Archives of Osteoporosis

, 13:25 | Cite as

Hyperkyphotic measures using distance from the wall: validity, reliability, and distance from the wall to indicate the risk for thoracic hyperkyphosis and vertebral fracture

  • Patcharawan Suwannarat
  • Pipatana AmatachayaEmail author
  • Thanat Sooknuan
  • Patiphan Tochaeng
  • Kanjana Kramkrathok
  • Thiwabhorn Thaweewannakij
  • Nuttaset Manimmanakorn
  • Sugalya AmatachayaEmail author
Original Article



C7WD is a practical, valid, and reliable measure that could clearly indicate a risk of hyperkyphosis and vertebral fracture in the elderly. The findings might be particularly of use in regions difficult to access radiology or for the determination of those who need further invasive radiologic examination and therapy.


To investigate psychometric properties of the 7th cervical vertebra wall distance (C7WD) to determine the risk of thoracic hyperkyphosis and spinal fracture, as compared to a standard radiologic Cobb’s method.


Community-dwelling elderly (n = 104), aged at least 60 years with occiput-wall distance > 0 cm, were assessed for their C7WD using rulers and a specially developed tool for an accurate perpendicular distance from C7 to the wall: infrared-gun kyphosis wall distance tool (IG-KypDisT). The first 15 participants were also involved in the reliability tests by a healthcare professional, village health volunteer, and caregiver. Within 7 days, all participants were at a hospital to complete a lateral plain radiograph (Cobb’s method).


Outcomes of C7WD had excellent correlation to the Cobb angles (r = 0.87 for rulers and r = 0.92 for IG-KypDisT), with excellent reliability when used by all three raters (ICC3,3 = 0.85–0.99). The C7WD of at least 7.5 and 9.5 cm had the best diagnostic properties to determine the risk of thoracic hyperkyphosis and vertebral fracture, respectively.


C7WD is valid and reliable with good diagnostic properties for thoracic hyperkyphosis and vertebral fracture. The findings confirm the use of C7WD using traditional ruler-based method as a practical tool to screen and monitor severity of thoracic hyperkyphosis in clinics and communities. In addition, the measurement using the IG-KypDisT provided accurate data that can be saved for further analysis; it is therefore suggested for research settings. The findings would promote the standardization of hyperkyphosis measurements in various settings.


Round back Dowager’s hump Assessment Spinal fracture Cobb angle 



The researchers sincerely thank Miss Arpassanan Wiyanad and Miss Pakwipa Chokphukiao for their contribution in data collection. In addition, the researchers are thankful for contribution and funding support from the Research and Researcher for Industries or RRi (Grant No. 5770I0039), Faculty of Engineering and Architecture, Rajamangala University of Technology Isan, Nakhon Ratchasima, and the Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Thailand.

Compliance with ethical standards

All procedures of the study were in accordance with the standards of the Ethics Committee for Human Research (HE581446). Eligible participants completed a written informed consent form before participation in this study.

Conflicts of interest



  1. 1.
    Kado DM, Prenovost K, Crandall C (2007) Narrative review: hyperkyphosis in older persons. Ann Intern Med 147:330–338CrossRefGoogle Scholar
  2. 2.
    Katzman WB, Wanek L, Shepherd JA, Sellmeyer DE (2010) Age-related hyperkyphosis: its causes, consequences, and management. J Orthop Sports Phys Ther 40:352–360CrossRefGoogle Scholar
  3. 3.
    Bouxsein ML, Melton LJ 3rd, Riggs BL et al (2006) Age- and sex-specific differences in the factor of risk for vertebral fracture: a population-based study using QCT. J Bone Miner Res 21:1475–1482CrossRefGoogle Scholar
  4. 4.
    Keller TS, Harrison DE, Colloca CJ, Harrison DD, Janik TJ (2003) Prediction of osteoporotic spinal deformity. Spine 28:455–462PubMedGoogle Scholar
  5. 5.
    Kado DM, Browner WS, Palermo L, Nevitt MC, Genant HK, Cummings SR (1999) Vertebral fractures and mortality in older women: a prospective study. Study of osteoporotic fractures research group. Arch Intern Med 159:1215–1220CrossRefGoogle Scholar
  6. 6.
    Siminoski K, Warshawski RS, Jen H, Lee KC (2011) The accuracy of clinical kyphosis examination for detection of thoracic vertebral fractures: comparison of direct and indirect kyphosis measures. J Musculoskelet Neuronal Interact 11:249–256PubMedGoogle Scholar
  7. 7.
    Tran TH, Wing D, Davis A, Bergstrom J, Schousboe JT, Nichols JF, Kado DM (2016) Correlations among four measures of thoracic hyperkyphosis in older adults. Osteoporos Int 27:1255–1259CrossRefGoogle Scholar
  8. 8.
    Kauffman KS, Myers DH (1997) The changing role of village health volunteers in northeast Thailand: an ethnographic field study. Int J Nurs Stud 34:249–255CrossRefGoogle Scholar
  9. 9.
    Amatachaya P, Wongsa S, Sooknuan T, Thaweewannakij T, Laophosri M, Manimanakorn N, Amatachaya S (2016) Validity and reliability of a thoracic kyphotic assessment tool measuring distance of the seventh cervical vertebra from the wall. Hong Kong Physiother J 35:30–36CrossRefGoogle Scholar
  10. 10.
    Antonelli-Incalzi R, Pedone C, Cesari M, Di Iorio A, Bandinelli S, Ferrucci L (2007) Relationship between the occiput-wall distance and physical performance in the elderly: a cross sectional study. Aging Clin Exp Res 19:207–212CrossRefGoogle Scholar
  11. 11.
    Balzini L, Vannucchi L, Benvenuti F, Benucci M, Monni M, Cappozzo A, Stanhope SJ (2003) Clinical characteristics of flexed posture in elderly women. J Am Geriatr Soc 51:1419–1426CrossRefGoogle Scholar
  12. 12.
    Wongsa S, Amatachaya P, Saengsuwan J, Amatachaya S (2012) Concurrent validity of occiput-wall distance to measure kyphosis in communities. J Clin Trials 2:1–3CrossRefGoogle Scholar
  13. 13.
    Wongsa S, Amatachaya S (2014) Kyphosis assessment. J Med Tech Phy Ther 26:105–116Google Scholar
  14. 14.
    Suwannarat P, Wattanapan P, Wiyanad A, Chokphukiao P, Wilaichit S, Amatachaya S (2017) Reliability of novice physiotherapists for measuring Cobb angle using a digital method. Hong Kong Physiother J 37:34–38CrossRefGoogle Scholar
  15. 15.
    Azadinia F, Kamyab M, Behtash H, Saleh Ganjavian M, Javaheri MR (2014) The validity and reliability of noninvasive methods for measuring kyphosis. J Spinal Disord Tech 27:E212–E218CrossRefGoogle Scholar
  16. 16.
    Mukaka MM (2012) Statistics corner: a guide to appropriate use of correlation coefficient in medical research. Malawi Med J 24(3):69–71PubMedPubMedCentralGoogle Scholar
  17. 17.
    Walter SD, Eliasziw M, Donner A (1998) Sample size and optimal designs for reliability studies. Stat Med 17:101–110CrossRefGoogle Scholar
  18. 18.
    Briggs AM,Wrigley TV, Tully EA, Adams PE, Greig AM, Bennell KL (2007) Radiographic measures of thoracic hyperkyphosis in osteoporosis: Cobb and vertebral centroid angles. Skelet Radiol 36:761–767CrossRefGoogle Scholar
  19. 19.
    Teixeira FA, Carvalho GA (2007) Reliability and validity of thoracic hyperkyphosis measurements using flexicurve method. Rev Bras Fisioter 11:173–137Google Scholar
  20. 20.
    Wu W, Liang J, Du Y et al (2014) Reliability and reproducibility analysis of the Cobb angle and assessing sagittal plane by computer-assisted and manual measurement tools. BMC Musculoskelet Disord 15:33CrossRefGoogle Scholar
  21. 21.
    Martinez-Abadias N (2005) Evolution patterns of the human skull. A quantitative genetic analysis of craniofacial phenotypic variation. University de BarcelonaGoogle Scholar
  22. 22.
    Di Bari M, Chiarlone M, Matteuzzi D et al (2004) Thoracic hyperkyphosis and ventilatory dysfunction in unselected older persons: an epidemiological study in Dicomano, Italy. J Am Geriatr Soc 52:909–915CrossRefGoogle Scholar
  23. 23.
    van der Jagt-Willems HC, de Groot MH, van Campen JP, Lamoth CJ, Lems WF (2015) Associations between vertebral fractures, increased thoracic kyphosis, a flexed posture and falls in older adults: a prospective cohort study. BMC Geriatr 15:34CrossRefGoogle Scholar
  24. 24.
    Schafer RC (1983) Body alignment, posture, and gait, 2nd edn. Williams & Wilkins, BaltimoreGoogle Scholar
  25. 25.
    Atkinson G, Nevill AM (1998) Statistical methods for assessing measurement error (reliability) in variables relevant to sports medicine. Sports Med 26:217–238CrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  • Patcharawan Suwannarat
    • 1
    • 2
  • Pipatana Amatachaya
    • 2
    • 3
    Email author
  • Thanat Sooknuan
    • 2
    • 4
  • Patiphan Tochaeng
    • 2
    • 4
  • Kanjana Kramkrathok
    • 2
    • 4
  • Thiwabhorn Thaweewannakij
    • 1
    • 2
  • Nuttaset Manimmanakorn
    • 2
    • 5
  • Sugalya Amatachaya
    • 1
    • 2
    Email author
  1. 1.School of Physical Therapy, Faculty of Associated Medical SciencesKhon Kaen UniversityKhon KaenThailand
  2. 2.Improvement of Physical Performance and Quality of Life (IPQ) Research GroupKhon Kaen UniversityKhon KaenThailand
  3. 3.Department of Mechanical Engineering, Faculty of Engineering and ArchitectureRajamangala University of Technology IsanNakhon RatchasimaThailand
  4. 4.Department of Electrical Engineering, Faculty of Engineering and ArchitectureRajamangala University of Technology IsanNakhon RatchasimaThailand
  5. 5.Department of Rehabilitation Medicine, Faculty of MedicineKhon Kaen UniversityKhon KaenThailand

Personalised recommendations