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Open Access Research article

Inter-rater reliability of the evaluation of muscular chains associated with posture alterations in scoliosis

Carole Fortin12*, Debbie Ehrmann Feldman34, Clarice Tanaka5, Michelle Houde6 and Hubert Labelle12

Author Affiliations

1 Centre de recherche du CHU Sainte-Justine, Montréal, Québec, Canada

2 Faculté de médecine, Université de Montréal, Montréal, Québec, Canada

3 École de réadaptation, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada

4 Groupe de Recherche Interdisciplinaire en Santé, Montréal, Québec, Canada

5 Department of Physiotherapy, Communication Science & Disorders and Occupational Therapy, Faculty of Medicine, University of São Paulo, São Paulo, Brazil

6 Institut de recherche du Centre universitaire de santé McGill, Montréal, Québec, Canada

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BMC Musculoskeletal Disorders 2012, 13:80  doi:10.1186/1471-2474-13-80

Published: 28 May 2012



In the Global postural re-education (GPR) evaluation, posture alterations are associated with anterior or posterior muscular chain impairments. Our goal was to assess the reliability of the GPR muscular chain evaluation.


Design: Inter-rater reliability study. Fifty physical therapists (PTs) and two experts trained in GPR assessed the standing posture from photographs of five youths with idiopathic scoliosis using a posture analysis grid with 23 posture indices (PI). The PTs and experts indicated the muscular chain associated with posture alterations. The PTs were also divided into three groups according to their experience in GPR. Experts’ results (after consensus) were used to verify agreement between PTs and experts for muscular chain and posture assessments. We used Kappa coefficients (K) and the percentage of agreement (%A) to assess inter-rater reliability and intra-class coefficients (ICC) for determining agreement between PTs and experts.


For the muscular chain evaluation, reliability was moderate to substantial for 12 PI for the PTs (%A: 56 to 82; K: 0.42 to 0.76) and perfect for 19 PI for the experts. For posture assessment, reliability was moderate to substantial for 12 PI for the PTs (%A > 60%; K: 0.42 to 0.75) and moderate to perfect for 18 PI for the experts (%A: 80 to 100; K: 0.55 to 1.00). The agreement between PTs and experts was good for most muscular chain evaluations (18 PI; ICC: 0.82 to 0.99) and PI (19 PI; ICC: 0.78 to 1.00).


The GPR muscular chain evaluation has good reliability for most posture indices. GPR evaluation should help guide physical therapists in targeting affected muscles for treatment of abnormal posture patterns.

Posture; Reliability; Muscular chain