ORIGINAL ARTICLE 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 1,2 & Pipatana Amatachaya 2,3 & Thanat Sooknuan 2,4 & Patiphan Tochaeng 2,4 & Kanjana Kramkrathok 2,4 & Thiwabhorn Thaweewannakij 1,2 & Nuttaset Manimmanakorn 2,5 & Sugalya Amatachaya 1,2 Received: 16 November 2017 /Accepted: 6 February 2018 # International Osteoporosis Foundation and National Osteoporosis Foundation 2018 Abstract Summary 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. Purpose 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. Methods 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). Results 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 (ICC 3,3 = 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 . Conclusion 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 standard- ization of hyperkyphosis measurements in various settings. Keywords Round back . Dowager’ s hump . Assessment . Spinal fracture . Cobb angle Introduction Thoracic hyperkyphosis is a progressive condition that is commonly characterized by a backward deviation of the thoracic spine exceeding 40 degrees, and it tends to increase with age [1]. Thus, the condition is particularly evidenced in the elderly (up to 40%), with the most pronounced in the oldest age groups. It can induce adverse health and other * Pipatana Amatachaya pipatana.am@rmuti.ac.th * Sugalya Amatachaya samata@kku.ac.th 1 School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand 2 Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand 3 Department of Mechanical Engineering, Faculty of Engineering and Architecture, Rajamangala University of Technology Isan, Nakhon Ratchasima, Thailand 4 Department of Electrical Engineering, Faculty of Engineering and Architecture, Rajamangala University of Technology Isan, Nakhon Ratchasima, Thailand 5 Department of Rehabilitation Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand Archives of Osteoporosis (2018) 13:25 https://doi.org/10.1007/s11657-018-0433-9