RELIABILITY OF A PHOTOGRAPHIC METHOD FOR ASSESSING STANDING POSTURE OF ELEMENTARY SCHOOL STUDENTS Jelena Paušić, PhD, a Željko Pedišić, MEd, b and Dražan Dizdar, PhD c ABSTRACT Objective: A high prevalence of poor standing posture among elementary schoolchildren indicates the need for the introduction of school-based interventions for improvement of postural alignments. For assessing the effect of intervention programs, reliable quantitative measures of standing posture should be used. Therefore, the purpose of this study was to examine the reliability of a photographic method for assessment of standing posture among elementary schoolchildren. Methods: The study was conducted on a convenience sample of 273 male students between 10 and 13 years old. Each subject was photographed in habitual standing posture, 3 times in a front view and 3 times in a side view. Deviations from ideal postural alignment were calculated with Posture Image Analyzer software and UTHSCSA ImageTool software. Interitem reliability was estimated using intraclass correlation coefficient. Results: Intraclass correlation coefficients for posture deviations assessed with Posture Image Analyzer ranged from 0.81 for knee joints deviation and ankle joints deviation in the coronal plane to 0.92 for trunk deviation and knee joints deviation in the sagittal plane. Intraclass correlation coefficients for posture deviations assessed with UTHSCSA ImageTool ranged from 0.80 for knee joints deviation in the coronal plane to 0.91 for trunk deviation and knee joints deviation in the sagittal plane. Conclusions: This study showed a satisfactory interitem reliability of a photographic method for the assessment of standing posture among elementary schoolchildren. (J Manipulative Physiol Ther 2010;33:425-431) Key Indexing Terms: Posture; Reproducibility of Results; Schools; Child I deal standing posture should allow for the maintenance of balance using the least musculoskeletal effort without a feeling of discomfort. The ideal alignment of body segments in standing posture should coincide with a vertical line passing through the center of gravity of the body. 1 From a lateral view, the ear, axis, shoulder, bodies of lumbar vertebrae, hip, knee, and the point just in front of the lateral malleolus should be situated on the same vertical line. 2 In the sagittal plane, the posture should be bilaterally symmetrical. 2 Large deviations from ideal postural alignment induce stress on spinal tissues, resulting in possible headaches, neck pain, back fatigue, and structural deformities of the spine, intervertebral discs, and spinal ligaments. 3,4 We assume that a negative influence of poor standing posture on health is especially expressed in primary school age. Namely, in that, period poor standing posture affects spinal tissues in combination with other risk factors, such as rapid changes in growth, backpack use, faulty sitting posture, and the use of nonergonomic school furniture. 5-8 Epidemiologic studies have shown that posture-related problems are very common among schoolchildren. Scoliosis was found in 4.2% of schoolchildren aged 8 to 15, 9 whereas 22% of schoolchildren reported having headaches at least once a week. 10 We assume that the high prevalence of such diagnoses could be, among other factors, a consequence of poor standing posture. Kratěnová et al 11 found that 38% of schoolchildren who were 11 years old had poor posture, which indicates a potential need for the introduction of school-based inter- ventions for improvement of postural faults. Such inter- ventions were well accepted among elementary school students. 12-14 Results of the abovementioned study 13 concerning effects of school-based interventions on chil- dren's posture are somewhat limited because of the qualitative nature of the methods used for postural a Assistant Professor, Faculty of Kinesiology, University of Split, Split, Croatia. b Research Associate, Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia. c Assistant Professor, Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia. Submit requests for reprints to: Željko Pedišić, MEd, Research Associate, Faculty of Kinesiology, University of Zagreb, Horva- čanski Zavoj 15, Zagreb, Croatia 21000 (e-mail: zeljko.pedisic@kif.hr). Paper submitted October 13, 2009; in revised form February 27, 2010; accepted March 29, 2010. 0161-4754/$36.00 Copyright © 2010 by National University of Health Sciences. doi:10.1016/j.jmpt.2010.06.002 425