Galley Proof 28/12/2018; 14:29 File: bmr–1-bmr171041.tex; BOKCTP/ljl p. 1 Journal of Back and Musculoskeletal Rehabilitation -1 (2018) 1–8 1 DOI 10.3233/BMR-171041 IOS Press The intra- and inter-observer reliability of interface pressure measurements of the Milwaukee brace in adolescents with hyperkyphosis Taher Babaee a , Mojtaba Kamyab a,∗ , Amir Ahmadi b , Mohammad Ali Sanjari c Mohammad Saleh Ganjavian d a Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran b Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran c Department of Rehabilitation Basic Sciences, School of Rehabilitation, and Biomechanics Lab, Rehabilitation Research Center, Iran University of Medical Sciences, Tehran, Iran d Department of Orthopaedic Surgery, Shafa Yahyaiian hospital, Iran University of Medical Sciences, Tehran, Iran Abstract. BACKGROUND: There is a lack of evidence in reliability of the modified sphygmomanometer to measure the brace-interface pad pressure in adolescents with Scheuermann’s kyphosis (SK). OBJECTIVES: To evaluate the intra- and inter-observer reliability of modified sphygmomanometer for measuring interface pad pressure in the Milwaukee brace. METHODS: Two observers measured the pressure of the shoulder and kyphosis pads in Milwaukee brace on 33 adolescents with SK with an average age of 14.67 ± 1.72 years and Cobb angle 64.48 ◦ ± 7.53 ◦ . All measurements were obtained in one day. The measurements were done in the inhalation and exhalation of tidal breathing during standing and sitting positions. The intra-class correlation coefficient (ICC), 95% confidence interval (CI), and linear mixed model ANOVA effects were calculated. RESULTS: The intra-observer reliability varied from a good ICC of 0.81 (0.66–0.90) to an excellent of 0.97 (0.95–0.98). The inter-observer reliability also varied from a good ICC of 0.82 (0.67–0.91) to an excellent of 0.96 (0.93–0.98). The linear mixed model ANOVA analysis showed that the rater, position, and breathing had a significant effect on the pad pressure measurements. CONCLUSIONS: The modified sphygmomanometer is a reliable tool to measure the pad pressure of the Milwaukee brace for adolescents with SK. Keywords: Pressure measurement, brace, scheuermann’s kyphosis, sphygmomanometer, reliability 1. Introduction 1 Thoracic hyperkyphosis is one of the most common 2 forms of spinal deformity during adolescence, with an 3 ∗ Corresponding author: Mojtaba Kamyab, Department of Or- thotics and Prosthetics, School of Rehabilitation Sciences, Iran Uni- versity of Medical Sciences, Madadkaran Avenue, Shahnazari St., Madar Square, Mirdamad Blvd., Tehran, Iran. Tel.: +98 21 2222 0947 (Ext 255); Fax: +98 21 2222 0946; E-mail: kamyab.m@iums. ac.ir. incidence of 1%–8% [1–3]. Adolescents with Scheuer- 4 mann’s kyphosis (SK) have an angular thoracic kypho- 5 sis, which is often accompanied by lumbar lordosis. 6 The head is often in a forward position, and the shoul- 7 ders are often in an internal rotated position [4]. 8 The Milwaukee brace is the most effective con- 9 ventional, non-surgical treatment for hyperkyphosis in 10 adolescents [4–7]. The brace consists of two pairs of 11 corrective pads. The kyphosis pads which apply force 12 anteriorly on the apex of the curve. The shoulder pads 13 ISSN 1053-8127/18/$35.00 c  2018 – IOS Press and the authors. All rights reserved uncorrected proof version