European Spine Journal

, Volume 19, Issue 6, pp 995–1003 | Cite as

Preliminary study: reliability of the spinal wheel. A novel device to measure spinal postures applied to sitting and standing

  • Liba Sheeran
  • Valerie Sparkes
  • Monica Busse
  • Robert van Deursen
Original Article


Postural re-education is an integral part of physiotherapy management in patients with back pain. Although the link between posture and back pain is largely unknown, postural re-education is performed on the premise of optimizing spinal alignment to minimize stresses on the passive structures of the spine, to facilitate optimal muscular support and thus to prevent possible damage and further pain. A reliable and clinically meaningful measurement of spinal postures to monitor such interventions remains challenging. This study evaluated within-day (intra-tester, inter-tester) and between-day (test–retest) reliability of a novel spinal wheel device measuring thoracic and lumbar postures during sitting and standing. 17 healthy volunteers (age 39.5 ± 5.4, BMI 25 ± 9.2; 9 males) were measured three times, by three testers, on two separate occasions (1 week apart). The angular change between C7 and T12 and between T12 and S1 provided thoracic and lumbar curvatures, respectively. Intra-class correlation coefficient (ICC) with 95% confidence intervals and typical error were calculated. Excellent reliability was demonstrated with intra-tester ICCs between 0.947 and 0.980 and typical error between 1.7° and 3.7° and inter-tester ICCs between 0.949 and 0.986 and typical error between 2.0° and 4.7°. Test–retest reliability was high with ICCs 0.719–0.908 and typical error between 4.0° and 7.4°. In conclusion, the spinal wheel demonstrated excellent within-day and high between-day reliability. The device may be used in conjunction with 2D camcorder to provide clinically useful visual evaluation of postures for assessment, intervention monitoring, and feedback during postural re-education.


Back pain Thoracic kyphosis Lumbar lordosis Non-invasive measurement Reliability 


  1. 1.
    O’Sullivan PB, Mitchell T, Bulich P, Waller R, Holte J (2006) The relationship between posture and back muscle endurance in industrial workers with flexion-related low back pain. Man Ther 11:264–271CrossRefPubMedGoogle Scholar
  2. 2.
    Dankaerts W, O’Sullivan P, Burnett A, Straker L (2006) Differences in sitting postures are associated with nonspecific chronic low back pain disorders when patients are subclassified. Spine 31:698–704CrossRefPubMedGoogle Scholar
  3. 3.
    Dankaerts W, O’Sullivan P, Burnett A, Straker L (2006) Altered patterns of superficial trunk muscle activation during sitting in nonspecific chronic low back pain patients: importance of subclassification. Spine 31:2017–2023CrossRefPubMedGoogle Scholar
  4. 4.
    Panjabi MM (2003) Clinical spinal instability and low back pain. J Electromyogr Kinesiol 13:371–379CrossRefPubMedGoogle Scholar
  5. 5.
    O’Sullivan PB, Grahamslaw KM, Kendell M, Lapenskie SC, Moller NE, Richards KV (2002) The effect of different standing and sitting postures on trunk muscle activity in a pain-free population. Spine 27:1238–1244CrossRefPubMedGoogle Scholar
  6. 6.
    Panjabi MM (1992) The stabilizing system of the spine. Part II. Neutral zone and instability hypothesis. J Spinal Disord 5:390–396 discussion 397CrossRefPubMedGoogle Scholar
  7. 7.
    Vezina MJ, Hubley-Kozey CL (2000) Muscle activation in therapeutic exercises to improve trunk stability. Arch Phys Med Rehabil 81:1370–1379CrossRefPubMedGoogle Scholar
  8. 8.
    van Dieen JH, Cholewicki J, Radebold A, van Dieen JH, Cholewicki J, Radebold A (2003) Trunk muscle recruitment patterns in patients with low back pain enhance the stability of the lumbar spine. Spine 28:834–841CrossRefPubMedGoogle Scholar
  9. 9.
    O’Sullivan PB, Twomey L, Allison GT (1998) Altered abdominal muscle recruitment in patients with chronic back pain following a specific exercise intervention. J Orthop Sports Phys Ther 27:114–124PubMedGoogle Scholar
  10. 10.
    O’Sullivan PB, Phyty GD, Twomey LT, Allison GT (1997) Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis. Spine 22:2959–2967CrossRefPubMedGoogle Scholar
  11. 11.
    Dankaerts W, O’Sullivan PB, Straker LM, Burnett AF, Skouen JS (2006) The inter-examiner reliability of a classification method for non-specific chronic low back pain patients with motor control impairment. Man Ther 11:28–39CrossRefPubMedGoogle Scholar
  12. 12.
    O’Sullivan P (2006) Classification of lumbopelvic pain disorders—why is it essential for management? Man Ther 11:169–170CrossRefPubMedGoogle Scholar
  13. 13.
    Ordway NR, Seymour R, Donelson RG, Hojnowski L, Lee E, Edwards TW (1997) Cervical sagittal range of motion analysis using three methods: cervical range of movement device, 3Space and Radiography. Spine 22:501–508CrossRefPubMedGoogle Scholar
  14. 14.
    Portek I, Pearcy MJ, Reader GP, Mowat AG (1983) Correlation between radiographic and clinical measurement of lumbar spine movement. Rheumatology 22:197–205CrossRefGoogle Scholar
  15. 15.
    Stokes IAF, Wilder DG, Frymoyer JW, Pope MH (1981) Assessment of patients with low-back-pain by biplanar radiographic measurement of intervertebral motion. Spine 6:233–240CrossRefPubMedGoogle Scholar
  16. 16.
    Kachingwe AF, Phillips BJ (2005) Inter- and intrarater reliability of a back range of motion instrument. Arch Phys Med Rehabil 86:2347–2353CrossRefPubMedGoogle Scholar
  17. 17.
    Ng JKF, Kippers V, Richardson CA, Parnianpour M (2001) Range of motion and lordosis of the lumbar spine: reliability of measurement and normative values. Spine 26:53–60CrossRefPubMedGoogle Scholar
  18. 18.
    Fitzgerald GK, Wynveen KJ, Rheault W, Rothschild B (1983) Objective assessment with establishment of normal values for lumbar spinal range of motion. Phys Ther 63:1776–1781PubMedGoogle Scholar
  19. 19.
    Tousignant M, Morissette J, Murphy M (2002) Criterion validity study of lumbar goniometers BROM II and EDI-320 for range of motion of lumbar flexion of low back pain patients. J Back Musculoskelet Rehabil 16:159–167Google Scholar
  20. 20.
    Troup JD, Hood CA, Chapman AE (1968) Measurements of the sagittal mobility of the lumbar spine and hips. Ann Phys Med 9:308–321PubMedGoogle Scholar
  21. 21.
    Troup JD, Foreman TK, Baxter CE, Brown D (1987) The perception of back pain and the role of psychophysical tests of lifting capacity. Spine 12:645–657CrossRefPubMedGoogle Scholar
  22. 22.
    Adams MA, Dolan P, Marx C, Hutton WC (1986) An electronic inclinometer technique for measuring lumbar curvature. Clin Biomech 1:130–134CrossRefGoogle Scholar
  23. 23.
    Chen SPC, Samo DG, Chen EH, Crampton AR, Conrad KM, Egan L, Mitton J (1997) Reliability of three lumbar sagittal motion measurement methods: Surface inclinometers. J Occup Environ Med 39:217–223CrossRefPubMedGoogle Scholar
  24. 24.
    Ensink FBM, Saur PMM, Frese K, Seeger D, Hildebrandt J (1996) Lumbar range of motion: Influence of time of day and individual factors on measurements. Spine 21:1339–1343CrossRefPubMedGoogle Scholar
  25. 25.
    Mayer TG, Kondraske G, Beals SB, Gatchel RJ (1997) Spinal range of motion—accuracy and sources of error with inclinometric measurement. Spine 22:1976–1984CrossRefPubMedGoogle Scholar
  26. 26.
    Miller SA, Mayer T, Cox R, Gatchel RJ (1992) Reliability problems associated with the modified Schober technique for true lumbar flexion measurement. Spine 17:345–348CrossRefPubMedGoogle Scholar
  27. 27.
    Williams R, Binkley J, Bloch R, Goldsmith CH, Minuk T (1993) Reliability of the modified-modified Schober and Double inclinometer methods for measuring lumbar flexion and extension. Phys Ther 73:33–44PubMedGoogle Scholar
  28. 28.
    Burton AK (1986) Regional lumbar sagittal mobility—measurement by flexicurves. Clin Biomech 1:20–26CrossRefGoogle Scholar
  29. 29.
    Burton AK, Tillotson KM, Troup JD (1989) Variation in lumbar sagittal mobility with low-back trouble. Spine 14:584–590CrossRefPubMedGoogle Scholar
  30. 30.
    Lundon KM, Li AM, Bibershtein S (1998) Interrater and intrarater reliability in the measurement of kyphosis in postmenopausal women with osteoporosis. Spine 23:1978–1985CrossRefPubMedGoogle Scholar
  31. 31.
    Tillotson KM, Burton AK (1991) Noninvasive measurement of lumbar sagittal mobility. An assessment of the flexicurve technique. Spine 16:29–33CrossRefPubMedGoogle Scholar
  32. 32.
    Burton AK, Tillotson KM (1989) Is recurrent low back trouble associated with increased lumbar sagittal mobility? J Biomed Eng 11:245–248CrossRefPubMedGoogle Scholar
  33. 33.
    Mannion A, Knecht K, Balaban G, Dvorak J, Grob D (2004) A new skin-surface device for measuring the curvature and global and segmental ranges of motion of the spine: reliability of measurements and comparison with data reviewed from the literature. Eur Spine J 13:122–136CrossRefPubMedGoogle Scholar
  34. 34.
    An KN, Jacobsen MC, Berglund LJ, Chao EYS (1988) Application of a magnetic tracking device to kinesiologic studies. J Biomech 21:613CrossRefPubMedGoogle Scholar
  35. 35.
    Fahrenberg J, FF, Smeja M, Muller V (1997) Assessment of posture and motion by multichannel piezoresistive accelerometer recordings. Pathophysiology 34:607–612Google Scholar
  36. 36.
    Mannion A, Troke M (1999) A comparison of two motion analysis devices used in the measurement of lumbar spinal mobility. Clin Biomech 14:612–619CrossRefGoogle Scholar
  37. 37.
    Swinkels A, Dolan P (2004) Spinal position sense and disease progression in ankylosing spondylitis—a longitudinal study. Spine 29:1240–1245CrossRefPubMedGoogle Scholar
  38. 38.
    Dolan P, Greenfield K, Nelson RJ, Nelson IW (2000) Can exercise therapy improve the outcome of microdiscectomy? Spine 25:1523–1532CrossRefPubMedGoogle Scholar
  39. 39.
    Newcomer KL, Laskowski ER, Yu B, Johnson JC, An KN (2000) Differences in repositioning error among patients with low back pain compared with control subjects. Spine 25:2488–2493CrossRefPubMedGoogle Scholar
  40. 40.
    Pearcy MJ, Hindle RJ (1989) New method for the non-invasive 3-dimensional measurement of human back movement. Clin Biomech 4:73–79CrossRefGoogle Scholar
  41. 41.
    Swinkels A, Dolan P (2000) Spinal position sense is independent of the magnitude of movement. Spine 25:98–104 discussion 105CrossRefPubMedGoogle Scholar
  42. 42.
    Newcomer K, Laskowski ER, Yu B, Larson DR, An KN (2000) Repositioning error in low back pain. Comparing trunk repositioning error in subjects with chronic low back pain and control subjects. Spine 25:245–250CrossRefPubMedGoogle Scholar
  43. 43.
    Harlick JC, Milosavljevic S, Milburn PD (2007) Palpation identification of spinous processes in the lumbar spine. Manual Ther 12:56–62CrossRefGoogle Scholar
  44. 44.
    Mayer RS, Chen IH, Lavender SA, Trafimow JH, Andersson GBJ (1995) Variance in the measurement of sagittal lumbar spine range of motion among examiners, subjects, and instruments. Spine 20:1489–1493CrossRefPubMedGoogle Scholar
  45. 45.
    O’Sullivan PB, Burnett A, Floyd AN, Gadsdon K, Logiudice J, Miller D, Quirke H (2003) Lumbar repositioning deficit in a specific low back pain population. Spine 28:1074–1079CrossRefPubMedGoogle Scholar
  46. 46.
    Swinkels A, Dolan P (1998) Regional assessment of joint position sense in the spine. Spine 23:590–597CrossRefPubMedGoogle Scholar
  47. 47.
    Vergara M, Page A, Sancho JL (2006) Analysis of lumbar flexion in sitting posture: Location of lumbar vertebrae with relation to easily identifiable skin marks. Int J Ind Ergonom 36:937–942CrossRefGoogle Scholar
  48. 48.
    Kellis E, Adamou G, Tzilios G, Emmanouilidou M (2008) Reliability of spinal range of motion in healthy boys using a skin-surface device. J Manipulative Physiol Ther 31:570–576CrossRefPubMedGoogle Scholar
  49. 49.
    Shrout PE, Fleiss JL (1979) Intraclass correlation: uses in assessing rater reliability. Psychol Bull 86:420–426CrossRefPubMedGoogle Scholar
  50. 50.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174CrossRefPubMedGoogle Scholar
  51. 51.
    Batterham AM, George KP (2003) Reliability in evidence based clinical practice: a primer for allied health professions. Phys Ther Sport 4:122–128CrossRefGoogle Scholar
  52. 52.
    Hopkins WG (2000) Measures of reliability in sports medicine and science. Sports Med 30:1–15CrossRefPubMedGoogle Scholar
  53. 53.
    Stratford PW, Goldsmith CH (1997) Use of the standard error as a reliability index of interest: an applied example using elbow flexor strength data. Phys Ther 77(6):745PubMedGoogle Scholar
  54. 54.
    Walter SD, Eliasziw M, Donner A (1998) Sample size and optimal designs for reliability studies. Stat Med 17:101–110CrossRefPubMedGoogle Scholar
  55. 55.
    Allison GT, Fukushima S (2003) Estimating three-dimensional spinal repositioning error: the impact of range posture and number of trials. Spine 28:2510–2516CrossRefPubMedGoogle Scholar
  56. 56.
    Dolan KJ, Green A (2006) Lumbar spine reposition sense: the effect of a slouched posture. Manual Ther 11:202–207CrossRefGoogle Scholar
  57. 57.
    Hultman G, Saraste H, Ohlsen H (1992) Anthropometry, Spinal-canal width, and flexibility of the spine and hamstring muscles in 45–55-year-old men with and without low-back-pain. J Spinal Disord 5:245–253CrossRefPubMedGoogle Scholar
  58. 58.
    Leroux MA, Zabjek K, Simard G, Badeaux J, Coillard C, Rivard CH (2000) A noninvasive anthropometric technique for measuring kyphosis and lordosis: an application for idiopathic scoliosis. Spine 25:1689–1694CrossRefPubMedGoogle Scholar
  59. 59.
    Pinel-Giroux FM, Mac-Thiong JM, de Guise JA, Berthonnaud E, Labelle H (2006) Computerized assessment of sagittal curvatures of the spine: comparison between Cobb and tangent circles techniques. J Spinal Disord Tech 19:507–512CrossRefPubMedGoogle Scholar
  60. 60.
    Polly DW Jr, Kilkelly FX, McHale KA, Asplund LM, Mulligan M, Chang AS (1996) Measurement of lumbar lordosis. Evaluation of intraobserver, interobserver, and technique variability. Spine 21:1530–1535 discussion 1535-6CrossRefPubMedGoogle Scholar
  61. 61.
    Goh S, Price RI, Leedman PJ, Singer KP (2000) A comparison of three methods for measuring thoracic kyphosis: implications for clinical studies. Rheumatology 39:310–315CrossRefPubMedGoogle Scholar
  62. 62.
    Carman DL, Browne RH, Birch JG (1990) Measurement of scoliosis and kyphosis radiographs—intraobserver and interobserver variation. J Bone Joint Surg 72A:328–333Google Scholar
  63. 63.
    Morrissy RT, Goldsmith GS, Hall EC, Kehl D, Cowie GH (1990) Measurement of the Cobb angle on radiographs of patients who have scoliosis—evaluation of intrinsic error. J Bone Joint Surg 72A:320–327Google Scholar
  64. 64.
    Dolan P (1993) Influence of lumbar and hip mobility on the bending stresses acting on the lumbar spine. Clin Biomech 8:185–192CrossRefGoogle Scholar
  65. 65.
    Atkinson G, Nevill AM (1998) Statistical methods for assessing measurement error (reliability) in variables relevant to sports medicine. Sports Med 26:217–238CrossRefPubMedGoogle Scholar
  66. 66.
    Power ML, Schulkin J (2008) Sex differences in fat storage, fat metabolism, and the health risks from obesity: possible evolutionary origins. Br J Nutr 99:931–940CrossRefPubMedGoogle Scholar
  67. 67.
    Kuo Y-L, Tully EA, Galea MP (2008) Skin movement errors in measurement of sagittal lumbar and hip angles in young and elderly subjects. Gait Posture 27:264–270CrossRefPubMedGoogle Scholar
  68. 68.
    Maffey-Ward L, Jull G, Wellington L (1996) Toward a clinical test of lumbar spine kinesthesia. J Orthop Sports Phys Ther 24:354–358PubMedGoogle Scholar
  69. 69.
    O’Sullivan P, Dankaerts W, Burnett A, Chen D, Booth R, Carlsen C, Schultz A (2006) Evaluation of the flexion relaxation phenomenon of the trunk muscles in sitting. Spine 31:2009–2016CrossRefPubMedGoogle Scholar
  70. 70.
    Panjabi MM (1992) The stabilizing system of the spine Part I Function, dysfunction, adaptation, and enhancement. J Spinal Disord 5:383–389 discussion 397CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Liba Sheeran
    • 1
  • Valerie Sparkes
    • 1
  • Monica Busse
    • 1
  • Robert van Deursen
    • 1
  1. 1.Department of Physiotherapy, School of Healthcare StudiesCardiff UniversityCardiffUK

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