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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 4  |  Issue : 1  |  Page : 36-40

Reliability of two newly designed pelvic inclinometer for measurement of pelvic inclination in sagittal plane


1 Department of Orthopaedics (Physiotherapy), Santosh Deemed to be University, Ghaziabad, Uttar Pradesh, India
2 Principal/Professor Santosh College of Physiotherapy, Santosh Medical and Dental College, Ghaziabad, Uttar Pradesh, India
3 Department of Orthopaedics, Santosh Hospital, Ghaziabad, Uttar Pradesh, India

Date of Submission20-Nov-2021
Date of Decision30-May-2022
Date of Acceptance07-Jun-2022
Date of Web Publication30-Jul-2022

Correspondence Address:
Dr. Nishant Kumar Bali
K-H21 Kavi Nagar Ghaziabad, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijptr.ijptr_68_21

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  Abstract 


Context: The use of a pelvic inclinometer in medical practice to evaluate pelvic inclination angle is speedy, noninvasive, and easy to use. There is currently no goniometer available for objective measurement of innominate bone inclination in standing. In clinical assessment, it is necessary to employ portable, reliable, low-cost, and safe measurement apparatus for the measurement of pelvic inclination.
Aims: To assess the inter- and intra-tester reliability of a tripod-mounted pelvic inclinometer and a hand-held inclinometer with smartphone application for measuring the angle of pelvic inclination in the sagittal plane.
Study Setting and Design: Design of assessing and measuring reliability of pelvic inclinometer in India.
Materials and Methods: A total of 160 individuals aged between 18 and 30 years volunteered to participate in the study. Pelvic inclination angle was measured on both sides using two newly developed pelvic inclinometers in the sagittal plane. One was tripod-mounted wooden arm inclinometer and the other was hand-held inclinometer with smartphone software application. Reliability was assessed for the tripod-mounted pelvic inclinometer apparatus that is based on the idea of measuring pelvic tilts with caliper. Further, reliability was also assessed for hand-held pelvic inclinometer with software application in a mobile cell device.
Statistical Analysis Used: Cronbach's alpha (C-alpha) and intraclass correlation coefficient (ICC) were used to test reliability.
Results: The intratester reliability of the tripod-mounted wooden arm inclinometer on both left (C-alpha - 0.98; ICC - 0.94) and right sides (C alpha - 0.97; ICC - 0.93) was high. Similar findings were noted with the hand-held inclinometer with smartphone software application, with intrarater reliability being high on both right (C-alpha - 0.98; ICC - 0.95) and left sides (C-alpha - 0.98; ICC - 0.96).
Conclusion: Both the newly designed pelvic inclinometers, i.e., tripod-mounted wooden arm inclinometer and hand-held inclinometer with smartphone software application, are reliable and consistent for measuring pelvic inclination in the sagittal plane.

Keywords: Development, Inclinometer, Pelvic tilt, Sagittal plane, Software application


How to cite this article:
Bali NK, Raghav D, Dwivedi A. Reliability of two newly designed pelvic inclinometer for measurement of pelvic inclination in sagittal plane. Indian J Phys Ther Res 2022;4:36-40

How to cite this URL:
Bali NK, Raghav D, Dwivedi A. Reliability of two newly designed pelvic inclinometer for measurement of pelvic inclination in sagittal plane. Indian J Phys Ther Res [serial online] 2022 [cited 2022 Nov 29];4:36-40. Available from: https://www.ijptr.org/text.asp?2022/4/1/36/353022




  Introduction Top


The angle formed by the horizontal plane and a line passing through the midpoint of the posterior superior iliac spine (PSIS) and the midpoint of the anterior superior iliac spine (ASIS) is known as pelvic tilt, which is commonly measured using a pelvic inclinometer.[1] Innominate bone inclination is frequently measured in a comfortable standing posture by a physical therapist to assess and diagnose for any problem with the spine or pelvis. When a person stands with increased lumbar lordosis, the abdominal muscles become weak and extended, while the spine's erector and hip flexor muscles get shortened. According to various studies, postural deviations that occur away from the neutral range is a key cause of back pain.[2] The sagittal plane alignment of the pelvis is described by the angle of pelvic tilt in relaxed standing. Anterior pelvic tilt is defined as a forward rotation of the pelvis that is followed by an increase in lumbar lordosis and is linked to a variety of musculoskeletal problems, including low back discomfort and anterior cruciate ligament deficit. Furthermore, because anterior pelvic tilt has been linked to a loss of core stability, the degree of pelvic tilt has been employed to assess core potency.[3]

To identify a link between ASIS and PSIS, Sanders and Stavrakas[4] used trigonometric methods to compute pelvic bone inclination. The use of pelvic inclinometer in medical observation to assess innominate bone tilt is a quick, painless, and simple procedure. Loebl[5] was one of the firsts to describe the use of an inclinometer. In the past, inclinometer was utilized in numerous experiments conducted by the researchers in various countries. Using indexed medical equipment ensures not only the safety but also the effectiveness of the instrument that will be utilized as an investigative tool in physiotherapy clinics. Measurement of sagittal plane pelvic bone inclination using a pelvic inclinometer and the instrument's accuracy has been assessed.[6]

However, in India, there is a lack of indigenously developed equipment in our country that hinders the ability of physiotherapists in India to conduct comprehensive clinical evaluations of patients for pelvic and spinal postural abnormalities. In this context, the authors attempted to develop newly designed inclinometers for the measurement of pelvic tilt. The idea was to utilize a reliable and persuasive device to assess the pelvic inclination angle that can be employed by physiotherapy clinicians. Hence, in the current work, we developed and studied reliability of two pelvic inclinometers including portable tripod-mounted pelvic inclinometer and inclinometer with smartphone application for measurement of pelvic tilt in the sagittal plane that is cost-effective and has better ease of application and measurement such that the physiotherapists can utilize a reliable and persuasive device to assess the pelvic inclination angle.


  Subjects and Methods Top


A total of 160 healthy students (100 males and 60 females) volunteered to participate who were orally invited to participate in the study. They were either students or staff members at deemed university in Ghaziabad, Uttar Pradesh. Active low back pain was used as the exclusion criteria to exclude the confounding effects of pain on body posture in the candidates included in the study. Before their participation, they all needed to sign written informed consent form that outlines the study exclusion criteria, as well as the study objectives and goals. The ethics committee of the deemed university accepted the study protocol.

Instrumentation

Tripod-mounted pelvic inclinometer

This apparatus is based on the idea of measuring pelvic tilt with three carved wooden pieces, one of which serve as a fixed arm and the other two as caliper ends. BOSCH professional GIM 60 is positioned on the middle arm. The entire instrument is mounted on a tripod with a mobile holder as shown in [Figure 1].
Figure 1: Hand-held inclinometer with smartphone software application

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Smartphone inclinometer

This study made use of following smartphone application:[1] Peter Breitling's “Bubble Level and Clinometers” from Google Play App store (https://appsto.re/th/cdqis.i; Google Play: https://play.google.com/store/apps/details?id = com.plaincode.clinometer). The hand-held instrument is based on the idea of measuring pelvic tilt with three carved wooden pieces, one of which works as an immovable arm and the other two as caliper ends. The smartphone with the above app is put on the middle arm as shown in [Figure 2].
Figure 2: Tripod-mounted wooden carved pelvic inclinometer

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Tripod stand with mobile holder

A tripod is a three-legged structure or stand that can be moved and is used to support the weight and maintain the stability of another object. The three-legged (triangular posture) design provides good base over gravitation load as well as horizontal shear stress, and by expanding the legs away from the vertical center, increased leverage for resisting tipping over owing to lateral forces can be achieved.

Procedure for measurement

Physiotherapist (secondary investigator [SI]) was instructed and skilled in the use of both inclinometers before assembling the investigational data. While the researchers (prime investigator) palpate the ASIS and PSIS, the subjects take an upright position with their weight evenly distributed and their arms crossed over their chest. Carrying the thumbs from inferior to superior and then on the most prominent projection of the ASIS, where it was visible with fingertip, was the first palpation of the ASIS. Following the iliac crest in the posterior direction along the crest line and then contacting the thumbs superiorly and laterally from the sacral edge to the most significant projection, the PSIS was palpated and marked. Then, the caliper tips were placed over the indicated landmarks and pushed together to a hard resistance. The inclinometer's angle of inclination was straightly assessed by the researcher. To get an average, three measurements were collected on each side with both inclinometers [Figure 3] and [Figure 4].
Figure 3: Application of tripod-mounted inclinometer

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Figure 4: Application of smartphone application inclinometer

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For the assessment of reliability purpose, both primary investigator (PI) and SI were asked to read each approach three times. As a result, each investigator should take note of six readings on each side, utilizing both approaches. A total of 12 readings were taken, including the right and left innominate bones, as well as the hand-held and tripod-mounted devices, as shown in flowchart [Figure 5].
Figure 5: Flowchart of methodology of the study

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Statistical analysis

Mean and standard deviations were taken and calculated using SPSS 16 version BM, Hyderabad. Test used for analysis was Cronbach's alpha (C-alpha) and intraclass correlation coefficient (ICC). For the purpose of statistical analysis and ease of understanding, following were the codes given to the readings taken by both investigators:

  • TMBIR 1st: Reading from a tripod inclinometer by PI (1st investigator) on the right side
  • TMBIL 1st: Reading from a tripod inclinometer by PI on the left side
  • TMBIR 2nd: Reading from a tripod inclinometer by SI (2nd investigator) on the right side
  • TMBIL 2nd: Reading from a tripod inclinometer by SI on the left side
  • HDSPR 1st: Reading from a hand-held smartphone inclinometer by PI (1st investigator) on the right side
  • HDSPL 1st: Reading from a hand-held smartphone inclinometer by PI (1st investigator) on the left side
  • HDSPR 2nd: Reading from a hand-held smartphone inclinometer by SI (2nd investigator) on the right side
  • HDSPL 2nd: Reading from a hand-held smartphone inclinometer by SI (2nd investigator) on the right side.



  Results Top


A total of 160 subjects were taken for the study. The study involved two researchers and two sets of sagittal plane pelvic tilt measurement on the right and left sides. Using a hand-held and tripod-mounted inclinometer, the mean of the primary researcher's three frequent sets of readings on mutual sides was taken. On the left, C- alpha was 0.98, and the ICC was 0.94, whereas on the right, C-alpha was 0.97 and the ICC was 0.93. The hand-held pelvic inclinometer's intratest reliability confirms the results. ICC of tripod-mounted wooden arm inclinometer for sagittal plane pelvic tilt in standing was 0.85 for mutual side with C-alpha value of 0.92 of right and left sides, while ICC for smartphone inclinometer with wooden arm for sagittal plane pelvic tilt was 0.86 with C-alpha value of 0.92 for mutual side [Table 1],[Table 2],[Table 3].
Table 1: Mean of measurements of both evaluators for the two inclinometers

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Table 2: Inter-rater reliability for both inclinometers

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Table 3: Intra-rater reliability for both inclinometers

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  Discussion Top


The goal of the current study was to determine reliability of tripod-mounted pelvic inclinometer and a smartphone application inclinometer among college students. The findings of the study demonstrated high inter- and intra-rater reliability of both inclinometers.

In the past, to find a link between ASIS and PSIS, Sanders and Stavrakas used the trigonometric method to assess pelvic tilt.[4] In a previous study, two therapists were required to note the reading with one therapist to hold the caliper and the other to take note of reading.[7] However, in the present study, tripod-mounted digital inclinometer was employed in such a way that it provides sagittal plane movement measurement of the pelvis. This design firmly conforms at patient's bony landmarks, making it easy to note the reading and application of inclinometer by a single therapist. Conventionally, only a skilled physical therapist was able to apply the pelvic inclinometer and make accurate measurements of pelvic inclination angle. These newly designed digital pelvic inclinometers show potential as valuable assessment equipment for clinicians treating pelvic asymmetry and pelvic tilt angle postural issues. The procedure's precision will enable for the collection of normal and pathological data.

In the present study, a mobile app inclinometer was employed to monitor pelvic tilt in such a way that it noted sagittal plane measurement of pelvic movement. Currently, no other study used mobile application to measure the pelvic movement in the sagittal plane. However, bubble level inclinometers with software application were created to utilize smartphone's inbuilt accelerometers in a prior study, and it was verified for detecting hip rotational angles.[8] As indicated by the systematic review which included 17 papers from 2011 to the present, the use of smartphone apps in the joint assessment is becoming more prevalent.[9]

Many of the existing applications make use of the smartphone's built-in accelerometers, but some additionally make use of magnetometers and camera systems. The applications are a wonderful alternative to traditional clinical approaches because of their low cost and accessibility across a wide range of smartphones, as well as, in contrast to goniometry, their simplicity and speed of usage. The challenges with hygiene are similar to those experienced when using an inclinometer, and smartphones with flat exteriors that can be wiped with alcohol have advantages in clinical practice and research.[10]

Although radiographic investigations provide the precise data on sagittal plane inclination, this methodology is often regarded as potentially risky and expensive. However, these portable inclinometers used in present study are non-radiographic method of assessing the normal deviation that may occur from day to day activities.


  Conclusion Top


The two newly designed inclinometers have good inter-rater and intra-rater reliability for measuring anterior/posterior pelvic tilt or inclination in the sagittal plane in standing. These inclinometers are feasible and have ease of application for assessment with good prognostic value.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Salian SC, Gupta S, Yardi S. Intra-tester and inter-tester reliability of measures of pelvic inclinometer in standing using hand held and mounted pelvic inclinometer in asymptomatic individuals. Int J Innov Res Dev 2015;4:18-22.  Back to cited text no. 1
    
2.
Koumantakis GA, Nikoloudaki M, Thacheth S, Zagli K, Bitrou K, Nigritinos A, et al. Reliability and validity measurement of sagittal lumbosacral quiet standing posture with a smartphone application in a mixed population of 183 college students and personnel. Adv Orthop 2016;2016:3817270. doi: 10.1155/2016/3817270.  Back to cited text no. 2
    
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Chowdhury S, Yardi S. Intertester and intratester reliability and validity of measures of innominate bone inclination in standing using PELVIN. Int J Innov Res Sci Eng Technol 2015;4:5069-77.  Back to cited text no. 3
    
4.
Sanders G, Stavrakas P. A technique for measuring pelvic tilt. Phys Ther 1981;61:49-50.  Back to cited text no. 4
    
5.
Loebl WY. Measurement of spinal posture and range of spinal movement. Ann Phys Med 1967;9:103-10.  Back to cited text no. 5
    
6.
Reddi HB, Vinod Kumar KC, John AT. Inter tester and intra tester reliability of a self-designed pelvic inclinometer in asymptomatic population: A pilot study. IJCRT 2018;6:744-8.  Back to cited text no. 6
    
7.
Walker ML, Rothstein JM, Finucane SD, Lamb RL. Relationships between lumbar lordosis, pelvic tilt, and abdominal muscle performance. Phys Ther 1987;67:512-6.  Back to cited text no. 7
    
8.
Ganokroj P, Sompornpanich N, Kerdsomnuek P, Vanadurongwan B, Lertwanich P. Validity and reliability of smartphone applications for measurement of hip rotation, compared with three-dimensional motion analysis. BMC Musculoskelet Disord 2021;22:166.  Back to cited text no. 8
    
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Keogh JW, Cox A, Anderson S, Liew B, Olsen A, Schram B, et al. Reliability and validity of clinically accessible smartphone applications to measure joint range of motion: A systematic review. PLoS One 2019;14:e0215806.  Back to cited text no. 9
    
10.
Vohralik SL, Bowen AR, Burns J, Hiller CE, Nightingale EJ. Reliability and validity of a smartphone app to measure joint range. Am J Phys Med Rehabil 2015;94:325-30.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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