二维图像体表测量中三种角度指标评估非特异性颈痛患者姿势的信效度研究

关键词：姿势  非特异性颈痛  信度  效度  图像测量

Keywords:posture  non-specific neck pain  reliability  validity  photographic measurement

摘要：

      摘要 目的：探究二维图像体表测量中，三个头颈部姿势指标的评估者内及评估者间信度，对比分析和量化三者从姿势角度对慢性非特异性颈痛的诊断及评估效能。 方法：研究共招募52例慢性非特异性颈痛患者（CNNP）和23例正常人。使用整体姿态系统采集二维面图像后，进行测量及相关研究分析。首先随机抽取25例CNNP患者图像数据分别由两个评估者在不同时间段对其颅椎角（CVA）、矢状面头部仰角（SHA）和肩前伸角（PSA）进行测量，以探究评估者间及评估者内信度。随后由其中一位评估者继续完成所有参与者的数据测量，汇总后进行诊断和评估效能研究。 结果：CNNP患者SHA、CVA和PSA的评估者内/评估者间信度分别为0.859/0.790、0.846/0.809和0.91/0.917，评估者内/间的三者的最小可检测变化（MDC）依次为3.536/4.234°、2.583/2.845°和7.429/7.147°。CNNP患者的SHA显著大于正常人群（P<0.01），而CVA和PSA明显小于正常人群（P<0.01）。三者的受试者工作曲线下面积（AUC）依次分别为0.861、0.794和0.947，PSA的效能最高。用于区分CNNP与正常人群的理想界值依次为19.5°、57.5°和31.5°。 结论：二维图像测量CVA、SHA和PSA在评估CNNP患者的颈前伸、头后仰及圆肩的异常姿势中具有较好的信效度。使用这些指标进行研究的过程中需要充分考虑其最小可检测差异和区分界值点。

Abstract:

      Abstract Objective：To explore the intra- and inter-rater reliability of three head and neck posture indicators in photographic images to assess the posture of patients with chronic non-specific neck pain (CNNP)， and to compare and quantify the diagnosis and assessment of chronic non-specific neck pain from the perspective of posture. Method：A total of 52 patients with CNNP and 23 normal subjects were enrolled. After collecting the right side image of the participants using the Global Posture System，25 patients were randomly selected and the Craniovetebral Angle (CVA)， Sagittal Head Angle (SHA) and Portracted Shoulder Angle (PSA) were measured by two assessors at two different time for reliability study. Then one of the assessors continued to complete the measurements of all participants for validity study. Result：The intra- and inter-rater reliability of SHA， CVA， and PSA in CNNP patients were 0.859/0.790， 0.846/0.809， and 0.91/0.917， respectively. And the corresponding minimal detectable change were 3.536/4.234°， 2.583/2.845° and 7.429/7.147°. The SHA of patients with CNNP was significantly greater than that of the normal population (P<0.01)， while CVA and PSA were significantly lower than those of the normal population (P<0.01). The area under the curve of SHA， CVA， and PSA were 0.861， 0.794 and 0.947， respectively， among which PSA was the most effective. The ideal cut-off point of three indicators to distinguish CNNP were 19.5°， 57.5°， and 31.5°， respectively. Conclusion：CVA， SHA and PSA from photographic measurements have good reliability and validity in evaluating the abnormal posture of the neck extension， head tilt and round shoulder of CNNP patients. The minimal detectable changes and cut-off point should be taken into account when using these indicators.