The strongest levels of evidence for reliability exists in support of the Debrunner kyphometer , Spinal Mouse and Flexicurve index , and for validity supports the arcometer and Flexicurve index .
BACKGROUND A wide array of instruments are available for non-invasive thoracic kyphosis measurement .
Guidelines for selecting outcome measures for use in clinical and research practice recommend that properties such as validity and reliability are considered .
This systematic review reports on the reliability and validity of non-invasive methods for measuring  thoracic kyphosis .
Interrater and Intrarater Reliability in the Measurement of Kyphosis in Postmenopausal Women With Osteoporosis
Study Design . A reliability study was performed using repeated r and om measurements involving three observers , 26 subjects and three instruments . Objectives . To determine the most reliable , cost‐effective , noninvasive , and clinical ly feasible method of measuring spinal kyphosis .  Summary of Background Data . The most clinical ly useful , noninvasive and reliable method of measuring postural deformity in spinal osteoporosis ( kyphosis ) remains unqualified . Despite traditional use of costly , invasive roentgenographs for the evaluation of spinal kyphosis , the reliability of this method remains question able . Methods . Twenty‐six postmenopausal women with known bone mineral density and a diagnosis of osteoporosis were recruited from the Osteoporosis Program at Women 's College Hospital , Toronto , Canada . Noninvasive measurements of thoracic kyphosis were obtained by three trained examiners using the DeBrunner 's kyphometer and the flexicurve ruler . The intrarater and interrater reliability of and between each method was compared , using roentgenographic films obtained in the sagittal plane . Spinal posture was classified according to the method of Itoi ( 1990 ) . Statistical computations were performed using SAS statistical software . Results . Consistent measurements were obtained with the  DeBrunner 's kyphometer  and the flexicurve ruler by each observer , according to the results of critical two‐way analysis of variance ( Intraclass Correlation Coefficient 2,1 ) . Measurements in two subgroups , healthy backs ( n = 11 ) and rounded backs ( n= 13 ) , showed consistent use of each noninvasive instrument with some examiner preference for specific tools . There was marginally better intrarater and interrater reliability using the DeBrunner 's kyphometer compared with that obtained with the flexicurve ruler . Two‐way analysis of variance ( Intraclass Correlation Coefficient 2,1 ) of collapsed data showed no significant difference in the reliability of the kyphometer , flexicurve ruler , or roentgenographs in the measurement of thoracic kyphosis . Conclusions . The flexicurve ruler and DeBrunner 's kyphometer had the closest agreement in the measurement of spinal kyphosis . The kyphometer demonstrated the least variation in intrarater and interrater reliability when compared with the flexicurve ruler and roentgenographs . The flexicurve ruler permits qualitative assessment of posture , however , and is the most costeffective instrument . The results of this study challenge the traditional belief that roentgenographic analysis is the best method for evaluating spinal kyphosis . The DeBrunner 's kyphometer and flexible ruler may represent viable , cost‐effective and noninvasive alternatives to roentgenographic evaluation of spinal kyphosis
The strongest levels of evidence for reliability exists in support of the Debrunner kyphometer , Spinal Mouse and Flexicurve index , and for validity supports the arcometer and Flexicurve index .
BACKGROUND A wide array of instruments are available for non-invasive thoracic kyphosis measurement .
Guidelines for selecting outcome measures for use in clinical and research practice recommend that properties such as validity and reliability are considered .
This systematic review reports on the reliability and validity of non-invasive methods for measuring  thoracic kyphosis .