Design and Validation of the Observational Static Posture Assessment Tool (OSPAT): A Psychometric Study

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Posture plays a crucial role in biomechanics and movement efficiency and also impacts an individual's appearance, confidence, and overall well-being. Existing visual assessment tools have not kept pace with the latest scientific Approaches and paradigm shifts in our understanding of the holistic assessment. This study aims to address this gap by designing and validating a new observational tool for observational postural assessment that integrates current scientific insight and best practices in musculoskeletal health. Methods This is a cross-sectional design including recruiting both qualitative and quantitates methods to develop and test psychometric properties of the Observational Static Posture Assessment Tool (OSPAT). To establish the validity of the OSPAT, we employed Lawshe's Content Validity Ratio (CVR) and Content Validity Index (CVI) through a collaborative process involving consultation with 12 experts. To test the reliability, 28 raters utilized the OSPAT on a sample of 80 individuals. Each practitioner rated the presence of postural deviations including Upper Crossed Syndrome, Sway Back Posture, Lower Crossed Syndrome, Genu Recurvatum, Scoliosis, Genu Varum, Genu Valgum, and Foot Pronation Syndrome in each subject using a 6-point scale of severity. We employed Kappa coefficients (κ) to assess both intra-rater and inter-rater reliability. Results The analysis for OSPAT validity showed overall CVR and CVI, (0.70 and CVI > 79) index, respectively. The results for OSPAT reliability revealed good intra-rater and inter-rater agreement, with κ values of 0.68 and 0.53, respectively. Conclusions The OSPAT showed promise for valid and reliable observational static postural assessment, overcoming the limitations of segmental evaluation by taking a holistic approach to postural assessment and considering the body as an interconnected system. Body Alignment Corrective exercises Figures Figure 1 Figure 2 Figure 3 Background Posture is a critical factor in determining the alignment of body segments at any given moment [ 1 ]. It is a major public health concern for individuals across different age groups, including children, adolescents, and adults, as it can have a significant impact on the development of musculoskeletal disorders [ 2 ]. Prolonged periods of sitting, especially during various activities at school, home, and work, can increase the risk of individuals adopting improper postures. This can result in the development of muscular imbalances and the onset of postural abnormalities [ 1 ]. Postural misalignments can result in muscle weakness and tightness, leading to a decreased range of motion in the joints. This can ultimately contribute to the development of musculoskeletal injuries and hinder daily activities, impacting the overall quality of life [ 1 , 3 ]. It is essential for clinicians and practitioners to possess the necessary skills to identify postural misalignments in order to prevent the progression and development of musculoskeletal issues and their associated complications. Various methods can be used to assess postural alignment, including visual observation [ 4 , 5 ], goniometry [ 5 , 6 ], Radiography [ 6 ], photogrammetry [ 5 , 6 ], and Optical motion capture system [ 6 , 7 ], with the latter being considered the most reliable due to its advanced technology. However, technology-based methods have their own set of implications in their analysis, such as the need for techniques that are simple and non-invasive, provide quick and accurate data, and address ethical concerns related to the use of images while protecting the interests of the subjects. Extensive research has shown that visual assessment tools are commonly utilized in evaluating posture across diverse populations [ 5 , 6 , 8 ]. Visual assessment enables practitioners to conduct a comprehensive assessment of their patients' musculoskeletal system in a quick, cost-effective, and non-invasive manner [ 8 – 11 ]. One of the most commonly utilized tools for visual assessment screening is the New York Posture Rating (NYPR) scale. The NYPR scale was first introduced in 1958 as part of a series of evaluations [ 12 ]. A revised version of the NYPR, which included a reduced number of items and an updated scoring system, was later incorporated into the Health Fitness Instructors Handbook by Howley and Franks from the University of the State of New York, Bureau of Physical Education [ 13 ]. The 1958 publication by NYPR provides a detailed compilation of three figure drawings for each of the 13 body alignment segments that collectively influence overall postural alignment. These segments include posterior views of the head, shoulders, spine, hips, feet, and arches, as well as lateral (left side) views of the neck, chest, shoulders, upper back, trunk, abdomen, and lower back. Each drawing is accompanied by brief verbal descriptions that highlight the visual cues serving as reference points for scoring. In the original version, a scoring system of 5 (indicating correct posture), 3 (representing slight deviation), or 1 (pronounced deviation) was utilized to assess each body segment (Fig. 1 ). ****Figure 1 near here**** The NYPR versions have been noted to have validity concerns, including the lack of items for assessing knee abnormalities and plantar arch. In contrast to the segmented approach of NYPR, Janda contends that the locomotor system of the human body cannot be adequately assessed and treated by concentrating on individual segments. Instead, he advocates for viewing and evaluating the body as a cohesive system. According to Janda, it is essential to consider the entire body as a unified entity during assessment, as all segments is interconnected through muscular and joint chains. By evaluating the body holistically, practitioners may avoid overlooking the root causes of musculoskeletal disorders [ 14 ]. Moreover, to the best of the authors' knowledge, there has been no study conducted to evaluate the reliability and validity of the NYPR scale. As a result, a new observational posture assessment tool was to be created to tackle the aforementioned concerns, with the aim of improving upon the existing NYPR scale by integrating new rating criteria to enhance its reliability and validity. The outcomes of the study are anticipated to enhance posture rating techniques in clinical environments and foster a deeper comprehension of posture-related concerns. Methods A multiphase, cross-sectional, qualitative field study was used for developing and psychometric testing of the Observational Static Posture Assessment Tool (OSPAT). Developing the OSPAT Selecting the Posture Assessment Indices The selection of posture indices in the study was based on their clinical relevance [ 15 ]. This means that the chosen posture indices were considered to be meaningful and important in the context of assessing posture-related issues or abnormalities. By selecting posture indices that are clinically relevant, researchers aimed to ensure that the posture assessment tool accurately captures and evaluates postural characteristics that are known to be significant indicators of health, function, or potential musculoskeletal problems. Prioritizing posture indices based on their clinical relevance enhances the validity and utility of the posture assessment tool in clinical settings, as it ensures that the tool can effectively address and evaluate postural issues that are of practical importance to healthcare professionals and patients. The selection of posture indices in the study was also guided by their ability to assess posture changes across all body segments regarding the janda approach [ 14 ], This criterion emphasizes the importance of capturing and evaluating postural alignment and deviations not only in specific body regions but across all body segments comprehensively. By considering posture indices that can assess posture changes across multiple body segments, the posture assessment tool developed in the study aims to provide a holistic and global evaluation of an individual's posture. This approach allows for a thorough assessment of postural alignment, symmetry, and potential deviations throughout the entire body, rather than focusing on isolated regions or segments. The incorporation of posture indices that cover various body segments enhances the tool's ability to capture complex postural changes and abnormalities that may involve multiple regions. This comprehensive assessment can contribute to a more complete understanding of an individual's postural profile and facilitate targeted interventions or treatments based on a thorough evaluation of posture across all body segments. Also ensuring the validity and reliability of the tool based on the Tyson and DeSouza's content validity study [ 16 ] and a high level of intra-rater reliability (intra-class correlation coefficient > 0.70) [ 11 ]. To select Indices for developing the OSPAT, The New York Posture Rating Scale (NYPRC) was targeted as the basis for this review, as it is a widely used tool. A thorough literature review was conducted to discuss the importance of posture rating, existing posture rating charts, and the limitations of the NYPRC. OSPAT Validity Assessment A panel of 12 experts evaluated the tool to determine its validity. To assess the validity of the developed tool, Lawshe's Content Validity Ratio (CVR) and Content Validity Index (CVI) were employed [ 17 ]. Content Validity Ratio (CVR) In the calculation of the Content Validity Ratio (CVR), the collective input of all panelists regarding the importance of the tested knowledge or skill was considered. The CVR was calculated based on the ratings provided by the experts. According to Lawshe's CVR table, for a panel of a minimum of 12 experts, each item should yield a calculated CVR value exceeding 0.56 to be considered valid [ 17 ]. Panelists were asked to rate each item on a scale of 1 to 3, where 1 signifies "not necessary," 2 indicates "useful but not essential," and 3 represents "essential" importance [ 18 ]. Content Validity Index (CVI) The Content Validity Index (CVI) was determined by panel members who assessed the clarity and relevance of the instrument items. They rated each item on a 4-point ordinal scale (1: not relevant, 2: somewhat relevant, 3: quite relevant, 4: highly relevant). The CVI was calculated by dividing the number of experts who rated the item as relevant or clear (rating 3 or 4) by the total number of content experts, providing an indication of the item's content validity [ 19 ]. ****Figure 2 near here**** OSPAT Reliability Assessment To evaluate the reliability of the newly developed Observational Static Posture Assessment Tool (OSPAT), a group of raters was trained to utilize the tool for assessing static posture in study participants. Both inter-rater reliability and intra-rater reliability were assessed to determine the consistency and reproducibility of posture assessments using OSPAT. Inter-rater reliability was evaluated by calculating intraclass correlation coefficients (ICCs) among different raters who independently assessed the static posture of the study participants using OSPAT. ICCs provide a statistical measure of agreement between multiple raters in their assessments of the same set of posture measurements. High ICC values indicate good agreement among raters in their evaluations of posture deviations and abnormalities. Intra-rater reliability was assessed by calculating ICCs for repeated assessments conducted by the same rater on the same set of study participants. This analysis examines the consistency of posture assessments performed by individual raters over time and helps determine the reliability of the OSPAT tool in producing consistent results when used by the same rater on multiple occasions. Raters A group of 28 experts specializing in musculoskeletal health and posture assessment participated as raters in the research study [ 20 ]. The raters selected had varying years of experience and expertise in assessing posture and musculoskeletal alignment. Each rater was tasked with assigning a severity score on a scale from 0 to 5 to indicate posture devotions including Upper Crossed Syndrome (UCS), Sway Back Posture (SBP), Lower Crossed Syndrome (LCS), Genu Recurvatum (GR), Scoliosis (SC), Genu Varum (GVR), Genu Valgum (GVG), and Foot Pronation Syndrome (FPS) of the study participants. The severity scoring system was designed to capture the extent of deviation from ideal posture, with 0 indicating no observable deviation and scores of 1 to 5 representing increasing levels of abnormality. A score of 1 indicated a minimal deviation, while scores of 4 or 5 indicated more severe abnormalities in posture that were readily apparent to the raters. Participants A total of 80 participants, aged between 18 and 25 years, were purposefully selected to participate in the research study. The inclusion criteria required participants to be within the specified age range to ensure a relatively homogeneous sample in terms of musculoskeletal development and postural alignment characteristics within the age group of interest. Exclusion criteria were put in place to ensure the exclusion of individuals who may have factors influencing musculoskeletal alignment that could confound the assessment of static posture. Participants with a history of previous spinal surgery, osteoporosis, major congenital anomalies affecting posture, previous spinal fractures, rheumatological conditions impacting musculoskeletal health, leg length discrepancy, or neurologic conditions that could affect posture were excluded from the study. Posture Assessment The method of photography was employed to assess static posture in a research study. Images were captured from three different views – front, side, and back to analyze body posture. To do so, Participants were instructed to wear minimal clothing to ensure clear visibility of their posture and were asked to stand naturally with their hands by their sides in their usual stance. .The camera was set up on a tripod at 4 meters distance and angle to capture high-resolution images of the subject's posture from each view. The camera height and alignment were carefully adjusted to ensure accurate image capture. Using a Panasonic Lumix camera photographs were taken of the individual standing in a natural and relaxed posture with their arms positioned by their sides. The images were then randomized and anonymized for evaluation. Data Analysis ICC values were used to determine the consistency and reliability of ratings among raters for both inter-rater and intra-rater assessments [ 21 ]. The statistical methods employed in the study included the calculation of Kappa coefficients (κ) to evaluate both intra-rater and inter-rater reliability. The interpretation of κ values in this research study followed established conventions in the literature, where values significantly below 0.5 indicate weak agreement. The interpretations used in this study are as follows: Poor agreement: κ < 0.40 Fair agreement: κ = 0.40–0.59 Good agreement: κ = 0.60–0.79 Excellent agreement: κ ≥ 0.80 Intra-rater reliability was assessed by comparing each examiner's initial assessment of a subject with their subsequent assessment of the same subject. On the other hand, inter-rater reliability was evaluated by comparing the initial assessments made by all examiners. This involved comparing each examiner's evaluation of a subject with that of every other examiner. ****Figure 3 near here**** Results Demographic information of the participants is presented in Table 1 . Table 1 Demographic Characteristic of Participants Variable Mean ± SD Age (yr) 20.4 ± 5.3 Height (cm) 176.8 ± 4.5 Weight (kg) 77.8 ± 5 ****Table 1 near here**** In the study, all 28 raters had experience ranging from 1 to 15 years of practice, with each group having an equal distribution of years of experience. This ensured a diverse range of expertise levels among the raters, allowing for comprehensive and varied assessments of static posture using the Observational Static Posture Assessment Tool (OSPAT). The results of the Kappa coefficient analysis indicated good intrarater and interrater agreement for each individual item assessed using the OSPAT tool, as well as for the overall questionnaire. The Kappa coefficient values of 0.68 and 0.53 demonstrated a substantial level of agreement among raters in their assessments of posture abnormalities and deviations. A Kappa coefficient of 0.68 for intrarater agreement signifies a substantial level of agreement among the same rater's repeated assessments of posture items over time. This level of agreement indicates that the raters were consistent in their evaluations when assessing the same set of posture measurements on different occasions. Similarly, a Kappa coefficient of 0.53 for interrater agreement indicates a moderate level of agreement among different raters when assessing posture using the OSPAT tool. This level of agreement suggests that there was a consistent understanding and interpretation of posture assessments among the diverse group of raters with varying levels of experience. These results highlight the reliability and consistency of the OSPAT tool in facilitating accurate and reproducible assessments of static posture, as evidenced by the good intrarater and interrater agreement demonstrated through the Kappa coefficient analysis (Table 2 ). Table 2 Mean Intrarater and Interrater Kappa Coefficients for each item of questionnaire Items Intrarater (95% CI) Description* Interrater (95% CI) Description* Item 1 (UCS) 0.55 (0.14–0.83) Fair 0.50 (0.10–0.63) Fair Item 2 (SBP) 0.53 (0.19–0.79) Fair 0.48 (0.06–0.73) Fair Item 3 (LCS) 0.61 (0.10–0.73) Good 0.53 (0.23–0.73) Fair Item 4 (GR) 0.80 (0.04–0.92) Excellent 0.61 (0.23–0.91) Good Item 5 (SC) 0.76 (0.16–0.87) Good 0.52 (0.13–0.63) Fair Item 6 (GVR) 0.90 (0.11–0.93) Excellent 0.70 (0.08–0.67) Good Item 7 (GVG) 0.60 (0.20–0.85) Good 0.45 (0.13–0.63) Fair Item 8 (FPS) 0.69 (0.10–0.75) Good 0.52 (0.11–0.73) Fair Overall 0.68 (0.02–0.71) Good 0.53 (0.06–0.72) Fair *Descriptor according to Altman et al (1990) interpretation of Kappa. Upper Crossed Syndrome (UCS), Sway Back Posture (SBP), Lower Crossed Syndrome (LCS), Genu Recurvatum (GR), Scoliosis (SC), Genu Varum (GVR), Genu Valgum (GVG), Foot Pronation Syndrome (FPS) ****Table 2 near here**** The CVR results for each item and overall tools are displayed in Table 3 . Also CVI results indicated that all items had a score above 0.79, considered as high content validity [ 22 ]. It suggests that the items included in the OSPAT tool were deemed relevant and clear by the group of raters who participated in the assessment. The high CVI scores reflect the consensus among the raters regarding the appropriateness and accuracy of the items included in the posture assessment tool. Table 3 Values of Content Validity Ratio (CVR) Items CVR Item 1 (UCS) 0.58 Item 2 (SBP) 0.62 Item 3 (LCS) 0.76 Item 4 (GR) 0.82 Item 5 (SC) 0.73 Item 6 (GVR) 0.89 Item 7 (GVG) 0.67 Item 8 (FPS) 0.57 Overall 0.70 Upper Crossed Syndrome (UCS), Sway Back Posture (SBP), Lower Crossed Syndrome (LCS), Genu Recurvatum (GR), Scoliosis (SC), Genu Varum (GVR), Genu Valgum (GVG), Foot Pronation Syndrome (FPS) ****Table 3 near here**** Discussion This study aimed to enhance the NYPR scale by developing an observational posture assessment tool and validating its use in clinical settings. The results showed good levels of intrarater and interrater agreement across the newly developed indices, with Kappa coefficients (κ) of 0.68 and 0.53, respectively. These values indicate good agreement levels, with the intrarater agreement considered substantial and the interrater agreement falling within the category of fair agreement based on conventional interpretations. In addition to the agreement metrics, the validity assessment results revealed favorable overall Content Validity Ratio (CVR) of 0.70 and Content Validity Index (CVI) greater than 0.79. These validity indicators suggest that the revised observational posture assessment tool is credible and appropriate for assessing posture visually. The high levels of agreement and validity observed in the study support the tool's potential utility in clinical settings, where rapid, non-invasive, and accurate assessments are crucial for effective diagnosis and treatment planning. Furthermore, the tool demonstrates reliability and validity across clinicians with varying levels of experience, indicating its applicability in diverse clinical settings. When assessing posture, a key concept is to focus on the kinetic chain, which refers to the interconnected series of joints and muscles that work together to produce movement. By examining the alignment and function of the entire kinetic chain, rather than just isolated segments, clinicians can gain a more comprehensive understanding of how posture is influenced by the body's movement patterns and muscle imbalances [ 14 ]. One important framework for understanding posture and movement patterns is the concept of upper and lower cross syndromes, originally proposed by Czech neurologist Vladimir Janda. Upper cross syndrome typically involves tightness and weakness in specific muscle groups in the upper body, leading to rounded shoulders, forward head posture, and an increased cervical curve. Lower cross syndrome, on the other hand, is characterized by imbalances in the muscles of the lower back, hips, and legs, resulting in an anterior pelvic tilt, increased lumbar curve, and potentially knee and foot issues [ 14 ]. The new observational posture assessment tool aligns with Janda's perspective on posture and movement patterns, moving away from the limitations of segmental evaluation [ 14 ]. By taking a holistic approach to postural assessment and considering the body as an interconnected system, clinicians can develop more effective interventions and preventive measures to address postural misalignments and musculoskeletal disorders. This comprehensive view allows for a deeper understanding of the underlying causes of postural issues, enabling clinicians to tailor interventions that target the root of the problem rather than just addressing the symptoms. In the present study, the reliability of the newly developed observational posture assessment tool was found to be comparable to or potentially even better than similar research studies, often demonstrating greater consistency in ratings. For instance, earlier studies like Watson and Mac Donncha [ 23 ] achieved slightly higher intra-rater reliability, but they had fewer raters, which could impact the generalizability of their findings. On the other hand, studies like the one by Fedorak et al. [ 20 ] that did not have specific rating guidelines reported lower reliability, underscoring the importance of having clear and standardized protocols in place for reliable assessments. Given the high cost and potential side effects associated with invasive methods of postural assessment, it is advisable to explore alternative tools or instruments that are more cost-effective and safer to use [ 24 ]. Observational assessment emerges as a favorable option in this regard, as it offers prompt and precise outcomes without the risk of side effects such as radiation exposure [ 25 ]. Additionally, observational assessment methods do not pose any significant risks to the individual undergoing evaluation. Furthermore, the present study has shown that the observational assessment tool demonstrated robust reliability and validity, establishing it as effective instruments for postural assessment purposes. It provides accurate and consistent results, making it a valuable asset in clinical practice for evaluating and monitoring posture-related conditions. The development of the enhanced observational posture assessment tool has significant implications for clinical practice, offering a practical and effective solution for clinicians to identify postural misalignments and potential musculoskeletal disorders in their patients. This holistic approach may lead to more effective interventions and preventive measures, ultimately improving patient outcomes. It is important to recognize the limitations of the study, despite its promising results. The sample size of 80 subjects and the specific age range of 18 to 25 years may restrict the generalizability of the findings. Including a broader demographic in future research studies would be beneficial to ensure that the results can be applied to a more diverse population. Furthermore, the study's reliance on clinician assessment for observational ratings may introduce a subjective bias that could affect the accuracy and consistency of the results. Developing objective measures to complement the observational assessments could help to mitigate this limitation and provide more reliable and consistent data. Conclusions The study's contribution to the field of postural assessment is significant, offering a reliable and validated tool that can enhance clinical practice. The revised observational assessment tool not only improves upon the NYPR scale but also provides a foundation for future research to build upon, with the ultimate goal of advancing our understanding and management of posture-related health concerns. The adoption of observational assessment tools for postural evaluation offers a safe, cost-effective, and reliable means of assessing posture with precision and efficiency. Abbreviations OSPAT Observational Static Posture Assessment Tool CVR Content Validity Ratio CVI Content Validity Index NYPR New York Posture Rating NYPRC New York Posture Rating Scale ICCs Intraclass Correlation Coefficients UCS Upper Crossed Syndrome SBP Sway Back Posture LCS Lower Crossed Syndrome GR Genu Recurvatum SC Scoliosis GVR Genu Varum GVG Genu Valgum FPS Foot Pronation Syndrome Declarations Ethics approval and consent to participate The Ethics Committee affirmed the research protocol of Sport Sciences Research Institute (Code: IR.SSRC.REC.1403.0 6 2). In addition, before beginning the research process, all participants in this study provided informed consent. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analyzed 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 This article is based on a research project that was carried out with the financial support of the research and funding of Sport Sciences Research Institute. Tehran. Iran. Research Projects Unit with project no. 11.3462. Authors' contributions Conceptualization, HA and MS; Methodology, HA, MS, SM and MB; Investigation, all authors; Writing – Original Draft, all authors; Writing – Review & Editing, all authors; Funding Acquisition, HA; Resources, HA; Supervision, HA. Acknowledgements The authors would like to acknowledge the participants of this study for their time and efforts. References Sahrmann S, Azevedo DC, Dillen LV. Diagnosis and treatment of movement system impairment syndromes. Braz J Phys Ther. 2017;21:391–99. 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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-4821933","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":343018976,"identity":"53933052-785a-485a-b460-809f4ff5c903","order_by":0,"name":"Hamed Abbasi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzElEQVRIiWNgGAWjYBACAwYGNmYgzcMPF2ImVotkA6laGAwOEOswcwbmZ48LaupkjM8ff/bhB4OdPAM77wO8Wiwb2MyNZxw7zGN2I8d4Zg9DsmEDM7sBfocdYDCT5mE7ANTCwwx0IXMCAzMbAb8cYP8mzfOvjse4//hjoJZ6YrTwmEnztjHzGDAkGAO1HCZCy2GecuOZfYd5JIB+YewxOG7YRlDL8fZtjwu+1dnzAx3G8KOiWp6f/xh+LWgRB4omAhpGwSgYBaNgFBABALQFM+NcrSL4AAAAAElFTkSuQmCC","orcid":"","institution":"Sport Sciences Research Institute","correspondingAuthor":true,"prefix":"","firstName":"Hamed","middleName":"","lastName":"Abbasi","suffix":""},{"id":343018977,"identity":"1eb9c772-60a5-48ad-bb53-fbf1791db4fa","order_by":1,"name":"Mohammadreza Seyedi","email":"","orcid":"","institution":"Sport Sciences Research Institute","correspondingAuthor":false,"prefix":"","firstName":"Mohammadreza","middleName":"","lastName":"Seyedi","suffix":""},{"id":343018979,"identity":"f9a81533-21d1-4684-8ad3-672653f9aca6","order_by":2,"name":"Esmaeil Mozafaripour","email":"","orcid":"","institution":"University of Guilan","correspondingAuthor":false,"prefix":"","firstName":"Esmaeil","middleName":"","lastName":"Mozafaripour","suffix":""},{"id":343018982,"identity":"8d814a6c-0926-4315-b0c0-e18ffce62758","order_by":3,"name":"Mahdi Bayati","email":"","orcid":"","institution":"Sport Sciences Research Institute","correspondingAuthor":false,"prefix":"","firstName":"Mahdi","middleName":"","lastName":"Bayati","suffix":""}],"badges":[],"createdAt":"2024-07-29 12:15:45","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4821933/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4821933/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":63264996,"identity":"75959323-ba0b-434e-86a9-fcaea5dffee1","added_by":"auto","created_at":"2024-08-26 09:57:17","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1702877,"visible":true,"origin":"","legend":"\u003cp\u003eDisplays the posterior view segments and side view segments from the New York Posture Rating Chart. The items marked with an asterisk (*) are excluded in the version published by Howley and Franks [13], which also modified the item scores to 10-5-0.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4821933/v1/19b3f9e94499f01b5dd1908f.jpg"},{"id":63264997,"identity":"0e87a157-70a9-439d-884e-182e289ba1c7","added_by":"auto","created_at":"2024-08-26 09:57:18","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":217414,"visible":true,"origin":"","legend":"\u003cp\u003eFlow of the study\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4821933/v1/5c8a96aa06db420f27994582.jpg"},{"id":63264995,"identity":"6373621b-7f20-4a54-a628-62624502972e","added_by":"auto","created_at":"2024-08-26 09:57:17","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1453011,"visible":true,"origin":"","legend":"\u003cp\u003eOSPAT form\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4821933/v1/208f7a8408b2ffedca903215.jpg"},{"id":71677777,"identity":"dc407287-12b7-4b76-a61c-bd39f45b7735","added_by":"auto","created_at":"2024-12-17 16:02:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3867910,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4821933/v1/ffa74c9f-55e2-4193-808e-7408d550f0c1.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Design and Validation of the Observational Static Posture Assessment Tool (OSPAT): A Psychometric Study","fulltext":[{"header":"Background","content":"\u003cp\u003ePosture is a critical factor in determining the alignment of body segments at any given moment [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It is a major public health concern for individuals across different age groups, including children, adolescents, and adults, as it can have a significant impact on the development of musculoskeletal disorders [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Prolonged periods of sitting, especially during various activities at school, home, and work, can increase the risk of individuals adopting improper postures. This can result in the development of muscular imbalances and the onset of postural abnormalities [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Postural misalignments can result in muscle weakness and tightness, leading to a decreased range of motion in the joints. This can ultimately contribute to the development of musculoskeletal injuries and hinder daily activities, impacting the overall quality of life [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. It is essential for clinicians and practitioners to possess the necessary skills to identify postural misalignments in order to prevent the progression and development of musculoskeletal issues and their associated complications. Various methods can be used to assess postural alignment, including visual observation [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], goniometry [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], Radiography [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], photogrammetry [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], and Optical motion capture system [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], with the latter being considered the most reliable due to its advanced technology. However, technology-based methods have their own set of implications in their analysis, such as the need for techniques that are simple and non-invasive, provide quick and accurate data, and address ethical concerns related to the use of images while protecting the interests of the subjects.\u003c/p\u003e \u003cp\u003eExtensive research has shown that visual assessment tools are commonly utilized in evaluating posture across diverse populations [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Visual assessment enables practitioners to conduct a comprehensive assessment of their patients' musculoskeletal system in a quick, cost-effective, and non-invasive manner [\u003cspan additionalcitationids=\"CR9 CR10\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. One of the most commonly utilized tools for visual assessment screening is the New York Posture Rating (NYPR) scale. The NYPR scale was first introduced in 1958 as part of a series of evaluations [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. A revised version of the NYPR, which included a reduced number of items and an updated scoring system, was later incorporated into the Health Fitness Instructors Handbook by Howley and Franks from the University of the State of New York, Bureau of Physical Education [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The 1958 publication by NYPR provides a detailed compilation of three figure drawings for each of the 13 body alignment segments that collectively influence overall postural alignment. These segments include posterior views of the head, shoulders, spine, hips, feet, and arches, as well as lateral (left side) views of the neck, chest, shoulders, upper back, trunk, abdomen, and lower back. Each drawing is accompanied by brief verbal descriptions that highlight the visual cues serving as reference points for scoring. In the original version, a scoring system of 5 (indicating correct posture), 3 (representing slight deviation), or 1 (pronounced deviation) was utilized to assess each body segment (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e****Figure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e near here****\u003c/p\u003e \u003cp\u003eThe NYPR versions have been noted to have validity concerns, including the lack of items for assessing knee abnormalities and plantar arch. In contrast to the segmented approach of NYPR, Janda contends that the locomotor system of the human body cannot be adequately assessed and treated by concentrating on individual segments. Instead, he advocates for viewing and evaluating the body as a cohesive system. According to Janda, it is essential to consider the entire body as a unified entity during assessment, as all segments is interconnected through muscular and joint chains. By evaluating the body holistically, practitioners may avoid overlooking the root causes of musculoskeletal disorders [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Moreover, to the best of the authors' knowledge, there has been no study conducted to evaluate the reliability and validity of the NYPR scale.\u003c/p\u003e \u003cp\u003eAs a result, a new observational posture assessment tool was to be created to tackle the aforementioned concerns, with the aim of improving upon the existing NYPR scale by integrating new rating criteria to enhance its reliability and validity. The outcomes of the study are anticipated to enhance posture rating techniques in clinical environments and foster a deeper comprehension of posture-related concerns.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eA multiphase, cross-sectional, qualitative field study was used for developing and psychometric testing of the Observational Static Posture Assessment Tool (OSPAT).\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDeveloping the OSPAT\u003c/h2\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003eSelecting the Posture Assessment Indices\u003c/h2\u003e \u003cp\u003eThe selection of posture indices in the study was based on their clinical relevance [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This means that the chosen posture indices were considered to be meaningful and important in the context of assessing posture-related issues or abnormalities. By selecting posture indices that are clinically relevant, researchers aimed to ensure that the posture assessment tool accurately captures and evaluates postural characteristics that are known to be significant indicators of health, function, or potential musculoskeletal problems. Prioritizing posture indices based on their clinical relevance enhances the validity and utility of the posture assessment tool in clinical settings, as it ensures that the tool can effectively address and evaluate postural issues that are of practical importance to healthcare professionals and patients.\u003c/p\u003e \u003cp\u003eThe selection of posture indices in the study was also guided by their ability to assess posture changes across all body segments regarding the janda approach [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], This criterion emphasizes the importance of capturing and evaluating postural alignment and deviations not only in specific body regions but across all body segments comprehensively. By considering posture indices that can assess posture changes across multiple body segments, the posture assessment tool developed in the study aims to provide a holistic and global evaluation of an individual's posture. This approach allows for a thorough assessment of postural alignment, symmetry, and potential deviations throughout the entire body, rather than focusing on isolated regions or segments.\u003c/p\u003e \u003cp\u003eThe incorporation of posture indices that cover various body segments enhances the tool's ability to capture complex postural changes and abnormalities that may involve multiple regions. This comprehensive assessment can contribute to a more complete understanding of an individual's postural profile and facilitate targeted interventions or treatments based on a thorough evaluation of posture across all body segments.\u003c/p\u003e \u003cp\u003eAlso ensuring the validity and reliability of the tool based on the Tyson and DeSouza's content validity study [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] and a high level of intra-rater reliability (intra-class correlation coefficient\u0026thinsp;\u0026gt;\u0026thinsp;0.70) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo select Indices for developing the OSPAT, The New York Posture Rating Scale (NYPRC) was targeted as the basis for this review, as it is a widely used tool. A thorough literature review was conducted to discuss the importance of posture rating, existing posture rating charts, and the limitations of the NYPRC.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eOSPAT Validity Assessment\u003c/h2\u003e \u003cp\u003eA panel of 12 experts evaluated the tool to determine its validity. To assess the validity of the developed tool, Lawshe's Content Validity Ratio (CVR) and Content Validity Index (CVI) were employed [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eContent Validity Ratio (CVR)\u003c/h2\u003e \u003cp\u003eIn the calculation of the Content Validity Ratio (CVR), the collective input of all panelists regarding the importance of the tested knowledge or skill was considered. The CVR was calculated based on the ratings provided by the experts. According to Lawshe's CVR table, for a panel of a minimum of 12 experts, each item should yield a calculated CVR value exceeding 0.56 to be considered valid [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Panelists were asked to rate each item on a scale of 1 to 3, where 1 signifies \"not necessary,\" 2 indicates \"useful but not essential,\" and 3 represents \"essential\" importance [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eContent Validity Index (CVI)\u003c/h2\u003e \u003cp\u003eThe Content Validity Index (CVI) was determined by panel members who assessed the clarity and relevance of the instrument items. They rated each item on a 4-point ordinal scale (1: not relevant, 2: somewhat relevant, 3: quite relevant, 4: highly relevant). The CVI was calculated by dividing the number of experts who rated the item as relevant or clear (rating 3 or 4) by the total number of content experts, providing an indication of the item's content validity [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e****Figure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e near here****\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eOSPAT Reliability Assessment\u003c/h2\u003e \u003cp\u003eTo evaluate the reliability of the newly developed Observational Static Posture Assessment Tool (OSPAT), a group of raters was trained to utilize the tool for assessing static posture in study participants. Both inter-rater reliability and intra-rater reliability were assessed to determine the consistency and reproducibility of posture assessments using OSPAT.\u003c/p\u003e \u003cp\u003eInter-rater reliability was evaluated by calculating intraclass correlation coefficients (ICCs) among different raters who independently assessed the static posture of the study participants using OSPAT. ICCs provide a statistical measure of agreement between multiple raters in their assessments of the same set of posture measurements. High ICC values indicate good agreement among raters in their evaluations of posture deviations and abnormalities.\u003c/p\u003e \u003cp\u003eIntra-rater reliability was assessed by calculating ICCs for repeated assessments conducted by the same rater on the same set of study participants. This analysis examines the consistency of posture assessments performed by individual raters over time and helps determine the reliability of the OSPAT tool in producing consistent results when used by the same rater on multiple occasions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eRaters\u003c/h2\u003e \u003cp\u003eA group of 28 experts specializing in musculoskeletal health and posture assessment participated as raters in the research study [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The raters selected had varying years of experience and expertise in assessing posture and musculoskeletal alignment. Each rater was tasked with assigning a severity score on a scale from 0 to 5 to indicate posture devotions including Upper Crossed Syndrome (UCS), Sway Back Posture (SBP), Lower Crossed Syndrome (LCS), Genu Recurvatum (GR), Scoliosis (SC), Genu Varum (GVR), Genu Valgum (GVG), and Foot Pronation Syndrome (FPS) of the study participants. The severity scoring system was designed to capture the extent of deviation from ideal posture, with 0 indicating no observable deviation and scores of 1 to 5 representing increasing levels of abnormality. A score of 1 indicated a minimal deviation, while scores of 4 or 5 indicated more severe abnormalities in posture that were readily apparent to the raters.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eA total of 80 participants, aged between 18 and 25 years, were purposefully selected to participate in the research study. The inclusion criteria required participants to be within the specified age range to ensure a relatively homogeneous sample in terms of musculoskeletal development and postural alignment characteristics within the age group of interest.\u003c/p\u003e \u003cp\u003eExclusion criteria were put in place to ensure the exclusion of individuals who may have factors influencing musculoskeletal alignment that could confound the assessment of static posture. Participants with a history of previous spinal surgery, osteoporosis, major congenital anomalies affecting posture, previous spinal fractures, rheumatological conditions impacting musculoskeletal health, leg length discrepancy, or neurologic conditions that could affect posture were excluded from the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePosture Assessment\u003c/h2\u003e \u003cp\u003eThe method of photography was employed to assess static posture in a research study. Images were captured from three different views \u0026ndash; front, side, and back to analyze body posture. To do so, Participants were instructed to wear minimal clothing to ensure clear visibility of their posture and were asked to stand naturally with their hands by their sides in their usual stance.\u003c/p\u003e \u003cp\u003e.The camera was set up on a tripod at 4 meters distance and angle to capture high-resolution images of the subject's posture from each view. The camera height and alignment were carefully adjusted to ensure accurate image capture. Using a Panasonic Lumix camera photographs were taken of the individual standing in a natural and relaxed posture with their arms positioned by their sides. The images were then randomized and anonymized for evaluation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eICC values were used to determine the consistency and reliability of ratings among raters for both inter-rater and intra-rater assessments [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The statistical methods employed in the study included the calculation of Kappa coefficients (κ) to evaluate both intra-rater and inter-rater reliability. The interpretation of κ values in this research study followed established conventions in the literature, where values significantly below 0.5 indicate weak agreement. The interpretations used in this study are as follows:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003ePoor agreement: κ\u0026thinsp;\u0026lt;\u0026thinsp;0.40\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eFair agreement: κ\u0026thinsp;=\u0026thinsp;0.40\u0026ndash;0.59\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eGood agreement: κ\u0026thinsp;=\u0026thinsp;0.60\u0026ndash;0.79\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eExcellent agreement: κ\u0026thinsp;\u0026ge;\u0026thinsp;0.80\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eIntra-rater reliability was assessed by comparing each examiner's initial assessment of a subject with their subsequent assessment of the same subject. On the other hand, inter-rater reliability was evaluated by comparing the initial assessments made by all examiners. This involved comparing each examiner's evaluation of a subject with that of every other examiner.\u003c/p\u003e \u003cp\u003e****Figure \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e3\u003c/span\u003e near here****\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eDemographic information of the participants is presented in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic Characteristic of Participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (yr)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e20.4\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e176.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e77.8\u0026thinsp;\u0026plusmn;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e****Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e near here****\u003c/p\u003e \u003cp\u003eIn the study, all 28 raters had experience ranging from 1 to 15 years of practice, with each group having an equal distribution of years of experience. This ensured a diverse range of expertise levels among the raters, allowing for comprehensive and varied assessments of static posture using the Observational Static Posture Assessment Tool (OSPAT).\u003c/p\u003e \u003cp\u003eThe results of the Kappa coefficient analysis indicated good intrarater and interrater agreement for each individual item assessed using the OSPAT tool, as well as for the overall questionnaire. The Kappa coefficient values of 0.68 and 0.53 demonstrated a substantial level of agreement among raters in their assessments of posture abnormalities and deviations.\u003c/p\u003e \u003cp\u003eA Kappa coefficient of 0.68 for intrarater agreement signifies a substantial level of agreement among the same rater's repeated assessments of posture items over time. This level of agreement indicates that the raters were consistent in their evaluations when assessing the same set of posture measurements on different occasions.\u003c/p\u003e \u003cp\u003eSimilarly, a Kappa coefficient of 0.53 for interrater agreement indicates a moderate level of agreement among different raters when assessing posture using the OSPAT tool. This level of agreement suggests that there was a consistent understanding and interpretation of posture assessments among the diverse group of raters with varying levels of experience.\u003c/p\u003e \u003cp\u003eThese results highlight the reliability and consistency of the OSPAT tool in facilitating accurate and reproducible assessments of static posture, as evidenced by the good intrarater and interrater agreement demonstrated through the Kappa coefficient analysis (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean Intrarater and Interrater Kappa Coefficients for each item of questionnaire\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntrarater (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDescription*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eInterrater (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDescription*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 1 (UCS)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.55 (0.14\u0026ndash;0.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.50 (0.10\u0026ndash;0.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 2 (SBP)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.53 (0.19\u0026ndash;0.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.48 (0.06\u0026ndash;0.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 3 (LCS)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.61 (0.10\u0026ndash;0.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.53 (0.23\u0026ndash;0.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 4 (GR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.80 (0.04\u0026ndash;0.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExcellent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.61 (0.23\u0026ndash;0.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 5 (SC)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.76 (0.16\u0026ndash;0.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.52 (0.13\u0026ndash;0.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 6 (GVR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.90 (0.11\u0026ndash;0.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExcellent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.70 (0.08\u0026ndash;0.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 7 (GVG)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.60 (0.20\u0026ndash;0.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.45 (0.13\u0026ndash;0.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 8 (FPS)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.69 (0.10\u0026ndash;0.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.52 (0.11\u0026ndash;0.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.68 (0.02\u0026ndash;0.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.53 (0.06\u0026ndash;0.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e*Descriptor according to Altman et al (1990) interpretation of Kappa.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eUpper Crossed Syndrome (UCS), Sway Back Posture (SBP), Lower Crossed Syndrome (LCS), Genu Recurvatum (GR), Scoliosis (SC), Genu Varum (GVR), Genu Valgum (GVG), Foot Pronation Syndrome (FPS)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e****Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e near here****\u003c/p\u003e \u003cp\u003eThe CVR results for each item and overall tools are displayed in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Also CVI results indicated that all items had a score above 0.79, considered as high content validity [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. It suggests that the items included in the OSPAT tool were deemed relevant and clear by the group of raters who participated in the assessment. The high CVI scores reflect the consensus among the raters regarding the appropriateness and accuracy of the items included in the posture assessment tool.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eValues of Content Validity Ratio (CVR)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCVR\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 1 (UCS)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 2 (SBP)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 3 (LCS)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 4 (GR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 5 (SC)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 6 (GVR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 7 (GVG)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 8 (FPS)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOverall\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eUpper Crossed Syndrome (UCS), Sway Back Posture (SBP), Lower Crossed Syndrome (LCS), Genu Recurvatum (GR), Scoliosis (SC), Genu Varum (GVR), Genu Valgum (GVG), Foot Pronation Syndrome (FPS)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e****Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e near here****\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to enhance the NYPR scale by developing an observational posture assessment tool and validating its use in clinical settings. The results showed good levels of intrarater and interrater agreement across the newly developed indices, with Kappa coefficients (κ) of 0.68 and 0.53, respectively. These values indicate good agreement levels, with the intrarater agreement considered substantial and the interrater agreement falling within the category of fair agreement based on conventional interpretations. In addition to the agreement metrics, the validity assessment results revealed favorable overall Content Validity Ratio (CVR) of 0.70 and Content Validity Index (CVI) greater than 0.79. These validity indicators suggest that the revised observational posture assessment tool is credible and appropriate for assessing posture visually. The high levels of agreement and validity observed in the study support the tool's potential utility in clinical settings, where rapid, non-invasive, and accurate assessments are crucial for effective diagnosis and treatment planning. Furthermore, the tool demonstrates reliability and validity across clinicians with varying levels of experience, indicating its applicability in diverse clinical settings.\u003c/p\u003e \u003cp\u003eWhen assessing posture, a key concept is to focus on the kinetic chain, which refers to the interconnected series of joints and muscles that work together to produce movement. By examining the alignment and function of the entire kinetic chain, rather than just isolated segments, clinicians can gain a more comprehensive understanding of how posture is influenced by the body's movement patterns and muscle imbalances [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOne important framework for understanding posture and movement patterns is the concept of upper and lower cross syndromes, originally proposed by Czech neurologist Vladimir Janda. Upper cross syndrome typically involves tightness and weakness in specific muscle groups in the upper body, leading to rounded shoulders, forward head posture, and an increased cervical curve. Lower cross syndrome, on the other hand, is characterized by imbalances in the muscles of the lower back, hips, and legs, resulting in an anterior pelvic tilt, increased lumbar curve, and potentially knee and foot issues [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe new observational posture assessment tool aligns with Janda's perspective on posture and movement patterns, moving away from the limitations of segmental evaluation [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. By taking a holistic approach to postural assessment and considering the body as an interconnected system, clinicians can develop more effective interventions and preventive measures to address postural misalignments and musculoskeletal disorders. This comprehensive view allows for a deeper understanding of the underlying causes of postural issues, enabling clinicians to tailor interventions that target the root of the problem rather than just addressing the symptoms.\u003c/p\u003e \u003cp\u003eIn the present study, the reliability of the newly developed observational posture assessment tool was found to be comparable to or potentially even better than similar research studies, often demonstrating greater consistency in ratings. For instance, earlier studies like Watson and Mac Donncha [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] achieved slightly higher intra-rater reliability, but they had fewer raters, which could impact the generalizability of their findings. On the other hand, studies like the one by Fedorak et al. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] that did not have specific rating guidelines reported lower reliability, underscoring the importance of having clear and standardized protocols in place for reliable assessments.\u003c/p\u003e \u003cp\u003eGiven the high cost and potential side effects associated with invasive methods of postural assessment, it is advisable to explore alternative tools or instruments that are more cost-effective and safer to use [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Observational assessment emerges as a favorable option in this regard, as it offers prompt and precise outcomes without the risk of side effects such as radiation exposure [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Additionally, observational assessment methods do not pose any significant risks to the individual undergoing evaluation.\u003c/p\u003e \u003cp\u003eFurthermore, the present study has shown that the observational assessment tool demonstrated robust reliability and validity, establishing it as effective instruments for postural assessment purposes. It provides accurate and consistent results, making it a valuable asset in clinical practice for evaluating and monitoring posture-related conditions.\u003c/p\u003e \u003cp\u003eThe development of the enhanced observational posture assessment tool has significant implications for clinical practice, offering a practical and effective solution for clinicians to identify postural misalignments and potential musculoskeletal disorders in their patients. This holistic approach may lead to more effective interventions and preventive measures, ultimately improving patient outcomes.\u003c/p\u003e \u003cp\u003eIt is important to recognize the limitations of the study, despite its promising results. The sample size of 80 subjects and the specific age range of 18 to 25 years may restrict the generalizability of the findings. Including a broader demographic in future research studies would be beneficial to ensure that the results can be applied to a more diverse population. Furthermore, the study's reliance on clinician assessment for observational ratings may introduce a subjective bias that could affect the accuracy and consistency of the results. Developing objective measures to complement the observational assessments could help to mitigate this limitation and provide more reliable and consistent data.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe study's contribution to the field of postural assessment is significant, offering a reliable and validated tool that can enhance clinical practice. The revised observational assessment tool not only improves upon the NYPR scale but also provides a foundation for future research to build upon, with the ultimate goal of advancing our understanding and management of posture-related health concerns. The adoption of observational assessment tools for postural evaluation offers a safe, cost-effective, and reliable means of assessing posture with precision and efficiency.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eOSPAT\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eObservational Static Posture Assessment Tool\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCVR\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eContent Validity Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCVI\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eContent Validity Index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eNYPR\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNew York Posture Rating\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eNYPRC\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNew York Posture Rating Scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eICCs\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIntraclass Correlation Coefficients\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eUCS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUpper Crossed Syndrome\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSBP\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSway Back Posture\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eLCS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLower Crossed Syndrome\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eGR\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGenu Recurvatum\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSC\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eScoliosis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eGVR\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGenu Varum\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eGVG\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGenu Valgum\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eFPS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFoot Pronation Syndrome\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Ethics Committee affirmed the research protocol of Sport Sciences Research Institute (Code: IR.SSRC.REC.1403.0\u003cspan dir=\"RTL\"\u003e6\u003c/span\u003e2). In addition, before beginning the research process, all participants in this study provided informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis article is based on a research project that was carried out with the financial support of the research and funding of Sport Sciences Research Institute. Tehran. Iran. Research Projects Unit with project no. 11.3462.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization, HA and MS; Methodology, HA, MS, SM and MB; Investigation, all authors; Writing \u0026ndash; Original Draft, all authors; Writing \u0026ndash; Review \u0026amp; Editing, all authors; Funding Acquisition, HA; Resources, HA; Supervision, HA.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to acknowledge the participants of this study for their time and efforts.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSahrmann S, Azevedo DC, Dillen LV. Diagnosis and treatment of movement system impairment syndromes. Braz J Phys Ther. 2017;21:391\u0026ndash;99.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdamczewska K, Wiernicka M, Malchrowicz-Mośko E, Małecka J, Lewandowski J. The Angle of Trunk Rotation in School Children: A Study from an Idiopathic Scoliosis Screening. Prevalence and Optimal Age Screening Value. Int J Environ Res Public Health. 2019;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaddad JM, Rietdyk S, Claxton LJ, Huber JE. Task-dependent postural control throughout the lifespan. Exerc Sport Sci Rev. 2013;41:123\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcRoberts LB, Cloud RM, Black CM. Evaluation of the New York Posture Rating Chart for Assessing Changes in Postural Alignment in a Garment Study. Cloth Text Res J. 2013;31:81\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSingla D, Veqar Z. Methods of postural assessment used for sports persons. J Clin Diagn Res. 2014;8:Le01\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXing Q, Hong R, Shen Y, Shen Y. Design and validation of depth camera-based static posture assessment system. iScience. 2023;26:107974.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTrovato B, Roggio F, Sortino M, Zangh\u0026igrave; M, Petrigna L, Giuffrida R et al. Postural Evaluation in Young Healthy Adults through a Digital and Reproducible Method. J Funct Morphol Kinesiol. 2022;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlves ME, Marinho DA, Carneiro DN, Alves J, Forte P, Nevill AM et al. A Visual Scan Analysis Protocol for Postural Assessment at School in Young Students. Int J Environ Res Public Health. 2020;17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAitken AW. Reliability of visual assessment of forward head posture in standing 2009.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoran R, Ljubotenski E. Reliability of visual assessment for lumbar curves in standing: Does clinical experience matter? Int J Osteopath Med. 2006;9:42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFortin C, Feldman DE, Cheriet F, Gravel D, Gauthier F, Labelle H. Reliability of a quantitative clinical posture assessment tool among persons with idiopathic scoliosis. Physiotherapy. 2012;98:64\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEducation NYBoP. The New York State Physical Fitness Test for Boys and Girls. Grades 4\u0026ndash;12: A Manual for Teachers of Physical Education. University of the State of New York, Bureau of physical education; 1958.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHowley ET, Franks BD. Health fitness instructor\u0026rsquo;s handbook. 2nd ed. Champaign: Human Kinetics; 1992.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePage P, Frank CC, Lardner R. Assessment and Treatment of Muscle Imbalance: The Janda Approach. Human Kinetics; 2010.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKendall FP, McCreary EK, Provance PG, Rodgers MM, Romani WA. Muscles: testing and function with posture and pain. Lippincott Williams \u0026amp; Wilkins Baltimore, MD; 2005.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTyson SF, DeSouza LH. A clinical model for the assessment of posture and balance in people with stroke. Disabil Rehabil. 2003;25:120\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLawshe CH. A quantitative approach to content validity. Pers Psychol. 1975;28:563\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGilbert GE, Prion S. Making sense of methods and measurement: Lawshe's content validity index. Clin Simul Nurs. 2016;12:530\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZamanzadeh V, Ghahramanian A, Rassouli M, Abbaszadeh A, Alavi-Majd H, Nikanfar A-R. Design and implementation content validity study: development of an instrument for measuring patient-centered communication. J Caring Sci. 2015;4:165.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFedorak C, Ashworth N, Marshall J, Paull H. Reliability of the visual assessment of cervical and lumbar lordosis: how good are we? Spine. 2003;28:1857\u0026ndash;59.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAltman DG. Practical statistics for medical research. Chapman and Hall/CRC; 1990.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTilden VP, Nelson CA, May BA. Use of qualitative methods to enhance content validity. Nurs Res. 1990;39:172\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWatson A, Mac Donncha C. A reliable technique for the assessment of posture: assessment criteria for aspects of posture. J Sports Med Phys Fit. 2000;40:260.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmith A, O'Sullivan P, Straker L. Classification of sagittal thoraco-lumbo-pelvic alignment of the adolescent spine in standing and its relationship to low back pain. Spine. 2008;33:2101\u0026ndash;07.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePetermann XB, Meereis ECW. Postural body: a systematic review about assessment methods. Man Ther Posturology Rehabil J. 2016:1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003c/ol\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":"Body, Alignment, Corrective exercises","lastPublishedDoi":"10.21203/rs.3.rs-4821933/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4821933/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePostural assessment is important for several reasons, poor posture can lead to a range of musculoskeletal issues. Posture plays a crucial role in biomechanics and movement efficiency and also impacts an individual's appearance, confidence, and overall well-being. Existing visual assessment tools have not kept pace with the latest scientific Approaches and paradigm shifts in our understanding of the holistic assessment. This study aims to address this gap by designing and validating a new observational tool for observational postural assessment that integrates current scientific insight and best practices in musculoskeletal health.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis is a cross-sectional design including recruiting both qualitative and quantitates methods to develop and test psychometric properties of the Observational Static Posture Assessment Tool (OSPAT). To establish the validity of the OSPAT, we employed Lawshe's Content Validity Ratio (CVR) and Content Validity Index (CVI) through a collaborative process involving consultation with 12 experts. To test the reliability, 28 raters utilized the OSPAT on a sample of 80 individuals. Each practitioner rated the presence of postural deviations including Upper Crossed Syndrome, Sway Back Posture, Lower Crossed Syndrome, Genu Recurvatum, Scoliosis, Genu Varum, Genu Valgum, and Foot Pronation Syndrome in each subject using a 6-point scale of severity. We employed Kappa coefficients (κ) to assess both intra-rater and inter-rater reliability.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe analysis for OSPAT validity showed overall CVR and CVI, (0.70 and CVI\u0026thinsp;\u0026gt;\u0026thinsp;79) index, respectively. The results for OSPAT reliability revealed good intra-rater and inter-rater agreement, with κ values of 0.68 and 0.53, respectively.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe OSPAT showed promise for valid and reliable observational static postural assessment, overcoming the limitations of segmental evaluation by taking a holistic approach to postural assessment and considering the body as an interconnected system.\u003c/p\u003e","manuscriptTitle":"Design and Validation of the Observational Static Posture Assessment Tool (OSPAT): A Psychometric Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-26 09:57:12","doi":"10.21203/rs.3.rs-4821933/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":"e1e88543-1fa0-4979-83bc-e224f0cef79c","owner":[],"postedDate":"August 26th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-12-17T15:53:54+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-26 09:57:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4821933","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4821933","identity":"rs-4821933","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}