Clinical measurement of the thoracic kyphosis. A study of the intra-rater reliability in subjects with and without shoulder pain Interrater and Intrarater Reliability in the Measurement of Kyphosis in Postmenopausal Women With Osteoporosis Radiographic measures of thoracic kyphosis in osteoporosis: Cobb and vertebral centroid angles Prediction of thoracic kyphosis using the Debrunner kyphometer. Musculoskeletal techniques for clinically stable adults with cystic fibrosis: a preliminary randomised controlled trial. Measurement of Thoracic and Lumbar Fracture Kyphosis: Evaluation of Intraobserver, Interobserver, and Technique Variability Measurement of Spinal Sagittal Configuration and Mobility with Debrunner's Kyphometer Use of Condition-Specific Patient-Reported Outcome Measures in Clinical Trials among Patients with Wrist Osteoarthritis: A Systematic Review Accurately measuring the quality and effectiveness of cervical spine surgery in registry efforts: determining the most valid and responsive instruments. Changes in flexed posture, musculoskeletal impairments, and physical performance after group exercise in community-dwelling older women. Thoracic spinal manipulation for musculoskeletal shoulder pain: Can an instructional set change patient expectation and outcome? Comparison of anterior and posterior double-rod instrumentation for thoracic idiopathic scoliosis: results of 141 patients Prospective randomized controlled comparison of posterior vs. posterior–anterior stabilization of thoracolumbar incomplete cranial burst fractures in neurological intact patients: the RASPUTHINE pilot study Thoracic hyperkyphosis: a survey of Australian physiotherapists. Immediate reduction in temporal sensory summation after thoracic spinal manipulation. Postural taping decreases thoracic kyphosis but does not influence trunk muscle electromyographic activity or balance in women with osteoporosis. Development of a Clinical Prediction Rule for Guiding Treatment of a Subgroup of Patients With Neck Pain: Use of Thoracic Spine Manipulation, Exercise, and Patient Education
Background Clinical sagittal plane assessment of the thoracic kyphosis angle is considered an essential component of the postural examination of patients presenting with upper body pain syndromes . Cervical headaches and conditions involving the shoulder , such as subacromial pain syndrome , have all been associated with an increase in the thoracic kyphosis . Concomitantly a decrease in the thoracic kyphosis as a result of a stretching and strengthening rehabilitation programme is believed to be associated with a reduction in symptoms and pain and improvement in function . Clinicians generally measure the sagittal plane kyphosis angle visually . There is no certainty that this method is reliable or is capable of measuring angular changes over time or in response to intervention . As such a simple and reliable clinical method of measuring the thoracic kyphosis would enable clinicians to record this information . The aim of this investigation was to determine the intra-tester reliability of measuring the thoracic kyphosis angle using a clinical method Methods Measurements were made in 45 subjects with and 45 subjects without upper body symptoms . Measurements were made with the subjects in relaxed st and ing . Two gravity dependent inclinometers were used to measure the kyphosis . The first was placed over the region of the 1st and 2nd thoracic spinous processes . The other , over the region of the 12th thoracic and 1st lumbar spinous processes . The angle produced by each inclinometer was measured 3 times in succession . Each set of 3 measurements was made on two occasions ( separated by a minimum of 30 minutes and additional data collection involving 46 further measurements of posture and movement on the same and an additional subject before the thoracic kyphosis measurements were re-measured ) by one rater . The reliability of the measurements was analyzed using 2-way ANOVA intraclass correlation coefficients ( ICC ) , 95 % confidence intervals ( CI ) and st and ard error of measurement ( SEM ) for precision , for a single measurement [ ICC(single ) ] and the average of 3 measures [ ICC(average ) ] . The assessor remained ' blinded ' to data input and the measurements were staggered to reduce examiner bias . Results The measurement of the thoracic kyphosis as used in this investigation was found to have excellent intra-rater reliability for both subjects with and without symptoms . The ICC(single ) results for the subjects without symptoms were , .95 ; ( 95 % CI .91-.97 ) . The corresponding ICC(average ) results were ; .97 ; ( 95 % CI .95-.99 ) . The results for the subjects with symptoms were ; 93 ; ( 95 % CI .88-.96 ) , for ICC(single ) and for ICC(average ) ; .97 ; ( 95 % CI .94-.98 ) . The SEM results for subjects without and with symptoms were 1.0 ° and 1.7 ° , respectively . Conclusions The findings of this immediate test-retest reliability study suggest that the clinical measurement of the thoracic kyphosis using gravity dependent inclinometers demonstrates excellent intra-rater reliability . Additional research is required to determine the inter-rater reliability of this method .Trial registration National Research Register : Study Design . A reliability study was performed using repeated r and om measurements involving three observers , 26 subjects and three instruments . Objectives . To determine the most reliable , cost‐effective , noninvasive , and clinical ly feasible method of measuring spinal kyphosis .  Summary of Background Data . The most clinical ly useful , noninvasive and reliable method of measuring postural deformity in spinal osteoporosis ( kyphosis ) remains unqualified . Despite traditional use of costly , invasive roentgenographs for the evaluation of spinal kyphosis , the reliability of this method remains question able . Methods . Twenty‐six postmenopausal women with known bone mineral density and a diagnosis of osteoporosis were recruited from the Osteoporosis Program at Women 's College Hospital , Toronto , Canada . Noninvasive measurements of thoracic kyphosis were obtained by three trained examiners using the DeBrunner 's kyphometer and the flexicurve ruler . The intrarater and interrater reliability of and between each method was compared , using roentgenographic films obtained in the sagittal plane . Spinal posture was classified according to the method of Itoi ( 1990 ) . Statistical computations were performed using SAS statistical software . Results . Consistent measurements were obtained with the  DeBrunner 's kyphometer  and the flexicurve ruler by each observer , according to the results of critical two‐way analysis of variance ( Intraclass Correlation Coefficient 2,1 ) . Measurements in two subgroups , healthy backs ( n = 11 ) and rounded backs ( n= 13 ) , showed consistent use of each noninvasive instrument with some examiner preference for specific tools . There was marginally better intrarater and interrater reliability using the DeBrunner 's kyphometer compared with that obtained with the flexicurve ruler . Two‐way analysis of variance ( Intraclass Correlation Coefficient 2,1 ) of collapsed data showed no significant difference in the reliability of the kyphometer , flexicurve ruler , or roentgenographs in the measurement of thoracic kyphosis . Conclusions . The flexicurve ruler and DeBrunner 's kyphometer had the closest agreement in the measurement of spinal kyphosis . The kyphometer demonstrated the least variation in intrarater and interrater reliability when compared with the flexicurve ruler and roentgenographs . The flexicurve ruler permits qualitative assessment of posture , however , and is the most costeffective instrument . The results of this study challenge the traditional belief that roentgenographic analysis is the best method for evaluating spinal kyphosis . The DeBrunner 's kyphometer and flexible ruler may represent viable , cost‐effective and noninvasive alternatives to roentgenographic evaluation of spinal kyphosis ObjectiveS everal measures can quantify thoracic kyphosis from radiographs , yet their suitability for people with osteoporosis remains uncertain . The aim of this study was to examine the validity and reliability of the vertebral centroid and Cobb angles  in people with osteoporosis . Design and patients  Lateral radiographs of the thoracic spine  were captured in 31 elderly women with osteoporosis .  Thoracic kyphosis was measured globally ( T1–T12 ) and regionally ( T4–T9 ) using Cobb and vertebral centroid angles . Multisegmental curvature was also measured by fitting polynomial functions to the thoracic curvature profile . Canonical and Pearson correlations were used to examine correspondence ; agreement between measures was examined with linear regression . Results Moderate to high intra- and inter-rater reliability was achieved ( SEM = 0.9–4.0 ° ) . Concurrent validity of the simple measures was established against multisegmental curvature ( r = 0.88–0.98 ) . Strong association was observed between the Cobb and centroid angles globally ( r = 0.84 ) and regionally ( r = 0.83 ) . Correspondence between measures was moderate for the Cobb method r = 0.72 ) , yet stronger for the centroid method ( r = 0.80 ) . The Cobb angle was 20 % greater for regional measures due to the influence of endplate tilt . Conclusions Regional Cobb and centroid angles are valid and reliable measures of thoracic kyphosis in people with osteoporosis . However , the Cobb angle is biased by endplate tilt , suggesting that the centroid angle is more appropriate for this population The Debrunner kyphometer is an accepted tool for detecting and evaluating  thoracic kyphosis .  This prospect i ve study was conducted to create a mathematical formula that provides , with high approximation , the roentgenographic angle of thoracic kyphosis ( T4-T12 ) using only the kyphometer . Several clinical ( kyphometer value , age , and sex ) and radiographic ( Cobb angle [ T4-T12 ] ) parameters from 90 consecutively screened adolescents ( 44 male and 46 female ) were correlated using simple and multiple linear regression analyses . The reliability of measurement using the Debrunner kyphometer was high . The kyphometer value was strongly correlated with the roentgenographically measured thoracic Cobb angle ( simple linear regression analysis ; probability range , 0.0026 to 0.0002 ) . There was no correlation between age or sex and thoracic kyphosis . The predicted kyphosis angle using the kyphometer and the mathematic formula was 44.66 degrees + /- 2.68 degrees , ( range 27 to 62 degrees ) , and the real roentgenographic kyphosis angle was 47.5 degrees + /- 3.53 degrees , ( range , 24 to 70 degrees ) . The kyphometer and formula were more reliable and accurate when kyphosis less than 50 degrees was measured . In this study , the authors constructed a mathematical formula that accurately provides the roentgenographic T4-T12 kyphosis angle in adolescents using only the Debrunner kyphometer with a deviation of less than 3 degrees . The authors recommend that all physicians engaged in kyphosis screening programs use the kyphometer combined with the recently constructed simple mathematic formula . This method will reduce the cost of school screening programs , overdiagnoses , and unnecessary exposure of adolescents to irradiation AIMS To assess the sensitivity of selected outcome measures to any change result ing from treatment of adults with cystic fibrosis with physiotherapy musculoskeletal techniques , use the data for sample size calculations for future studies and assess the acceptability of the methods to potential participants . DESIGN Preliminary , prospect i ve , single-blind , r and omised controlled trial . SETTING Specialist cystic fibrosis centre . PARTICIPANTS Adults recruited from a cystic fibrosis outpatient clinic . INTERVENTIONS The control group received normal optimal physiotherapy care and the intervention group received weekly musculoskeletal treatment for 6 weeks in addition to normal optimal physiotherapy care . OUTCOME MEASURES Recorded at baseline , 3 , 6 and 12 weeks . The outcome measures were posture ( thoracic index ) , chest wall excursion , forced expiratory volume in 1 second ( FEV₁ ) , visual analogue scale for pain , modified shuttle test and Cystic Fibrosis Quality of Life Question naire -- Section One ( physical functioning ) . STATISTICAL ANALYSIS Descriptive statistics [ using medians and interquartile ranges ( IQRs ) ] and linear regression mixed model . RESULTS From a total of 20 subjects , 10 were r and omised to each group . Fifty percent of subjects were male , with a median age of 27 years ( IQR 25 to 34 ) , median FEV(1 ) of 1.75 l ( IQR 1.4 to 2.4 ) and median body mass index of 20.8 ( IQR 20.0 to 23.5 ) . Baseline differences between groups in thoracic index and modified shuttle test made any differences difficult to interpret , but the results for thoracic index and chest wall excursion at the third rib in the treatment group showed a trend towards improvement . The usefulness of FEV₁ , the visual analogue scale for pain and the Cystic Fibrosis Quality of Life Question naire as measures is unclear . CONCLUSION Further musculoskeletal studies in people with cystic fibrosis should consider using thoracic index and a measure of lung function in addition to FEV₁. The musculoskeletal techniques appear to be acceptable to people with cystic fibrosis , and do not seem to have associated adverse effects Study Design . Statistical analysis of various measurement techniques for thoracolumbar burst fracture kyphosis on lateral radiograph . Objective . To determine the most reliable measurement technique . Summary of Background Data . The treatment of thoracic and lumbar burst fractures involves many factors , including the degree of result ant kyphosis . Although various methods have been described , no study has directly compared these methods for reliability and reproducibility . Methods . Fifty lateral radiographs of thoracic and lumbar burst fractures were r and omly selected and measured on two separate occasions by three spine surgeons using five different measurement techniques .  Radiograph quality , fracture type , and the center beam location were determined . Statistical analysis included analysis of variance for repeated measures and analysis of variance using a generalized linear model . Results . Intraclass correlation coefficients were most consistent for Method 1 ( rho = 0.83–0.94 ) followed by Method 4 ( rho = 0.65–0.89 ) and Method 5 ( rho = 0.73–0.85 ) . Intraobserver agreement ( % of repeated measures within 5 ° of the original measurement ) ranged between 72 % and 98 % for all techniques for all three observers , with Method 1 showing the best agreement ( 84%–98 % ) . Paired comparisons between observers varied considerably with interobserver reliability correlation coefficients ranging from 0.52 to 0.93 . Method 1 showed the highest interobserver reliability coefficient ( 0.81 , range 0.71–0.93 ) followed by Method 5 ( 0.71 , range 0.68–0.75 ) . Method 1 also had the highest percentage of agreement within categories ( 90 % within 5 ° ) . Conclusions . Method 1 ( measuring from the superior endplate of the vertebral body one level above the injured vertebral body to the inferior endplate of the vertebral body one level below ) showed the best intraobserver and interobserver reliability overall A considerable number of instruments have been described for noninvasive measurements of the sagittal configuration and mobility of the thoracolumbar spine . With Debrunner 's kyphometer , it is possible to obtain this information in approximately 1 minute in a clinical setting . A minor modification of the kyphometer to increase its range of measurement of lumbar extension is described . Repeatability of measurements with the instrument was studied on 31 healthy individuals in a r and omized cross-over model . In another study , ten individuals were examined ten times each by the same investigator within 3 weeks . These studies showed good reproducibility for measurements with the  kyphometer .  The importance of st and ardized instructions for measurement procedures is emphasized . The statistical approach to repeatability of measurements is discussed Background . This paper aim ed to identify condition-specific patient-reported outcome measures used in clinical trials among people with wrist osteoarthritis and summarise empirical peer- review ed evidence supporting their reliability , validity , and responsiveness to change . Methods . A systematic review of r and omised controlled trials among people with wrist osteoarthritis was undertaken . Studies reporting reliability , validity , or responsiveness were identified using a systematic reverse citation trail audit procedure . Psychometric properties of the instruments were examined against predefined criteria and summarised . Results . Thirteen clinical trials met inclusion criteria . The most common patient-reported outcome was the disabilities of the arm , shoulder , and h and question naire ( DASH ) . The DASH , the  Michigan H and Outcomes Question naire ( MHQ ) , the  Patient Evaluation Measure ( PEM ) , and the  Patient-Reported Wrist Evaluation ( PRWE ) had evidence supporting their reliability , validity , and responsiveness . A post-hoc review of excluded studies revealed the AUSCAN Osteoarthritis H and Index as another suitable instrument that had favourable reliability , validity , and responsiveness . Conclusions . The DASH , MHQ , and AUSCAN Osteoarthritis H and Index instruments were supported by the most favourable empirical evidence for validity , reliability , and responsiveness . The PEM and PRWE also had favourable empirical evidence reported for these elements . Further psychometric testing of these instruments among people with wrist osteoarthritis is warranted BACKGROUND CONTEXT There is a growing dem and to measure the real-world effectiveness and value of care across all specialties and disease states . Prospect i ve registries have emerged as a feasible way to capture real-world care across large patient population s. However , the proven validity of more robust and cumbersome patient-reported outcome instruments ( PROi ) must be balanced with what is feasible to apply in large-scale registry efforts . Hence , commercial registry efforts that measure quality and effectiveness of care in an attempt to guide quality improvement , pay for performance , or value-based purchasing should incorporate measures that most accurately represent patient-centered improvement . PURPOSE We set out to establish the relative validity and responsiveness of common PROi in accurately determining effectiveness of cervical surgery for neck and arm pain in registry efforts . STUDY DESIGN Prospect i ve cohort study . PATIENT SAMPLE Eighty-eight patients undergoing primary anterior cervical discectomy and fusion ( ACDF ) for neck and arm pain . OUTCOME MEASURES Patient-reported outcome measures for pain ( numeric rating scale for neck pain [ NRS-NP ] and arm pain [ NRS-AP ] ) , disability ( neck disability index [ NDI ] ) , general health ( short-form 12-item survey physical component summary [ SF-12 PCS ] and mental component summary [ SF-12 MCS ] ) , and quality of life ( Euro-Qol-5D [ EQ-5D ] ) were assessed . METHODS Eighty-eight patients undergoing primary ACDF for neck and arm pain were entered into a Web-based prospect i ve registry . Baseline and 12-month patient-reported outcomes ( NRS-NP , NRS-AP , NDI , SF-12 PCS , SF-12 MCS , and EQ-5D ) were assessed . Patients were also asked whether they experienced a level of improvement after ACDF that met their expectation ( meaningful improvement ) . To assess the validity of NRS-NP , NRS-AP , and NDI ( measures of pain and disability ) to discriminate between meaningful and nonmeaningful improvement and the validity of SF-12 PCS , SF-12 MCS , and EQ-5D ( measures of general health and quality of life ) to discriminate between meaningful and nonmeaningful improvement , receiver-operating characteristic curves were generated for each outcome instrument . The greater the area under the curve ( AUC ) , the more valid the discriminator . The difference between st and ardized response means ( SRMs ) in patients reporting meaningful improvement versus not was calculated to determine the relative responsiveness of each outcome instrument to changes in  pain and QOL after surgery . RESULTS For pain and disability , both NDI ( AUC=0.75 ) and NRS-AP ( AUC=0.74 ) were valid discriminators of meaningful improvement . Numeric rating scale for neck pain ( AUC=0.69 ) was a poor discriminator . Neck disability index was also most responsive to postoperative improvement ( SRM difference 0.78 ) , followed by NRS-AP ( SRM difference 0.59 ) and NRS-NP ( SRM difference 0.46 ) . For general health and quality of life , SF-12 PCS ( AUC=0.79 ) was the only valid discriminator of meaningful improvement . Euro-Qol-5D ( AUC=0.68 ) and SF-12 MCS ( AUC=0.44 ) were poor discriminators . Short-form 12 physical component summary ( SRM difference 1.08 ) was also most responsive compared with EQ-5D ( SRM difference 0.89 ) and SF-12 MCS ( SRM difference 0.01 ) . CONCLUSIONS For pain and disability , NDI is the most valid and responsive measure of improvement after surgery for neck and arm pain . Numeric rating scale for neck pain and NRS-AP are poor substitutes for NDI when measuring effectiveness of care in registry efforts . For health-related quality of life , only SF-12 PCS could accurately discriminate meaningful improvement after cervical surgery and was found to be most valid and responsive . Large-scale registry efforts aim ed at measuring effectiveness of cervical spine surgery should use NDI and SF-12 to accurately assess improvements in pain , disability , and quality of life OBJECTIVE To determine whether improvements in flexed posture , strength , range of motion ( ROM ) , and physical performance would be observed after 12 weeks of group exercise in older women who because of age are prone to flexed posture and impaired physical function . DESIGN Pretest-posttest of outcome measures . SETTING Outpatient academic medical center . PARTICIPANTS Twenty-one women with thoracic kyphosis of 50 degrees or greater . INTERVENTION Multidimensional group exercise performed 2 times a week for 12 weeks . MAIN OUTCOME MEASURES Primary dependent measures of flexed posture included kyphosis , forward head , and height . Other dependent measures included spinal extensor muscle strength ; shoulder , hip , and knee ROM ; balance ; modified Physical Performance Test ( PPT ) ; jug test ; and gait speed . RESULTS Baseline kyphosis was 57 degrees + /-5.0 degrees , and age was 72.0+/-4.2 years . There were significant improvements in usual ( -6 degrees + /-3 degrees ) and best kyphosis ( -5 degrees + /-3 degrees ) ( P<.001 ) , spinal extensor muscle strength ( 21%+/-13 % of peak torque/body weight , P<.001 ) , popliteal angle ( right , 7 degrees + /-7 degrees ; left , 9 degrees + /-10 degrees ; P<.001 ) , modified PPT ( 2+/-2 points , P<.001 ) , and jug test ( -1.4+/-1.3s , P<.001 ) . Age and modified PPT at baseline correlated with change in kyphosis ( r=0.5 , P=.02 ; r=.42 , P=.055 , respectively ) . CONCLUSIONS Multidimensional group exercise reduced measured kyphosis and improved strength , ROM , and physical performance . This study provides a promising exercise intervention that may improve posture and physical performance in older women with flexed posture STUDY DESIGN Planned secondary analysis of a r and omized clinical trial . OBJECTIVES To examine : 1 ) patients ' baseline expectations for treatment outcome of thoracic high velocity low amplitude thrust manipulations ( HVLATM ) to the thoracic spine for shoulder pain ; 2 ) if the message conveyed by the clinician changed the patients ' expectation ; 3 ) any differences in outcome based on expectation independent of messaging . ; and 4 ) any differences in outcome for those patients whose expectations significantly changed as a result of the messaging . BACKGROUND Thoracic HVLATM may be an effective intervention for patients suffering from musculoskeletal shoulder pain . The role of expectation in the treatment effectiveness of this intervention has not been established . METHODS Subjects ' expectations regarding the effectiveness of  HVLATM  on shoulder pain were recorded at baseline . This was reassessed immediately following the provision of positive or neutral instructional set . The subjects then received a thoracic or scapular HVLATM . The Shoulder Pain and Disability Index ( SPADI ) and the numeric pain rating scale ( NPRS ) were used as outcomes measures . RESULTS There was a 10 subject change ( 23 % ) in positive expectation that was statistically significant ( p = 0.019 ) following a positive message . There was no statistically significant difference in pain and function when these subjects were compared to all other subjects . CONCLUSION Although patients ' expectations of positive outcome significantly changed when providing a positive instructional set , these changes did not translate into clinical ly significant short term changes in shoulder pain and function . LEVEL OF EVIDENCE 1b Ventral derotation spondylodesis , according to Zielke , achieves good results in operative treatment of idiopathic thoracic scolioses . Corrections of scoliotic major and secondary curve as well as derotation of the spine are reliably performed . The high rate of rod fractures with subsequent correction loss as well as a proportionate kyphogenic effect represents a problem . By keeping to the correcting principle , anterior double-rod instrumentation ( Halm-Zielke Instrumentation ) is to be stable in a similar way as posterior double-rod systems . Thus , it is done to facilitate brace-free postoperative care and to prevent excessive kyphotic pattern of the spine . In this prospect i ve study , we retrospectively collected data . We performed radiological follow-up of two groups of patients with idiopathic thoracic scoliosis ( King II , III and IV ) undergoing an operation with posterior approach ( USS instrumentation , posterior group , n=104 ) in 1997 and 1998 or being corrected with an anterior fusion ( Halm-Zielke instrumentation , anterior group , n=37 ) between 2000 and 2001 . Mean age of all patients for operation was 15±4 years . Follow-up was performed after 4±2 years on average . Preoperative measurements of the major and secondary curve , the lateral profile , rotation and frontal balance ( C7 to S1 ) did not show any significant differences apart from a more severe scoliotic curve in the lumbar spine for the anterior group with appropriately higher lumbar rotation . During follow-up we noticed similar corrections of the thoracic major and lumbar curve in both groups ranging from 49 to 56 % . In case of hypokyphotic ( T4–T12≤20 ° ) scoliosis a kyphogenic effect on the thoracic spine was achieved with both surgical methods . Hyperkyphotic ( T4–T12≥40 ° ) scolioses were flattened by posterior spinal fusion ; the effect of anterior spinal fusion was not significant . Correction of thoracic and lumbar rotation in the anterior group by 37 or 30 % was more significant than in the posterior group by 27 or 20 % . There was no impact of anterior technique on the balance of the spine whereas the latter shifted by an average of 7 mm to the left in the posterior group . The number of fused segments was significantly smaller in the anterior group with 7±1 vertebral bodies ( posterior , 11±1 vertebral bodies ) . Rates of complication were identical with 11 or 12 % in both groups during follow-up . Anterior and posterior double-rod instrumentations result in comparable corrections for idiopathic thoracic scoliosis of the major and secondary curve . In case of posterior technique , however , four vertebral bodies less were integrated in spondylodesis on average . Balance of the spine did not change after anterior spondylodesis ; however , it declined by using the posterior technique . Augmentation of the anterior threaded rod combined with a solid second rod significantly decreases the rate of implant breakages and reliably reduces consecutive correction losses Purpose If surgery for thoracolumbar incomplete cranial burst fractures ( Magerl A3.1.1 ) is necessary , the ideal stabilization strategy still remains undetermined . To justify posterior – anterior stabilization , which generates higher costs and potentially higher morbidity vs. posterior-only stabilization , clinical trials with sufficient power and adequate methodology are required . This prospect i ve r and omized single-centre pilot trial was design ed to enable sufficient sample -size calculation for a r and omized multicentre clinical trial ( RASPUTHINE ) . Methods Patients with a traumatic thoracolumbar ( Th11–L2 ) incomplete burst fracture ( Magerl A3.1.1 ) were r and omly assigned either to the interventional group ( posterior – anterior ) or to the control group ( posterior-only ) . Primary endpoint of the study was the clinical outcome measured using the Oswestry Disability Index ( ODI ) at 24 months . Radiological outcome was assessed as secondary endpoint by evaluation of mono- and bisegmental kyphotic angulation and monosegmental fusion . Results 21 patients were r and omly assigned to interventional group ( n = 9 ) or control group ( n = 12 ) . One posterior-only treated patient showed a severe initial loss of correction result ing in a crossover to additional anterior bisegmental fusion . The ODI measures at the primary study endpoint showed less but insignificant ( p = 0.67 ) disability for the interventional group over the control group ( 13.3 vs. 19.3 % ) . Comparison of preoperative bisegmental kyphosis in supine position with the bisegmental kyphosis at 24-month FU in upright position showed a worsened kyphosis for the control group ( 10.7 ° → 15.6 ° ) , whereas an improved kyphosis ( 11 ° → 8.3 ° ) was detectable for the interventional group . Conclusion The results of this pilot RCT showed less disability for the posterior – anterior group linked with a significant better restoration of the sagittal profile in comparison with the posterior-only group . To detect a clinical ly significant difference using the ODI and assuming a 20 % loss of FU rate , a total of 266 patients have to be studied in the multicentre trial BACKGROUND Age-related thoracic hyperkyphosis can lead to poor health outcomes including pain and dysfunction . Physiotherapists are fundamentally involved in the assessment and treatment of this problem but there is no published data that details assessment and treatment strategies or the attitudes of practitioners with respect to hyperkyphosis . PURPOSE The purpose of the study is to ascertain current physiotherapy practice for , and attitudes to , the assessment and treatment of thoracic hyperkyphosis in Australia . METHOD A stratified r and om sample ( N = 468 ) of Australian physiotherapists in all states and territories working in hospitals , outpatient clinics and community clinics were sent an anonymous cross-sectional postal survey . The survey had six sections identifying clinical profile , prevalence , measurement strategy , treatment frequency , treatment strategy and evidence source . RESULTS A response rate of 47 % with anonymity preserved was achieved . The majority of respondents had a musculoskeletal practice profile ( 75 % ) . Seventy-eight per cent encountered hyperkyphosis at least weekly , and three treatment sessions were most commonly given ( 35 % ) . Visual inspection was almost universally used to assess the degree of hyperkyphosis ( 98 % ) , and for 64 % it was their only measurement tool . Postural re-education  was the most common treatment strategy ( 90 % ) but the range of treatments reported was diverse . The primary source of evidence used by the majority of respondents was their undergraduate education , and there was concern expressed that physiotherapists lack good evidence upon which to make therapeutic decisions about hyperkyphosis . CONCLUSIONS Thoracic hyperkyphosis is commonly encountered by physiotherapists . Measurement of treatment efficacy is highly subjective , and the treatment modalities employed are diverse . Many physiotherapists based their management of hyperkyphosis on their undergraduate education alone BACKGROUND CONTEXT Spinal manipulative techniques ( SMT ) have shown clinical effectiveness in some patients with musculoskeletal pain . PURPOSE We performed the current experiment to test whether regional pain modulation is to be expected from thoracic SMT . STUDY DESIGN / SETTING R and omized experimental design performed in a university pain laboratory . OUTCOME MEASURES The primary outcome was experimental pain sensitivity in cervical and lumbar innervated area . METHODS Ninety healthy volunteers were r and omly assigned to receive one of three interventions ( SMT , exercise , or rest ) to the upper thoracic spine . Participants completed question naires about pain-related affect and expectations regarding each of the interventions . We collected experimental pain sensitivity measures of cervical and lumbar innervated areas before and immediately after r and omly assigned intervention . Mixed model analysis of covariance was used to test changes in measures of experimental pain sensitivity . RESULTS No interactions or intervention ( group ) effects were noted for pressure or A-delta-mediated thermal pain responses . Participants receiving SMT had greater reductions in temporal sensory summation ( TSS ) . CONCLUSIONS This present study indicates thoracic SMT that reduces TSS in healthy subjects . These findings extend our previous work in healthy and clinical subjects by indicating change in the nocioceptive afferent system occurred caudal to the region of SMT application . However , the duration of reduction in TSS is unknown , and more work needs to be completed in clinical population s to confirm the relevance of these findings BACKGROUND Greater thoracic kyphosis is associated with increased biomechanical loading of the spine which is potentially problematic in individuals with osteoporotic vertebral fractures . Conservative interventions that reduce thoracic kyphosis warrant further investigation . This study aim ed to investigate the effects of therapeutic postural taping on thoracic posture . Secondary aims explored the effects of taping on trunk muscle activity and balance . METHODS Fifteen women with osteoporotic vertebral fractures participated in this within-participant design study . Three taping conditions were r and omly applied : therapeutic taping , control taping and no taping .  Angle of thoracic kyphosis was measured after each condition . Force plate-derived balance parameters and trunk muscle electromyographic activity ( EMG ) were recorded during three static st and ing tasks of 40s duration . RESULTS There was a significant main effect of postural taping on thoracic kyphosis ( p=0.026 ) , with a greater reduction in thoracic kyphosis after taping compared with both control tape and no tape . There were no effects of taping on EMG or balance parameters . CONCLUSIONS The results of this study demonstrate that the application of postural therapeutic tape in a population with osteoporotic vertebral fractures induced an immediate reduction in thoracic kyphosis . Further research is needed to investigate the underlying mechanisms associated with this decrease in kyphosis Background and Purpose To date , no studies have investigated the predictive validity of variables from the initial examination to identify patients with neck pain who are likely to benefit from thoracic spine thrust manipulation . The purpose of this study was to develop a clinical prediction rule ( CPR ) to identify patients with neck pain who are likely to experience early success from thoracic spine thrust manipulation . Subjects This was a prospect i ve , cohort study of patients with mechanical neck pain who were referred for physical therapy . Methods Subjects underwent a st and ardized examination  and then a series of thoracic spine thrust manipulation techniques . They were classified as having experienced a successful outcome at the second and third sessions based on their perceived recovery . Potential predictor variables were entered into a stepwise logistic regression model to determine the most accurate set of variables for prediction of treatment success . Results Data for 78 subjects were included in the data analysis , of which 42 had a successful outcome . A CPR with 6 variables was identified . If 3 of the 6 variables ( positive likelihood ratio=5.5 ) were present , the chance of experiencing a successful outcome improved from 54 % to 86 % . Discussion and Conclusion The CPR provides the ability to a priori identify patients with neck pain who are likely to experience early success with thoracic spine thrust manipulation . However , future studies are necessary to vali date the rule
The strongest levels of evidence for reliability exists in support of the Debrunner kyphometer , Spinal Mouse and Flexicurve index , and for validity supports the arcometer and Flexicurve index .
BACKGROUND A wide array of instruments are available for non-invasive thoracic kyphosis measurement .
Guidelines for selecting outcome measures for use in clinical and research practice recommend that properties such as validity and reliability are considered .
This systematic review reports on the reliability and validity of non-invasive methods for measuring  thoracic kyphosis .