Propriedades de medida de instrumentos clínicos para mensuração da postura torácica: uma revisão sistemática com metanálise

Abstract

In clinical practice, the thoracic posture assessment by physical therapists is usually performed by visual inspection. This reduces the precision of quantifying the magnitude of changes in thoracic posture associated with different health conditions, aging and treatments. The relationship of thoracic posture in the sagittal plane with different health conditions and aging has been investigated in several studies due to the implications that the reduction or increase of this curvature can cause throughout life. The use of low-cost, portable, and easy-to-handle instruments can contribute to thoracic posture measurement in clinical environments by ensuring a quick and comfortable patient evaluation. These instruments allow accurate measurement and monitoring of the thoracic posture to prevent or minimize its consequences and evaluate the effectiveness of the treatment. Therefore, the aim of this study was to systematically review studies that investigated the reliability and validity of clinical instruments for quantitative assessment of thoracic posture in the sagittal plane. A systematic search of the MEDLINE and EMBASE (by Ovid) database was performed, from the earliest record to December 2019, with additional search on Google Scholar and hand-searching. The search was conducted using terms related to “thoracic kyphosis”, measurement properties (validity and reliability), and clinical instruments. Studies that investigated the reliability or validity of non-invasive thoracic posture measurement instruments in the sagittal plane were included regardless of the study design or language. Two reviewers screened titles, abstracts, and full texts for studies inclusion and examined the methodological quality of included studies according to Brink and Louw appraisal tool. When sufficient data were present for a given clinical instrument, data were meta-analyzed on Pearson correlation coefficients (r) or Intraclass Correlation Coefficients (ICC) for validity and reliability, respectively. Measures with excellent psychometrics (ICC>0.80 and r>0.80) and 9/10 in clinical utility scores were recommended. This review was registered at PROSPERO (CRD42019124956). Sixty studies were included in the systematic review. Fourteen instruments were pooled in the meta-analyzes showing excellent levels of intra- and inter-rater reliability and a moderate to strong correlation with the gold standard. Pooling of intrarrater reliability estimated overall reliability of 0.94 (95% CI 0.93 – 0.96); I²: 61.42%; interrater reliability estimated overall reliability of 0.92 (95% CI 0.90 – 0.95); I²: 80.15% and correlation of instruments with X-ray exams estimated overall validity of 0.80 (95% CI 0.73 – 0.85); I²: 90.67%. Sensitivity analyses suggested that different instruments and may impact on the overall data estimated. The findings of this review suggests that Flexicurve Angle and Index, Analog Inclinometer and Spinal Mouse are reliable and valid instruments for measuring thoracic posture. The clinical utility analysis points to the use of Flexicurve Angle and Analog Inclinometer in clinical practice.