SciELO – Brasil – Biofotogrametria confiabilidade das medidas do protocolo do software para avaliação postural (SAPO) Biofotogrametria confiabilidade das medidas do protocolo do software para avaliaçã

Abstracts

Fotogrametria ; Reprodutibilidade do testes ; Postura ; Avaliação de programas e instrumentos de pesquisa A fotogrametria vem sendo utilizada como um valioso recurso diagnóstico para a verificação vitamin e mensuração de alterações posturais, porém a ausência de padronização das referências anatômicas, do ângulos obtidos entre estas e sua significância dificulta a comparação entre estudos e a confiabilidade suffice resultados encontrados. O objetivo do estudo foi verificar a confiabilidade bury e intra-examinadores district attorney medidas angulares propostas pelo software de avaliação postural SAPO v. 0.68. Participaram do estudo 24 sujeitos, oxygen quais foram fotografados na postura em pé, seguindo as recomendações do SAPO. Três avaliadores ( A, B e C ) experientes no uso do programa analisaram as imagens, repetindo essa análise sete defense intelligence agency após. A variância, o coeficiente de correlação intraclasse ( ICC ) e teste T com nível significância de 5 % foram aplicados. Resultados indicaram que na confiabilidade interexaminadores dos 20 ângulos mensurados, department of the interior foram classificados como não aceitáveis ( A13 : ICC=0,623 e A14 : ICC=0,568 ), um como aceitável ( A19 : ICC=0,743 ), um como muito bom ( A20 : ICC=0,860 ) e 16 como excelentes ( ICC > 0,90 ). Na avaliação district attorney repetibilidade do método, por um mesmo avaliador, dois ângulos mensurados pelo examinador A foram significativamente diferentes em duas medidas ( A11 : p=0,015 ; A12 : p=0,026 ) ; também dois ângulos pelo examinador B ( A2 : p=0,019 ; A12 : p=0,015 ) e um ângulo pelo examinador C ( A16 ; p=0,011 ). Concluíu-se que os ângulos propostos pelo protocolo SAPO mostraram-se confiáveis após avaliação entre diferentes examinadores para mensurar operating system segmentos corporais Photogrammetry is a valuable tool for the diagnosis and measurement of postural changes, but the miss of calibration of anatomic references and angular measures impairs the comparison between studies and compromises the dependability of the results. The objective of this study was to evaluate the inter- and intraexaminer dependability of angular measures proposed by the SAPO carriage assessment software ( v. 0.68 ). twenty-four subjects were photographed in the standing side according to the recommendations of the SAPO software. Three examiners ( A, B and C ) experienced in the use of the software analyzed the images and repeated the analysis after 7 days. Variance, intraclass correlation coefficient coefficient ( ICC ), and t-test adopting a level of meaning of 5 % were applied. With deference to interexaminer dependability among the 20 angles measured, two were classified as impossible ( A13 : ICC = 0.623 ; A14 : ICC = 0.568 ), one as satisfactory ( A19 : ICC = 0.743 ), one as identical good ( A20 : ICC = 0.860 ), and 16 as excellent ( ICC > 0.90 ). evaluation of repeatability of the method acting by the same examiner showed that two angles measured by examiner A differed significantly between the two measurements ( A11 : phosphorus = 0.015 ; A12 : p = 0.026 ), as did two angles measured by examiner B ( A2 : p = 0.019 ; A12 : p = 0.015 ) and one fish measured by examiner C ( A16, phosphorus = 0.011 ). In conclusion, comparison between different examiners showed that the angles proposed by the SAPO protocol are authentic for the measurement of body segments.

ORIGINAL ARTICLE

IUniversidade Federal de Santa Maria. Santa Maria, RS. Brasil

IIUniversidade Federal de Santa Maria. Programa de Pós-graduação em Distúrbios district attorney Comunicação Humana. Santa Maria, RS. Brasil

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ABSTRACT

Photogrammetry is a valuable tool for the diagnosis and measurement of postural changes, but the miss of standardization of anatomic references and angular measures impairs the comparison between studies and compromises the dependability of the results. The objective of this study was to evaluate the inter- and intraexaminer dependability of angular measures proposed by the SAPO carriage appraisal software ( v. 0.68 ). twenty-four subjects were photographed in the standing position according to the recommendations of the SAPO software. Three examiners ( A, B and C ) experienced in the manipulation of the software analyzed the images and repeated the analysis after 7 days. Variance, intraclass correlation coefficient ( ICC ), and t-test adopting a level of meaning of 5 % were applied. With respect to interexaminer dependability among the 20 angles measured, two were classified as unacceptable ( A13 : ICC = 0.623 ; A14 : ICC = 0.568 ), one as acceptable ( A19 : ICC = 0.743 ), one as very good ( A20 : ICC = 0.860 ), and 16 as excellent ( ICC > 0.90 ). evaluation of repeatability of the method acting by the same examiner showed that two angles measured by examiner A differed significantly between the two measurements ( A11 : phosphorus = 0.015 ; A12 : phosphorus = 0.026 ), as did two angles measured by examiner B ( A2 : phosphorus = 0.019 ; A12 : phosphorus = 0.015 ) and one slant measured by examiner C ( A16, phosphorus = 0.011 ). In conclusion, comparison between unlike examiners showed that the angles proposed by the SAPO protocol are reliable for the measurement of soundbox segments .

Key words: Evaluation of research programs and joyride ; Photogrammetry ; Posture ; Reproducibility .

INTRODUCTION

body pose is defined as the balance arrangement of body structures and is determined by the proportional side of body segments at a given time1-3. In the ideal postural conjunction, it is expected that the muscles, joints and their implicit in structures are in a department of state of dynamic balance wheel that causes minimum try and overload and permits the most efficient performance of the locomotive apparatus1. however, although consensus exists regarding effective carriage and its implications, soundbox military capability is a complex phenomenon that is unmanageable to measure4 .

The evaluation of body pose in the standing position has been widely used over several decades in both clinical commit and scientific studies as a diagnostic cock and for the plan and monitor of physiotherapeutic treatment4-6. different methods such as digital photogrammetry are available for the biomechanical psychoanalysis of carriage in a electrostatic position7-14. The american Society of Photogrammetry defines photogrammetry as “ the art, science and engineering of obtaining dependable information about physical objects and the environment through the processes of commemorate, measuring and interpreting photographic images and patterns of beaming electromagnetic energy and early sources ”. According to Ribeiro et al15, photogrammetry is a relatively elementary, well applied and aim proficiency. Its abject cost, easy photo-interpretation, high preciseness, and reproducibility of the results, equally well as the possibility to store and access records, are advantages that explain the wide application of this method. Photogrammetry is besides a valuable creature for the monitor of postural changes over prison term since it permits to capture elusive changes and to correlate different parts of the body that are unmanageable to measure16. however, the repeatability of the technique for this temporal evaluation, a well as in scientific studies, should be guaranteed by a series of methodological parameters7 .

The combination of digital photography and softwares that permit the measurement of angles and horizontal and vertical distances such as Corel Draw and AutoCAD, or programs specifically developed for model assessment such as the Alcimagem and SAPO ( Posture Assessment Software ) programs has led to the far-flung use of photogrammetry. The SAPO software is a computer program developed by researchers of the University of São Paulo that is freely available on the internet. The software is based on the digitization of images and comprises different functions such as persona calibration, soar, score of anatomical reference landmarks, and measurement of distances and body angles17,18. The SAPO protocol is a proposal of landmarks and measures that can be used for postural assessment. The option of these landmarks was based on clinical relevance, scientific testify, methodological viability, and applicability18 .

angular measurements in the human torso are used for the investigation of articulation dysfunction and are an crucial parameter for physiotherapeutic monitoring, motivation and treatment conformity of the patient, quantification of disorders, evaluation of the efficacy of interventions, and fabrication of orthoses 19. however, the miss of calibration of anatomic landmarks and angular measurements used in photogrammetry studies impairs the comparison between investigations and the establishment of the results found .

Despite the increasing number of studies using photogrammetry11,13,16,20, there is no standardization of the angles used for the decision of certain postural changes. In addition, only few studies have evaluated the dependability and reproducibility of the position assessment programs used. therefore, the objective of the salute study was to evaluate the inter- and intraobserver dependability of the angular measures defined in the protocol of the SAPO v. 0.68 software .

METHODOLOGICAL PROCEDURES

Subjects

twenty-four subjects ranging in age from 20 to 35 years ( base : 25 years ) were randomly selected from a pose assessment database of patients with temporomandibular disorders. Excluded were amputate patients, patients with neurological problems, systemic diseases, congenital clubfoot, lower limb fracture and balance disorders, and patients undergo physiotherapeutic treatment .

The study was approved by the Ethics Committee of the Federal University of Santa Maria ( protocol 0048.0.243.000-08 ). The volunteers signed a formal accept phase to participate in the study according to Resolution 196/96 of the National Health Council .

Photographic recording

The photograph were taken according to the recommendations of the SAPO software. For this aim, a plumb line was attached to the ceiling and two styrofoam balls were fixed to the electrify 1 meter apart for subsequent double calibration. The subject was positioned in such a manner that he and the plumb argumentation were on the same plane perpendicular to the axis of the digital television camera ( Sony, DSC-S40, resolution of 4.1 megapixels, 3.0x soar ). The camera was positioned at a distance of 3 meters and supported on a tripod at a height of about half the acme of the topic .

The topic was photographed in the anterior, left lateral and posterior views. According to the SAPO protocol, the bony landmarks, which served as guides for calculation of the angular measures, were marked with styrofoam balls at the anatomic landmarks illustrated in Figure 1. The angles used by the protocol are shown in Picture 1. The marking of anatomic landmarks and photographic recording were constantly performed by two prepare examiners .

Photogrammetry

After skill of the photograph, the images were transferred to a calculator and copies were given to three examiners, who were experienced in the consumption of the SAPO program, for photogrammetric psychoanalysis of the body position of all subjects. The instructions were to calibrate the image, mark the landmarks used by the protocol, create a report of analysis, and export it to Excel. This procedure was repeated after one workweek for the evaluation of repeatability and dependability. The angles between the anatomic landmarks determined by the protocol were quantified mechanically according to software conventions .

Data analysis

The SPSS 17.0 and SAS 9.1 programs were used for statistical psychoanalysis. The normality of the angular datum was tested by the Shapiro-Wilks test. one-way analysis of variance ( ANOVA ) was then applied to the set of data of the three examiners to evaluate differences between variances, and the Tukey multiple comparisons post-test was used to determine which means were significantly different .

Interobserver reproducibility, i, the fact that the same resultant role is obtained for the same slant provides by different examiner, was evaluated using the intraclass correlation coefficient coefficient ( ICC ). An ICC higher than 0.7 is normally used in dependability studies as the brink to indicate a “ sufficiently reproducible ” method acting. An ICC of 1 indicates identical angular measures in the comparisons performed. ICC values lower than 0.70 are classified as not acceptable, values of 0.71 to 0.79 as acceptable, values of 0.80 to 0.89 as very beneficial, and values higher than 0.90 as excellent4,21,22 .

Intraobserver repeatability, which is defined as the ability of an examiner to provide the lapp resultant role for the lapp angle on different occasions, was evaluated based on the degree of taxonomic dispute between pairwise measurements ( the like examiner at two distinct time points ) using the copulate t -test. A flat of significance of 5 % was adopted in this study .

RESULTS

table 1 shows the results of ANOVA obtained for the angles measured by the three examiners and the interobserver ICC. The angular measures obtained by the three examiners during photogrammetric analysis by the SAPO protocol in the two situations proposed are shown in table 2. This table besides shows the taxonomic differences between the two measurements obtained by the lapp examiner ( copulate t -test ) .

ANOVA revealed no significant differences between the measurements obtained by the three examiners. similarly, the flat of dependability and reproducibility of the angles were confirmed by the ICC : two of the 20 angles measured were classified as not acceptable ( A13 and A14 ), one as acceptable ( A19 ), one as identical good ( A20 ), and 16 as excellent .

evaluation of the repeatability of the method acting performed by the same examiner on different days showed that two angles measured by examiner A were importantly different ( A11, A12 ), as were two angles measured by examiner B ( A2, A12 ), and one lean measured by examiner C ( A16 ) .

DISCUSSION

A dependable diagnostic operation is defined as a method acting in which repeated measures of the same variable constantly yield the same solution within satisfactory variations. Reliability is related to the preciseness of the routine, which should be reproducible and static and show a minimal systematic or random error. measurement errors are due to variations between observers, assessment tools or the variable to be measured. If dependability is first gear, the robustness of the method acting can not be determined23 .

The dependability of most angles described in this study has not been evaluated, although they are wide used in scientific studies11,16,20. In this respect, using intra- and interobserver assessment, Zonnenberg et al.8 found that photogrammetry provides dependable data and consistent measures. Iunes et al.4 evaluated the intra- and interobserver dependability of 22 angles measured with the Alcimagem software. Four of these angles are besides used in the SAPO protocol ( A3, A9, A10, and A11 ). In the portray study, excellent dependability was obtained for four angles upon interobserver appraisal, and intraobserver evaluation revealed alone one angle ( A11 ) that differed between the two measurements performed by examiner A. In the study of Iunes et al.4, angles A3, A9 and A10 showed excellent interobserver dependability and slant A11 very well dependability. Intraobserver evaluation showed that angles A3 and A9 did not reach acceptable levels, whereas the dependability of angles A10 and A11 was acceptable. Braz, Goes and Carvalho17 demonstrated the dependability and intra- and interobserver cogency of the SAPO software, but the authors analyzed 15 different angular measures obtained with goniometers arranged in a dialog box. Sacco et al.12 analyzed lower limb angles with the Corel Draw v. 12 and SAPO v. 0.63 programs and compared them to those obtained with a goniometer. The authors found the results obtained with the unlike methods to be authentic, except for lean Q which presented similar results with the photogrammetry tools but different values when measured with a goniometer. In the present discipline, angle Q ( A9 and A10 ) showed an excellent flat of inter- and intraobserver dependability, in agreement with the study of Caylor, Fites and Worrel24 .

The results of the inter- and intraobserver evaluation showed that most of the angular measurements of the SAPO protocol are reliable. Among the angles that showed non-acceptable ICC upon interobserver evaluation ( A13 and A14 ) and non-repeatable intraobserver values ( A2, A11, A12, and A16 ), five were obtained in the sagittal horizon. Iunes et al.4 besides observed that angular measurements made in the sagittal view were less authentic than those measured in the frontal watch. Angles A13 and A14 are traced from the acromion, trochanter and upright reference credit line and lateral malleolus, respectively. The lower reproducibility of these angles might have been due to subjectivity of the examiners or to occasional factors, suggesting circumspection when using these angles for lateral pass military capability assessment. With esteem to angles A11, A12 and A16 that consider the tragus, seventh cervical vertebra, acromion and iliac spines, variations in the deep views exist when localizing anatomic landmarks recorded on the photograph. This fact may explain the miss of repeatability between measurements. however, Dunk et al.20 found the sagittal view to best reflect the clinical development of postural changes since in this horizon the angular measurements differ from zero, whereas in the frontal view they tend to approach zero ( symmetry ). The authors besides emphasized that the results of photogrammetry are dependable when anatomic landmarks are used rather of an external vertical reference .

The reproducibility of the Alcimagem software investigated by Iunes et al.4 using to photographs of the lapp subject was classified as unsatisfactory for 15 of the 22 angles analyzed. The authors explained these findings by the error built-in to the experimental routine since the subjects were photographed at clear-cut time points. analysis of the angular measurements of the SAPO protocol showed that four of the 20 angles were not reproducible in two measurements of the same examiner using the lapp photograph. One of these angles ( A12 ) could not be reproduced by two of the three examiners ( examiners A and B ). Since the error implicit in to the placement of the markers, i, the position of the apparatus, was controlled since the three examiners evaluated the same record, this difference may be explained by the abject resolving power of the photograph and/or by the hindrance of subjective factors of the examiner at the clock of analysis. In addition, the little number of subjects may besides have influenced the results .

Dunk et al.25 studied the dependability of photogrammetry in determining a stable measure of person position. A across-the-board coefficient of mutant and broken ICC indicated the poor repeatability of the method for the evaluation of subjects on the like day and on different days. The authors reported that the use of upright references for the calculation of angles is subject to errors due to body variations in the digest position. This brings into wonder the robustness of photogrammetry as a tool to monitor postural changes .

It should be emphasized that photogrammetry provides a two-dimensional quantification of the soundbox and that the truthful postural change may be hidden by the flat evaluated. frankincense, this method acting should not replace, but preferably complement, clinical examen. The advantages of the protocol of the SAPO software are its practicality and that it permits the standardization of measures and application of photogrammetry, and the attendant comparison between studies. Its disadvantages are related to lateral pass postural appraisal since postural changes, specially in relation to the spinal anesthesia curves, are good visualized in this opinion and the stream SAPO protocol does not evaluate these curves. however, this does not compromise the SAPO program, but suggests far analysis and inclusion of extra angular measurements obtained in the sagittal position in the protocol .

The reproducibility of this evaluation at distinct time points is hush a col in photogrammetry studies and this was not the objective of the give probe. further studies are needed to analyze angular measurements in subjects whose anatomical reference landmarks were marked on different days .

CONCLUSION

The present results showed that most of the angular measurements proposed for the quantification of postural asymmetries by the protocol of the SAPO software are satisfactorily authentic when evaluated by different examiners using the same photographic record. Interobserver assessment revealed that two angles in the sagittal opinion did not reach an satisfactory degree of dependability. In contrast, evaluation of intraobserver dependability showed that two angles measured by examiner A differed significantly between the two measurements, as did two angles measured by examiner B, and one angle measured by examiner C. Thus, greater caution is needed when using these angles obtained in the sagittal position .

REFERENCES

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