWNgGAWjYDCCAwyMj/9UHGBgkIDwDYjRwmzAc+YAAw8pWtgkeNtI0cJ3/HSChOS8O/L20g2MH34wHDYmqEXyTO4GA8Ntzwx7ZA4wS/YwHDYjqMXgBu+GhMRthxl7JBIYpBkYDtsQpeXAwTmH7YFamH8Tq2VjY2PD4USgFjaQLYQdBvTLZmaGY8+Se24ktln2GKQT9j7f8bPbfzPU3LFtn5F8+MaPCmvDBoJ6EICxgaiIHAWjYBSMglFABAAAAIc/0hVeb90AAAAASUVORK5CYII=","orcid":"","institution":"University of Bath","correspondingAuthor":true,"prefix":"","firstName":"Daniel","middleName":"Christopher","lastName":"Martin","suffix":""},{"id":343060794,"identity":"0cb38f1b-08e7-4858-978f-1b0b42e492a9","order_by":1,"name":"Polly McGuigan","email":"","orcid":"","institution":"University of Bath","correspondingAuthor":false,"prefix":"","firstName":"Polly","middleName":"","lastName":"McGuigan","suffix":""},{"id":343060795,"identity":"6357c228-7f25-453e-9463-3bf34db0e8e5","order_by":2,"name":"Raluca Matei","email":"","orcid":"","institution":"University of Bath","correspondingAuthor":false,"prefix":"","firstName":"Raluca","middleName":"","lastName":"Matei","suffix":""},{"id":343060796,"identity":"6b781d7a-033e-4316-821b-cf87ac926e12","order_by":3,"name":"Gok Kandasamy","email":"","orcid":"","institution":"Teesside University","correspondingAuthor":false,"prefix":"","firstName":"Gok","middleName":"","lastName":"Kandasamy","suffix":""}],"badges":[],"createdAt":"2024-07-23 12:07:33","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4788633/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4788633/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":63005798,"identity":"c7b9d7c4-cb4a-4b8a-ab8d-a92edc4d7f50","added_by":"auto","created_at":"2024-08-22 04:18:19","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":52973,"visible":true,"origin":"","legend":"\u003cp\u003eDifferences in MHP views on grading posture\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4788633/v1/3e66216ef37b73037bd6b359.png"},{"id":74236264,"identity":"684d89e4-eb9e-4454-add0-180db4f9b77f","added_by":"auto","created_at":"2025-01-20 08:54:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":629622,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4788633/v1/84d72859-e928-458c-bb49-60e1bbbded52.pdf"},{"id":63005799,"identity":"5629a021-4ed7-4618-8ace-b1a5bc7d2347","added_by":"auto","created_at":"2024-08-22 04:18:20","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":20626,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterial1.docx","url":"https://assets-eu.researchsquare.com/files/rs-4788633/v1/925412bc2a0e2d8e8e30ccfd.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Musculoskeletal Healthcare Professionals' perspectives on objective postural assessment (Expectation and Experience): A UK (Multiprofessional) nationwide survey","fulltext":[{"header":"HIGHLIGHTS","content":"\u003cp\u003eVisual estimation is the predominant method of postural assessment among UK-based MHPs.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eClinicians think changes to posture are short and long-term\u003c/p\u003e\n\u003cp\u003eClinicians perceive there is a link between pain and posture\u003c/p\u003e\n\u003cp\u003eExercise, education, and activity are perceived to influence posture\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eSpinal pain is a common occurrence, with prevalence ranging from 28% to 49% in the UK population, maximal prevalence peaking between 41-50 years, and severity continuing to increase with age [1, 2]. \u0026nbsp;Between 24% and 80% of people who experience spinal pain have a recurrent episode later in life [3, 4]. \u0026nbsp;The aetiology of spinal pain can include mechanical, biopsychosocial, co-morbidities and genetic factors, varying in composition for individuals presenting with pain [4]. \u0026nbsp;This multi-factorial nature of spinal pain can make it challenging for musculoskeletal health professionals (MHP) to differentiate between predisposing factors [5, 6]. \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAlthough spinal pain has been associated with mechanical factors and spinal disorders, the relationship between spinal disorders and pain remains unclear [7-9]. \u0026nbsp;Forward head posture is believed to be a factor in mechanical neck pain [10, 11], and reduced lumbar lordosis curvature shows a strong relationship to increased spinal pain [12]. \u0026nbsp;Scoliosis or spinal asymmetry can produce spinal pain in youth populations; however, there are no linear relationships between deformity and pain [13, 14]. \u0026nbsp;Whilst posture and pain seem to connect, establishing the relationship's true nature remains elusive. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOne of the challenges in managing spinal conditions is knowing whether or not spinal position can change, transiently or permanently, and the consequences this will have. \u0026nbsp;Some spinal deformities have increased prevalence in an ageing population [15], and excessive kyphosis is associated with higher mortality [16]. \u0026nbsp;Forward head posture is associated with increased thoracic kyphosis and shoulder protraction [17] and, together with scoliosis, is increasingly linked to spinal pain with age [18], despite studies struggling to dissociate the confounding factors [10, 19].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe\u0026nbsp;critical question that remains is whether an individual's spinal pain can cause changes to structural biomechanics [20]. \u0026nbsp;There remains a debate on this question, and clinicians' views on the topic are influenced by educational background, clinical expertise, and interpretation of the literature on posture [9]. \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs part of musculoskeletal assessment, MHPs conduct quick and easy objective assessments to confirm a clinical opinion [21]. \u0026nbsp;Once the basic assessment has been completed, other measures are sometimes used to increase the clinician's confidence in the diagnosis, provide accuracy, and produce reviewable measures and educational tools [22]. \u0026nbsp;Currently, clinicians do not have an orthostatic postural measurement tool that is universally accepted and validated; indeed, the area of objective posture assessment is under-researched, particularly in the musculoskeletal clinical environment [23, 24]. \u0026nbsp;Laboratory-based measurements are the most accurate way of assessing objective posture but require complex technology and expertise, which is not feasible in the clinical environment [24] and leads to results that can be deemed clinically irrelevant. \u0026nbsp;Table 1\u0026nbsp;summarises how objective posture assessment is conducted in clinical and laboratory settings, including the capability to perform 2D/3D analysis and cost implications. \u0026nbsp;Whilst three-dimensional visual estimation is thought to be the predominant measure of orthostatic posture in clinical practice, several studies have modelled orthostatic posture onto two dimensions (coronal and sagittal) and justified this approach through technological inaccessibility of 3D assessment [25, 26]. \u0026nbsp;In recent years, 3D methods have been possible due to the improvement in mobile technology [27]; however, following a review of the literature (\u003cstrong\u003eTable 1\u003c/strong\u003e), mobile marker-based reliability and validity of clinical 2D and 3D objective assessment have not been seen in the industry-leading mobile application [28].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1 - insert\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn addition to the issues around the reliability and validity of current measurement tools, potentially high costs, and an apparent lack of consensus on what should be assessed, little is known about clinicians' actual use of various orthostatic postural assessments and their views around objective postural assessment. \u0026nbsp;As such, this study aimed: (a) to determine MHPs' use of objective orthostatic postural assessment, (b) to describe their views on objective postural assessment, and (c) to determine what key features an application-based objective posture modality would require to measure posture in a clinical environment. \u0026nbsp;\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis was an exploratory, ad-hoc, cross-sectional study utilising a survey developed on the JISC online surveys platform and distributed through professional interest groups: the iCSP website (professional physiotherapist community); the 'Let's Talk Osteopathy' Facebook page; the General Chiropractic Council administration department; and the lead author's professional network via LinkedIn. \u0026nbsp;Ethical approval was granted by the University of Bath's Research Ethics Approval Committee for Health (EP 22087), and responses were collected over six weeks. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe questions used in the survey were informed by previous systematic reviews on posture, for example, the link between posture and pain [9, 10] and consensus among the authors.\u003c/p\u003e\n\u003cp\u003eAn initial survey draft was shared with a group of three MHPs (one physiotherapist, one osteopath and one chiropractor) with substantial clinical experience (mean = 24 years musculoskeletal experience) for feedback and review.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThen, to test its validity, the lead author piloted a draft survey distributed among eight clinical colleagues with an average of 18 years of musculoskeletal clinical experience. \u0026nbsp;Feedback was collated and presented to the research team. \u0026nbsp;The survey covered two areas: experience and expectations. \u0026nbsp;The first area included five items aimed at clarifying MHPs' experience with posture as an objective measure, while the second area (seven items) focused on exploring MHPs' expectations around objective posture in a clinical context. \u0026nbsp;Of the twelve items, eight were closed questions, and three included a combination of open and closed options, with one question allowing only open responses. \u0026nbsp;Two closed questions included a ranking process to understand which modalities clinicians may prioritise treating postural-related issues, whilst the remainder used a tick box for selection and open inputted through text fields. \u0026nbsp;Input from academic colleagues and clinicians enabled amendments to the survey on the online survey site (Supplementary Material\u0026nbsp;1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eParticipant eligibility criteria\u0026nbsp;\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe survey was open to Chartered Physiotherapists, General Chiropractic Council and General Osteopathic Council registered MHPs with a minimum of one year of clinical experience. \u0026nbsp;Respondents were excluded if they did not confirm a valid registration number for their specific regulatory body.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eData Analysis\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe closed-ended question survey data were downloaded from the Online surveys webpage as frequencies and percentages into an Excel document. \u0026nbsp;Chi squared tests were undertaken to determine the differences between professions and in responses between the different musculoskeletal health professions. \u0026nbsp;Content analysis was conducted on open-ended responses. \u0026nbsp;The lead author took a hybrid (deductive and inductive) approach to coding these responses and organised them into new categories determined by both responses and the closed questions. \u0026nbsp;The Nvivo software package was used for the analysis [39]. \u0026nbsp;The results are presented descriptively in line with SAMPL guidance on descriptive statistics [40] and include relevant categories from the two survey sections. \u0026nbsp;Where responses appeared to differ between professions, the authors tested for statistical significance using Chi-squared test with the level of significance set to p\u0026lt;0,05 using SPSS version 17 (SPSS, IBM, USA).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 432 respondents completed the survey, but one respondent did not indicate consent so their data were not included, resulting in a sample size 431. \u0026nbsp;A single respondent agreed to the consent for the survey but refused to contribute any responses to any of the questions and is not included in the data analysis. \u0026nbsp;The breakdown of professions represented in the sample is shown in\u0026nbsp;\u003cstrong\u003eTable 2\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePerspectives on posture\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eObjective (a) - The MHPs\u0026apos; use of postural assessment\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAssessing posture in clinical practice received 429 valid responses. \u0026nbsp;Of the responses, 85% (363/427) said they assessed posture objectively. \u0026nbsp;These included 84% (285/340) of physiotherapists, 88% (38/43) of osteopaths, and 89% (40/45) of chiropractors.\u003c/p\u003e\n\u003cp\u003eThe objective assessment of posture among MHPs was multimodal. \u0026nbsp;Out of 430 responses around the main modes of assessment, 78% (336/430) were visual estimation, 9% (38/430) photogrammetry, and 9% (39/430) mobile applications. \u0026nbsp;Physiotherapists (80%, 272/342) and chiropractors (84%, 38/45) were more likely than osteopaths (64%, 27/42) to conduct visual assessments. \u0026nbsp;The results of Fisher\u0026apos;s Exact Test (p=0.06) indicate an association approaching significance between the professions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNotably, 22% (95/429) did not objectively measure posture with a similar split on the interprofessional breakdown for physiotherapists (22%, 74/342), chiropractors (18%, 8/45), and osteopaths (31%, 13/42). \u0026nbsp;The difference between the professions was significant, with X\u003csup\u003e2\u003c/sup\u003e = 5.950 and p = 0.05. \u0026nbsp;The 28 responses to the open question on modes of assessment were grouped into 12 categories. \u0026nbsp;Six responses involved photogrammetry; four cases had already selected photogrammetry as an option; therefore, only two responses were added to categories determined by the closed questions. \u0026nbsp;Similarly, the visual estimation data increased by a single response. \u0026nbsp;Other types of posture assessment included X-ray (3/430), tactile methods (6/430) and other video/ software methods (4/430).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe usefulness of a tool for grading posture received 429 responses; however, three respondents gave two answers instead of one, such as \u0026apos;yes/maybe\u0026apos; or \u0026apos;maybe/no\u0026apos;. \u0026nbsp;The responses for each professional are shown in \u003cstrong\u003eFig. 1\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eOverall, 29% (125/432) said \u0026apos;yes\u0026apos;, 37% (160/432) \u0026apos;maybe\u0026apos;, and 34% (147/429) \u0026apos;no\u0026apos; when asked if a posture grading tool would be useful. \u0026nbsp;Interestingly, 49% of chiropractors reported \u0026apos;yes\u0026apos; compared with 27% of physiotherapists and 23% of osteopaths. \u0026nbsp;Similarly, among those who said \u0026apos;no\u0026apos;, 37% were physiotherapists, 33% osteopaths, and only 16% of chiropractors \u003cstrong\u003e(\u003c/strong\u003e\u003cstrong\u003eFig. 1\u003c/strong\u003e\u003cstrong\u003e).\u0026nbsp;\u003c/strong\u003e The Fisher\u0026apos;s Exact test results were statistically significant with (p=0.011).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eObjective (b) \u0026ndash; MHPs\u0026apos; perspectives on objective posture assessment\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePostural change\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eOf 431 respondents who answered whether posture can change, 66% (284) responded \u0026apos;yes definitely\u0026apos;, and 31% (133) responded \u0026apos;maybe\u0026apos;. \u0026nbsp;Nine of the 14 remaining respondents said that standing posture is still part of their assessment.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOnly 19% of respondents thought changes were long-standing or short-term, not both. \u0026nbsp;The remaining respondents considered the changes to be both long-standing and short-term. \u0026nbsp;The percentage difference between the professions was not significant between professions with X\u003csup\u003e2\u003c/sup\u003e = 0.827 and p = 0.66. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePostural management\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA total of 429 respondents answered the importance of treating posture. \u0026nbsp;Eight respondents provided two responses to the question, suggesting clinical opinions vary on the importance of treating postural asymmetry. \u0026nbsp;The \u0026apos;sometimes\u0026apos; answer was the most frequent, with a higher percentage of physiotherapists (76%) than chiropractors (67%) and osteopaths (60%). \u0026nbsp;The difference between professions was X\u003csup\u003e2\u003c/sup\u003e = 6.570 and p = 0.04.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3 - insert\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhen treating posture, the top five attributes that change posture are Exercise, Education, Behavioural Change, Activity, and Work. \u0026nbsp;Of the 429 respondents, 94% (404) chose the exercise modality, with a subset of 42% most important and another 28% ranking it second most important (\u003cstrong\u003eT\u003c/strong\u003e\u003cstrong\u003eable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e3\u003c/strong\u003e). \u0026nbsp;Education was the second most popular modality to change posture, with 89% (380/429) responses, out of which 46% chose it as most important, and 29% chose it as second most important. \u0026nbsp;The third most popular modality was behavioural change (81%), with an even split of ranked choices. \u0026nbsp;The fourth choice was activity, chosen by 78% of respondents. \u0026nbsp;However, this was ranked lower overall, with 30% choosing it as third and 27% choosing it as fourth. \u0026nbsp;Work as a modality had 49% of responses, with lower ranked responses; 29% mentioned it as their fourth choice and 35% as their fifth choice. \u0026nbsp;Manual therapy as a modality had 40% responses with lower rated responses; 25% opted for it as the fourth choice, and 34% as the fifth choice. \u0026nbsp;The proportion of chiropractors choosing manual therapy (87%) was substantially higher than that of osteopaths (63%) and physiotherapists (30%), The difference between the professions was significant with X\u003csup\u003e2\u003c/sup\u003e = 63.205 and p \u0026lt; 0.001. \u0026nbsp;Some of the other modalities were predominately in the lower ranked options and with fewer responses: Orthotics/ Bracing (24%), Medication (9%), Clothing (9%), Hydrotherapy (7%), Acupuncture (6%), and Electrotherapy (5%). \u0026nbsp;However, psycho-social (18/429), ergonomics (7/429), pain (6/429) and body awareness (5/429) also had sufficient frequencies to warrant further description. \u0026nbsp;In addition, several low-frequency codes described other modes, including taping, surgery, biofeedback, nutrition and footwear.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe wider context of posture\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eMuch debate continues about the social construct of optimal posture. \u0026nbsp;In response to the question about whether there is an optimal posture, there were 430 responses. \u0026nbsp;Each of the six MHPs recorded two responses, again indicating that opinions vary among clinicians. \u0026nbsp;A total of 62% of Chiropractors (28/45) answered \u0026apos;yes\u0026apos; or \u0026apos;maybe\u0026apos; compared to 57% (221/385) of osteopaths and physiotherapists. \u0026nbsp;The difference between the professions was approaching significance with X\u003csup\u003e2\u003c/sup\u003e = 3.597 and p = 0.058. \u0026nbsp;The Osteopaths represented the most likely profession to answer \u0026apos;maybe\u0026apos;, whilst the physiotherapists were most likely to respond \u0026apos;no\u0026apos;. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOf 423 respondents, 65% said there was a link between posture and pain; specifically, 71% were chiropractors, and only 61% were osteopaths. \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLastly, respondents were asked about the importance of posture in terms of function versus the aesthetic (visual) aspect. \u0026nbsp;Out of 429 respondents, 75% considered that \u0026apos;yes\u0026apos;, function is more important than visual appearance, and 22% answered \u0026apos;maybe\u0026apos;. \u0026nbsp;Compared with the other professions, osteopaths displayed a predominance towards the function construct of posture.\u003c/p\u003e\n\u003cp\u003eObjective (c) \u0026ndash; Attributes of mobile application for objective postural assessment\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhen asked which attributes could help develop a mobile application, out of 385 responses, 80% were from physiotherapists, 9% from osteopaths, and 10% from chiropractors. \u0026nbsp;Some of the respondents did not give answers for all five attributes. \u0026nbsp;The top 5 attributes listed by frequency were: \u0026nbsp;\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eEase of use, 89% (95% chiropractors, 91% physiotherapists. and 75% osteopaths)\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eReliability/validity, 78% (80% physiotherapists, 75% osteopaths, and 73% chiropractors)\u003c/li\u003e\n \u003cli\u003eTime efficiency, 72% (74% physiotherapists, 70% chiropractors, and 53% osteopaths)\u003c/li\u003e\n \u003cli\u003eLow Cost, 64% (68% chiropractors, 65% physiotherapists, and 58% osteopaths)\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eThe most common open-text response (12 respondents) suggested no need for a mobile application, with a higher percentage of osteopaths not answering this question compared to the other professions. \u0026nbsp;A separate open question was included to facilitate freedom of expression about potential application attributes. \u0026nbsp;Of 185 respondents, 22% reported they did not want a more objective measure, and 10% were unsure. \u0026nbsp;Other responses (n\u0026gt;2) included patient epidemiology, the ability to link fixed and non-fixed pathologies, review local areas of postural discrepancy, compare with previous data sets, link to clinical reasoning, Beighton Scale, body type, pain score, and kinesiological variables.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eWhat does the paper answer? \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis is the first study to describe views on posture among UK-based MHPs. \u0026nbsp;It identifies the use of objective orthostatic postural assessment, quantifies the modalities of use within postural assessment and describes the MHPs' views on postural assessment. \u0026nbsp;Asking for input from representatives of three musculoskeletal professions allowed further exploration of differences and similarities in approaches to objective postural assessment. \u0026nbsp;In addition, it identifies features that may provide a solution to greater levels of objectivity within the postural assessment field through a mobile application. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhy are MHPs' views on objective postural assessment important? \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAmongst MHPs, objective postural assessment has been commonplace; however, the proportions of clinicians using it as part of their clinical assessment have been unknown [41]. \u0026nbsp;The results of this survey indicated that 85% of 432 MHPs objectively assess posture as part of their clinical assessment, with a higher percentage of osteopaths and chiropractors than physiotherapists. \u0026nbsp;Differences in teaching/training, understanding of the literature on posture, and clinical experience could potentially and partly explain the different percentages [20, 42]. \u0026nbsp;In addition, clinicians who follow physiotherapist-led literature may be more likely to endorse the narrative showing no clear correlation between posture and lower back pain [43-45]. \u0026nbsp;Clinically, due to different training and literature narratives, physiotherapists could potentially miss predisposing factors and pathologies based on their choice not to review standing posture as part of the musculoskeletal assessment [43, 46]. \u0026nbsp;Interestingly, chiropractors within the UK appear to be less likely to assess posture than Canadian chiropractors [47]. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eVisual estimation\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhen looking at the specific modalities of postural assessment, osteopaths were less likely to use visual estimation than other professionals. \u0026nbsp;Visual estimation remains the predominant measure of posture despite literature calling it into question [41, 48]. \u0026nbsp;The two main reasons visual estimation should be used as the first line of clinical assessment are usability and clinometry [23]. \u0026nbsp;Although most MHPs use postural assessment, it is unclear why osteopaths are less likely to use visual estimation as a modality. \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOther clinical objective posture modalities\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThere have been moves towards objective posture measurement from a clinical perspective within the literature [26, 27, 49]. \u0026nbsp;According to this survey, MHPs are more likely to use other objective modalities alongside visual estimation rather than as stand-alone methods, which aligns with the literature [23]. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGrading Posture\u003c/p\u003e\n\u003cp\u003eSeveral studies have attempted to grade posture [50, 51]; however, the need and desire amongst MHPs to use these scales have been questionable. \u0026nbsp;Also, almost half of chiropractors surveyed in this study thought grading posture was beneficial compared to three-quarters of physiotherapists and osteopaths who thought grading was not helpful. \u0026nbsp;The Foot Posture Index is an example of how grading posture can be brought into the clinical environment for localised areas of the body. \u0026nbsp;Still, there are no widely used clinical measures for global body postures [52]. \u0026nbsp;Two of the advantages of such a rating scale are the ability of the scale to work across three dimensions and the validity and reliability of the tool [53, 54]. \u0026nbsp;According to this study's respondents, validity and reliability were two key aspects of an application measuring posture. \u0026nbsp;However, to date, no measure fits these criteria in the objective postural assessment clinical arena. \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhat are the relevance/implications for MHPs?\u003c/p\u003e\n\u003cp\u003eVisual estimation remains the bedrock of objective postural assessment. \u0026nbsp;However, with the advent of technology, there does seem to be an increasing number of MHPs willing to use technology in an attempt to be more objective in this aspect of clinical practice, and this paper suggest the development of an objective postural assessment measure provided it meets the following criteria:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eEasy to use\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eReliable and Valid\u003c/li\u003e\n \u003cli\u003eTime efficient\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eLess relevant factors included integration with hardware, two/three-dimensional options, and automatic digitised assessment. \u0026nbsp;It is also noted that even if an application fulfilled the criteria mentioned by most clinicians, a proportion of MHPs would not support or use it. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStrengths and Limitations\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo our knowledge, this is the first survey of musculoskeletal healthcare professionals on objective standing posture. \u0026nbsp;The survey contributes to the debate on objective measurement of posture as a modality for musculoskeletal healthcare practice. \u0026nbsp;Some response differences are unclear, such as the 65 respondents who said they did not routinely use posture in clinical practice, and the 95 who said they do not measure posture. \u0026nbsp;The survey was distributed to UK-based MHPs recruited via professional networks. \u0026nbsp;Although the use of LinkedIn enhanced recruitment and led to a low number of incomplete surveys, it may have led to some sampling bias as some of the respondents were part of the professional network of the lead researcher. \u0026nbsp;Individual perceptions of the terms may have differed. \u0026nbsp;For example, some may consider exercise a form of behavioural change. \u0026nbsp;Given the exploratory nature of this study, we recognise that these results cannot be generalised to all MHPs within the UK; however, our findings provide some insight into the variety of perspectives among MHPs. More robust methodologies are needed to explore this area further. \u0026nbsp;\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe study's findings shed light on the perceptions of different MHPs' concerning objective posture. There is a commonality in how physiotherapists, osteopaths and chiropractors assess their patients; however, several MHPs, as part of their clinical reasoning process, choose not to evaluate posture routinely. While visual estimation is the mainstay of clinical practice, an opportunity to support clinicians with improved objectification remains elusive. This survey's findings also provide insight into how MHPs view posture and what they require from an objective postural mobile application tool.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cu\u003eEthics Approval and Consent to participate\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was granted by the University of Bath’s Research Ethics Approval Committee for Health (EP 22087), and all participants provided digitally recorded informed consent.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eConsent for publication\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAvailability of data and materials\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used/ or analysed during the current study are available from the corresponding author on reasonable request\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eCompeting interests\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eFunding\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAuthor’s Contributions\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eD.C.M., G.K., and M.P.M. contributed to the study's concept and design. D.C.M. performed the data interpretation and analysis and drafted the manuscript. D.C.M., R.M., G.K. and M.P.M. took part in interpreting the results, crucially reviewed and revised the manuscript, and approved the final version to be submitted for publication.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAcknowledgements\u0026nbsp;\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable \u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eMacfarlane GJ, Beasley M, Jones EA, Prescott GJ, Docking R, Keeley P, et al. The prevalence and management of low back pain across adulthood: Results from a population-based cross-sectional study (the MUSICIAN study). Pain. 2012 153(1):27-32. \u0026nbsp;https://doi.org/10.1016/j.pain.2011.08.005\u003c/li\u003e\n \u003cli\u003eBaskozos G, H\u0026eacute;bert HL, Pascal MMV, Themistocleous AC, Macfarlane GJ, Wynick D, et al. Epidemiology of neuropathic pain: An analysis of prevalence and associated factors in UK Biobank. Pain Reports. 2023 8(2):1-11. https://doi.org/10.1097%2FPR9.0000000000001066\u003c/li\u003e\n \u003cli\u003eHoy D, Brooks P, Blyth F, Buchbinder R. The Epidemiology of low back pain. Best Practice \u0026amp; Research Clinical Rheumatology 2010 Dec 1;24(6):769-781. https://doi.org/10.1016/j.berh.2010.10.002\u003c/li\u003e\n \u003cli\u003eHartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, et al. What low back pain is and why we need to pay attention. The Lancet 2018 391(10137):2356-2367. https://doi.org/10.1016/S0140-6736(18)30480-X\u003c/li\u003e\n \u003cli\u003eWill JS, Bury DC, Miller JA. Mechanical low back pain. American Family Physician\u0026nbsp;98(7):421-428. https://www.aafp.org/pubs/afp/issues/2018/1001/p421.html\u003c/li\u003e\n \u003cli\u003eWilson F, Ardern CL, Hartvigsen J, Dane K, Trompeter K, Trease L, et al. Prevalence and risk factors for back pain in sports: a systematic review with meta-analysis. British Journal of Sports Medicine 2021\u0026nbsp;55(11): 601-607. https://doi.org/10.1136/bjsports-2020-102537\u003c/li\u003e\n \u003cli\u003eIzzo R, Popolizio T, D\u0026rsquo;Aprile P, Muto M. Spinal pain. European Journal of Radiology\u0026nbsp;2015 84(5): 746-756. https://doi.org/10.1016/j.ejrad.2015.01.018\u003c/li\u003e\n \u003cli\u003eYang H, Liu H, Li Z, Zhang K, Wang J, Wang H. et al. Low back pain associated with lumbar disc herniation: role of moderately degenerative disc and annulus fibrous tears. International Journal of Clinical and Experimental Medicine\u0026nbsp;2015 8(2): 1634-1644. \u0026nbsp;http://www.ncbi.nlm.nih.gov/pmc/articles/pmc4402739/\u003c/li\u003e\n \u003cli\u003eSwain CTV, Pan F, Owen PJ, Schmidt H, Belavy DL. No consensus on causality of spine postures or physical exposure and low back pain: A systematic review of systematic reviews. Journal of Biomechanics, 2020 102: 1-6. \u0026nbsp;https://doi.org/10.1016/j.jbiomech.2019.08.006\u003c/li\u003e\n \u003cli\u003eMahmoud NF, Hassan KA, Abdelmajeed SF, Moustafa IM, Silva AG. The Relationship Between Forward Head Posture and Neck Pain: a Systematic Review and Meta-Analysis. Current Reviews in Musculoskeletal Medicine. 2019 12(4): 562-577. \u0026nbsp;https://doi.org/10.1007/s12178-019-09594-y\u003c/li\u003e\n \u003cli\u003eBalthillaya GM, Parsekar SS, Gangavelli R, Prabhu N, Bhat SN, Rao BK. Effectiveness of posture-correction interventions for mechanical neck pain and posture among people with forward head posture: protocol for a systematic review. BMJ Open, 2022 12(3): e054691. \u0026nbsp;https://doi.org/10.1136/bmjopen-2021-054691\u003c/li\u003e\n \u003cli\u003eChun S-W, Lim C-Y, Kim K, Hwang J, Chung SG. The relationships between low back pain and lumbar lordosis: a systematic review and meta-analysis. The Spine Journal, 2017 17(8): 1180-1191. \u0026nbsp;https://doi.org/10.1016/j.spinee.2017.04.034\u003c/li\u003e\n \u003cli\u003eTh\u0026eacute;roux J, Le May S, Fortin C, Labelle H. Prevalence and Management of Back Pain in Adolescent Idiopathic Scoliosis Patients: A Retrospective Study. Pain Research and Management, 2015 20(3): 153-157. https://doi.org/10.1155/2015/674354\u003c/li\u003e\n \u003cli\u003eBalagu\u0026eacute; F, Pellis\u0026eacute; F. Adolescent idiopathic scoliosis and back pain. Scoliosis and Spinal Disorders. 2016 11(1): 27. \u0026nbsp;https://doi.org/10.1186%2Fs13013-016-0086-7\u003c/li\u003e\n \u003cli\u003eDiebo BG, Shah NV, Pivec R, Naziri Q, Patel A, Post NH, et al. From Static Spinal Alignment to Dynamic Body Balance. JBJS reviews.\u0026nbsp;2018 6(7): e3. https://doi.org/10.2106/jbjs.rvw.17.00189\u003c/li\u003e\n \u003cli\u003eHijikata Y, Kamitani T, Sekiguchi M, Otani K, Konno S-I, Takegami M, et al. Association of kyphotic posture with loss of independence and mortality in a community-based prospective cohort study: the Locomotive Syndrome and Health Outcomes in Aizu Cohort Study (LOHAS). BMJ Open. 2022 12(3): e052421. \u0026nbsp;https://doi.org/10.1136/bmjopen-2021-052421\u003c/li\u003e\n \u003cli\u003eSingla D., Veqar Z, Association Between Forward Head, Rounded Shoulders, and Increased Thoracic Kyphosis: A Review of the Literature. Journal of Chiropractic Medicine. 2017 16(3): 220-229. \u0026nbsp;https://doi.org/10.1016%2Fj.jcm.2017.03.004\u003c/li\u003e\n \u003cli\u003eAmes CP, Scheer JK, Lafage V, Smith JS, Bess S, Berven SH, et al. Adult Spinal Deformity: Epidemiology, Health Impact, Evaluation, and Management. Spine Deformity, 2016 4(4): 310-322. \u0026nbsp;https://doi.org/10.1016/j.jspd.2015.12.009\u003c/li\u003e\n \u003cli\u003eSarig Bahat H, Levy A., Yona T, The association between forward head posture and non-specific neck pain: A cross-sectional study. Physiotherapy theory and practice. 2023 39(8): 1736\u0026ndash;1745. \u0026nbsp; https://doi.org/10.1080/09593985.2022.2044420.\u003c/li\u003e\n \u003cli\u003eLederman E. The fall of the postural-structural-biomechanical model in manual and physical therapies: Exemplified by lower back pain. Journal of Bodywork and Movement Therapies. 2011 15(2): 131-138. \u0026nbsp;https://doi.org/10.1016/j.jbmt.2011.01.011\u003c/li\u003e\n \u003cli\u003eHouglum PA, Boyle-Walker KL, Houglum DE. Rehabilitation of Musculoskeletal Injuries. Human Kinetics; 2022\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eChartered Society of Physiotherapy (2022) London: CSP https://www.csp.org.uk/professional-clinical/research-evaluation/outcome-experience-measures.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eWoldendorp KH, Kleinbergen JFE, Boonstra AM, de Schipper AW, Arendzen JH, Reneman MF. Quality and usability of clinical assessments of static standing and sitting posture: A systematic review. Journal of Back and Musculoskeletal Rehabilitation. 2022 35(2): 223-238. \u0026nbsp;https://doi.org/10.3233/bmr-200073\u003c/li\u003e\n \u003cli\u003eKandasamy G, Bettany-Saltikov J, Van Schaik P. Posture and Back Shape Measurement Tools: A Narrative Literature Review. \u0026nbsp;Spinal Deformities in Adolescents, Adults and Older Adults: IntechOpen. 2021 \u0026nbsp;https://doi.org/10.5772/intechopen.91803\u003c/li\u003e\n \u003cli\u003eLee HJ, Cho HE, Kim M, Chung SY., Park JH. Validity and Reliability of a Non-Radiographic Postural Analysis Device Based on an RGB-Depth Camera Comparing EOS 3D Imaging: A Prospective Observational Study Healthcare. 2023 11(5): 1-11. \u0026nbsp;https://doi.org/10.3390/healthcare11050686\u003c/li\u003e\n \u003cli\u003eFortin C, Van Schaik P, Aubin-Fournier J-F, Bettany-Saltikov J, Bernard J-C., Ehrmann Feldman D. (2018) \u0026apos;The acceptance of the clinical photographic posture assessment tool (CPPAT). BMC Musculoskeletal Disorders. 2018 19(1): 366. \u0026nbsp;https://doi.org/10.1186/s12891-018-2272-7\u003c/li\u003e\n \u003cli\u003eMoreira R, Teles A, Fialho R, dos Santos TCP, Vasconcelos SS, de Sa I C, et al. Can human posture and range of motion be measured automatically by smart mobile applications? Medical Hypotheses.\u0026nbsp;2020 142: 1-7. \u0026nbsp; https://doi.org/10.1016/j.mehy.2020.109741\u003c/li\u003e\n \u003cli\u003eHopkins BB, Vehrs PR, Fellingham GW, George JD, Hager R, Ridge ST. Validity and Reliability of Standing Posture Measurements Using a Mobile Application. Journal of Manipulative and Physiological Therapeutics.\u0026nbsp;2019 42(2): 132-140. \u0026nbsp;https://doi.org/10.1016/j.jmpt.2019.02.003\u003c/li\u003e\n \u003cli\u003eShin S., Yoo W. Inter-tester Reliability of Lumbar Lordosis Posture Classification Using a Novel Screening Device.\u0026nbsp;Journal of Manipulative and Physiological Therapeutics. 2021 44(1): 35\u0026ndash;41. https://doi.org/10.1016/j.jmpt.2019.12.012.\u003c/li\u003e\n \u003cli\u003eGolalizadeh D, Toopchizadeh V, Farshbaf-Khalili A, Salekzamani Y, Dolatkhah N., Pirani A. Faulty posture: Prevalence and its relationship with Body Mass Index and Physical Activity among female adolescents. Biomedical Human Kinetics. 2020 12(1): 25\u0026ndash;33. \u0026nbsp; https://doi.org/10.2478/bhk-2020-0004.\u003c/li\u003e\n \u003cli\u003eDimitriadis Z, Parintas I, Karamitanis G, Abdelmesseh K, Koumantakis GA, Kastrinis A. Reliability and Validity of the Double Inclinometer Method for Assessing Thoracolumbar Joint Position Sense and Range of Movement in Patients with a Recent History of Low Back Pain. Healthcare. 2022 11(105): 1-11. https://doi.org/10.3390/healthcare11010105.\u003c/li\u003e\n \u003cli\u003eSuzuki Y, Kawai H, Kojima M, Shiba Y, Yoshida H, Hirano H. et al. \u0026nbsp;Construct validity of posture as a measure of physical function in elderly individuals: Use of a digitalized inclinometer to assess trunk inclination. \u0026nbsp;Geriatrics \u0026amp; Gerontology International. 2016 16(9): 1068\u0026ndash;1073. \u0026nbsp; https://doi.org/10.1111/ggi.12600.\u003c/li\u003e\n \u003cli\u003eFurlanetto TS, Sedrez JA, Candotti CT, Loss JF. Photogrammetry as a tool for the postural evaluation of the spine: A systematic review. World Journal of Orthopedics. 2016 7(2): 136\u0026ndash;148. \u0026nbsp;https://doi.org/10.5312/wjo.v7.i2.136.\u003c/li\u003e\n \u003cli\u003eWu H-D, Liu W, Wong M-S, 2020. Reliability and validity of lateral curvature assessments using clinical ultrasound for the patients with scoliosis: a systematic review. European Spine Journal. 2020 29(4): 717\u0026ndash;725. \u0026nbsp;https://doi.org/10.1007/s00586-019-06280-y.\u003c/li\u003e\n \u003cli\u003ePivotto LR, Navarro IJRL., Candotti CT. Radiography and photogrammetry-based methods of assessing cervical spine posture in the sagittal plane: A systematic review with meta-analysis. Gait \u0026amp; posture. \u0026nbsp;2021 84(2): 357\u0026ndash;367. \u0026nbsp; https://doi.org/10.1016/j.gaitpost.2020.12.033.\u003c/li\u003e\n \u003cli\u003ePark B-KD, Jones MLH, Ebert S, Reed MP. A parametric modeling of adult body shape in a supported seated posture including effects of age. Ergonomics. 2022 65(6): 795\u0026ndash;803. \u0026nbsp; https://doi.org/10.1080/00140139.2021.1992020.\u003c/li\u003e\n \u003cli\u003eLabecka MK, Plandowska M, Moir\u0026eacute; topography as a screening and diagnostic tool\u0026mdash;A systematic review. PloS one. 2021 16(12): 1-15. https://doi.org/10.1371/journal.pone.0260858.\u003c/li\u003e\n \u003cli\u003eKandasamy G, Bettany-Saltikov J, Van Schaik P. Measurement of Three-Dimensional Back Shape of Normal Adults Using a Novel Three-Dimensional Imaging Mobile Surface Topography System (MSTS): An Intra- and Inter-Rater Reliability Study. Healthcare. 2023 11(23):1-13. \u0026nbsp;https://doi.org/10.3390/healthcare11233099.\u003c/li\u003e\n \u003cli\u003eLindgren BM, Lundman B, Graneheim UH.\u0026nbsp;Abstraction and interpretation during the qualitative content analysis process. International Journal of Nursing Studies.\u0026nbsp;2020 108(8): 1-6 https://doi.org/10.1016/j.ijnurstu.2020.103632\u003c/li\u003e\n \u003cli\u003eLang TA., Altman DG. Basic statistical reporting for articles published in Biomedical Journals: The \u0026quot;Statistical Analyses and Methods in the Published Literature\u0026quot; or the SAMPL Guidelines. International Journal of Nursing Studies. 2015 52(1): 5-9. \u0026nbsp;https://doi.org/10.1016/j.ijnurstu.2014.09.006\u003c/li\u003e\n \u003cli\u003eFedorak C, Ashworth N, Marshall J., Paull H. Reliability of the Visual Assessment of Cervical and Lumbar Lordosis: How Good Are We? Spine. 2003 28(16): 1857-1859. \u0026nbsp; https://doi.org/10.1097/01.brs.0000083281.48923.bd\u003c/li\u003e\n \u003cli\u003eHohenschurz-Schmidt D, Thomson OP, Rossettini G, Miciak M, Newall D, Roberts L. et al. Avoiding Nocebo and other undesirable effects in chiropractic, osteopathy and physiotherapy: An invitation to reflect \u003cem\u003eMusculoskeletal Science and Practice\u003c/em\u003e, 2022 62(10): 1-12. \u0026nbsp;https://doi.org/10.1016/j.msksp.2022.102677\u003c/li\u003e\n \u003cli\u003eSlater D, Korakakis V, O\u0026apos;Sullivan P, Nolan D., O\u0026apos;Sullivan K. \u0026quot;Sit Up Straight\u0026quot;: Time to Re-evaluate. The Journal of Orthopaedic and Sports Physical Therapy. 2019 49(8): 562-564. \u0026nbsp;https://doi.org/10.2519/jospt.2019.0610\u003c/li\u003e\n \u003cli\u003eO\u0026apos;Sullivan K, O\u0026apos;Sullivan P, O\u0026apos;Sullivan L., Dankaerts W. What do physiotherapists consider to be the best sitting spinal posture? Manual Therapy. 2012 17(5): 432-437. \u0026nbsp;https://doi.org/10.1016/j.math.2012.04.007\u003c/li\u003e\n \u003cli\u003eWernli K, O\u0026apos;Sullivan P, Smith A, Campbell A., Kent P. Movement, posture and low back pain. \u0026nbsp;How do they relate? \u0026nbsp;A replicated single‐case design in 12 people with persistent, disabling low back pain. European Journal of Pain. 2020 24(9): 1831-1849. https://doi.org/10.1002/ejp.1631\u003c/li\u003e\n \u003cli\u003eWilliams CA., Lewis L. Mindsets in health professions education: A scoping review. Nurse education today. 2021 100: 1-7. https://doi.org/10.1016/j.nedt.2021.104863.\u003c/li\u003e\n \u003cli\u003eHinton PM, McLeod R, Broker B, Maclellan CE. Outcome measures and their everyday use in chiropractic practice. The Journal of the Canadian Chiropractic Association. 2010 54(2): 118-131. \u0026nbsp;https://pubmed.ncbi.nlm.nih.gov/20520756\u003c/li\u003e\n \u003cli\u003eLang AE., Milosavljevic S. Visual estimation of shoulder posture: accuracy and reliability across five planes of motion. Physical Therapy Reviews. 2019 24(3-4): 118-124. \u0026nbsp;https://doi.org/10.1080/10833196.2019.1637594\u003c/li\u003e\n \u003cli\u003eLichota M, Plandowska M, Mil P. The Shape of Anterior-Posterior Curvatures of the Spine in Athletes Practising Selected Sports. Polish Journal of Sport and Tourism. 2011 18(2): 112-116. \u0026nbsp;https://doi.org/10.2478/v10197-011-0009-3\u003c/li\u003e\n \u003cli\u003eLudwig O, Dindorf C, Kelm J, Simon S, Nimmrichter F, Fr\u0026ouml;hlich M. Reference Values for Sagittal Clinical Posture Assessment in People Aged 10 to 69 Years. International Journal of Environmental Research and Public Health. 2023 20(5): 1-16. \u0026nbsp; https://doi.org/10.3390/ijerph20054131\u003c/li\u003e\n \u003cli\u003eLudwig O, Hammes A, Kelm J., Schmitt E. Assessment of the posture of adolescents in everyday clinical practice: Intra-rater and inter-rater reliability and validity of a posture index. Journal of Bodywork and Movement Therapies.\u0026nbsp;2016 20(4): 761-766. \u0026nbsp;https://doi.org/10.1016/j.jbmt.2016.04.004\u003c/li\u003e\n \u003cli\u003eRedmond AC, Crosbie J., Ouvrier RA. Development and validation of a novel rating system for scoring standing foot posture: The Foot Posture Index. Clinical Biomechanics.\u0026nbsp;2006 21(1): 89-98. \u0026nbsp;https://doi.org/10.1016/j.clinbiomech.2005.08.002\u003c/li\u003e\n \u003cli\u003eTerada M, Wittwer AM, Gribble PA. Intra-rater and inter-rater reliability of the five image-based criteria of the foot posture index-6. International Journal of Sports Physical Therapy. 2014 9(2): 187-94. \u0026nbsp;https://pubmed.ncbi.nlm.nih.gov/24790780\u003c/li\u003e\n \u003cli\u003eTeles A, Fialho R, Baluz R, Santos TC, Moreira R, Goulart-Filho R. et al. Mobile Applications for Assessing Human Posture: A Systematic Literature Review. Electronics, 2020 9(8): 1-24. https://doi.org/10.3390/electronics9081196\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e Measurements of Objective Posture, Setting, Mode, Examples, Costings and Psychometric properties [23, 24, 26]\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003eMethod of Posture Assessment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eClinical or Laboratory Based\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003e2-dimensional (2D) or 3-dimensional (3D)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eExamples\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eCost \u0026nbsp;(Low \u0026ndash; below \u0026pound;20, Medium - \u0026pound;20-100, High \u0026gt; \u0026pound;100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003ePsychometric Properties\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.1052631578947367%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003eRuler-based\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eClinical\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003e2D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eFleximeter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eGood reliability for sagittal lumbar posture [29, 30]\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.1052631578947367%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003eInclinometry\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eClinical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003e2D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eMeasure App (iPhone)/ Goniometer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003ePoor reliability for Joint Position Sense of Spine with Spinal Pain [31], however construct validity shown for assessing function in elderly [32]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.1052631578947367%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003eVisual Estimation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eClinical\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003e2D/3D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eClinical assessment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eDirect visual observation with raters has been recommended [23]\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.1052631578947367%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003ePhotogrammetry\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eClinical/ Laboratory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003e2D/3D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eFortin 2017/ KINECT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eLow-High\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eMultiple methods make it difficult to determine reliability. \u0026nbsp;Few RCT means validity is problematic too [33]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.1052631578947367%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003eSurface-based markers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eClinical/ Laboratory\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003e2D/3D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eVICON\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eHigh\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eGold-standard non-radiographic method, with high validity and reliability [28]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.1052631578947367%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003eUltrasound\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eClinical/ Laboratory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003e3D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Lab based\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eModerate-level evidence of reliability or validity [34]\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.1052631578947367%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003eRadiographic\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eClinical/ Laboratory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003e2D/ 3D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eX-Ray standard or low-dose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eHigh\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eGold-standard assessment of spinal curvature [28, \u0026nbsp; \u0026nbsp; 35]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.1052631578947367%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Shape Modelling\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eClinical/ Laboratory\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003e2D/3D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eApp based \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eHigh \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eNew method, no validation or reliability studies at present in relation to postural assessment [36]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.1052631578947367%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Topography\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eClinical/ Laboratory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003e2D/3D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Lab based\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eHigh\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eModerate evidence for reliability and validity [37]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.1052631578947367%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.473684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Light Based\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eLaboratory\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003e2D/3D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;PAViR\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eHigh \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eICC values 0.70 \u0026ndash; 0 .98 for intra and inter-rater reliability [38]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.1052631578947367%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp; \u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e Number and proportion of respondents by profession\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.87755102040816%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003ePhysiotherapist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003eOsteopath\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003eChiropractor\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.87755102040816%\" valign=\"top\"\u003e\n \u003cp\u003eNumber of participants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e343\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.87755102040816%\" valign=\"top\"\u003e\n \u003cp\u003ePercentage of survey population\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 3\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;- Rated attributes most likely to change posture\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003eN=429\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.68041237113402%\" valign=\"top\"\u003e\n \u003cp\u003eRespondents = n(%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003eFirst\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003eSecond\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003eThird\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003eFourth\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Fifth\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003eExercise\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.68041237113402%\" valign=\"top\"\u003e\n \u003cp\u003e404 (94%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e168 (42%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e111 (28%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e73 (18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;33 (8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e19 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003eEducation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.68041237113402%\" valign=\"top\"\u003e\n \u003cp\u003e380 (89%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e174 (46%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e110 (29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e51 (13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;31 (8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e14 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003eBehavioural Change\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.68041237113402%\" valign=\"top\"\u003e\n \u003cp\u003e346 (81%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e70 (20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e90 (26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e83 (24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e62 (18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e41 (12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003eActivity\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.68041237113402%\" valign=\"top\"\u003e\n \u003cp\u003e337 (79%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e33 (8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e57 (13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e101 (24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e89 (21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e57 (13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003eWork\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.68041237113402%\" valign=\"top\"\u003e\n \u003cp\u003e212 (49%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e17 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e23 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e38 (9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e61 (14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e73 (17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003eManual Therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.68041237113402%\" valign=\"top\"\u003e\n \u003cp\u003e171 (40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e23 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e15 (3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e33 (8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e43 (10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e57 (13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003eOrthotics/ Bracing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.68041237113402%\" valign=\"top\"\u003e\n \u003cp\u003e104 (24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e7 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e16 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e24 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e19 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e38 (9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003eMedication\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.68041237113402%\" valign=\"top\"\u003e\n \u003cp\u003e40 (9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e1 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e1 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e9 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e13 (3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e16 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003eClothing\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.68041237113402%\" valign=\"top\"\u003e\n \u003cp\u003e38 (9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e1 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e4 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e4 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e7 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e22 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003eHydrotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.68041237113402%\" valign=\"top\"\u003e\n \u003cp\u003e33 (7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e3 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e6 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e4 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e7 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e13 (3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003eElectrotherapy\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.68041237113402%\" valign=\"top\"\u003e\n \u003cp\u003e22 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e2 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e8 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e3 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e9 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003eAcupuncture\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.68041237113402%\" valign=\"top\"\u003e\n \u003cp\u003e25 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e1 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e6 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e5 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e1 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e12 (3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003eOther\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.68041237113402%\" valign=\"top\"\u003e\n \u003cp\u003e67 (16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e18 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e8 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e8 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e10 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"top\"\u003e\n \u003cp\u003e25 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eFile name including file format \u0026ndash; Supplementary material 1.docx\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTitle of Data \u0026ndash; Example of survey sent to participants \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDescription of Data \u0026ndash; All questions included from the original survey\u003c/p\u003e\n\u003cp\u003eFile name including file format - Additional file 1.xlsx\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTitle of Data - Raw data from the survey\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDescription of Data The raw data from this file is shown throughout several Excel sheets that display some of the data analysis processes.\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"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":"Posture, Assessment, Measurement, Spinal, Pain, Survey.","lastPublishedDoi":"10.21203/rs.3.rs-4788633/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4788633/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e \u003c/em\u003eSpinal pain is commonly assessed by physiotherapists, osteopaths and chiropractors in musculoskeletal practice in the UK. \u0026nbsp;Typically, assessment involves some form of visual estimation, but further objective measurement is not preferred due to logistical factors. \u0026nbsp;This study explored the views of physiotherapists, osteopaths, and chiropractors around objective postural assessment and factors that may influence clinical reasoning.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e \u003c/em\u003eAn online, exploratory, ad-hoc, cross-sectional survey was designed to collect data on views around objective postural assessment. \u0026nbsp;The survey was distributed among relevant professional groups.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e:\u003c/strong\u003e A total of 431 respondents (343 physiotherapists, 43 osteopaths, and 45 chiropractors) took part. \u0026nbsp;As much as 85% of respondents use some form of postural assessment within clinical practice. \u0026nbsp;Most respondents perceived that posture can change and that the changes can be short-term and long-standing. \u0026nbsp;Exercise, education, and behavioural change were perceived as top interventions to change posture.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003c/em\u003e These results provide insights into the current position of MHPs' views within the UK and facilitate conversation regarding the objective measurement of posture in the 21\u003csup\u003est\u003c/sup\u003e century.\u003c/p\u003e","manuscriptTitle":"Musculoskeletal Healthcare Professionals' perspectives on objective postural assessment (Expectation and Experience): A UK (Multiprofessional) nationwide survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-22 04:18:14","doi":"10.21203/rs.3.rs-4788633/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":"1495e088-ed01-4f46-a586-54719ff405dd","owner":[],"postedDate":"August 22nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-20T08:54:16+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-22 04:18:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4788633","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4788633","identity":"rs-4788633","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}