Validity of a qualitative visual method for diagnosing forward head posture

Introduction

Forward head posture (FHP) is quantitatively diagnosed by measuring the craniovertebral angle (CVA). A qualitative visual method has recently been introduced but the validity of this method has not been confirmed. The present study aimed to clarify the validity of the visual method, using CVA methods as a standard.

Methods

CVAs were measured photographically, adopting reported criteria of less than 53° or 55° to diagnose FHP. The visual method defined a positive FHP as the back of participant's head not touching the wall while standing with heels, buttocks and shoulder blades touching the wall. These studies were performed in healthy young adults. Rates of positive FHP were compared between methods. Positive predictive values were then calculated for FHP based on CVA methods.

Results

The study population comprised 37 men and 43 women (21 ± 1 years). With the visual method, 41% (33/80) had FHP. With CVA methods using criteria of 53° and 55°, 34% (27/80) and 50% (40/80) displayed FHP, respectively. However, the visual method exhibited a male predominance in the group with FHP compared to that without FHP, together with high body mass index (BMI). Positive predictive values were 0.42 and 0.61 for FHP by CVA methods using criteria of 53° and 55°, respectively.

Conclusion

The visual method exhibited positivity rates approximating those using CVA methods of 53° and 55°. However, the relatively low positive predictive values suggested the visual method was inferior to CVA methods, partly due to the increased positivity rate for males with high BMI.