A total of 432 respondents completed the survey, but one respondent did not indicate consent so their data were not included, resulting in a sample size 431. A single respondent agreed to the consent for the survey but refused to contribute any responses to any of the questions and is not included in the data analysis. The breakdown of professions represented in the sample is shown in Table 2.
Table 2
Perspectives on posture
Objective (a) - The MHPs' use of postural assessment
Assessing posture in clinical practice received 429 valid responses. Of the responses, 85% (363/427) said they assessed posture objectively. These included 84% (285/340) of physiotherapists, 88% (38/43) of osteopaths, and 89% (40/45) of chiropractors.
The objective assessment of posture among MHPs was multimodal. Out of 430 responses around the main modes of assessment, 78% (336/430) were visual estimation, 9% (38/430) photogrammetry, and 9% (39/430) mobile applications. Physiotherapists (80%, 272/342) and chiropractors (84%, 38/45) were more likely than osteopaths (64%, 27/42) to conduct visual assessments. The results of Fisher's Exact Test (p=0.06) indicate an association approaching significance between the professions.
Notably, 22% (95/429) did not objectively measure posture with a similar split on the interprofessional breakdown for physiotherapists (22%, 74/342), chiropractors (18%, 8/45), and osteopaths (31%, 13/42). The difference between the professions was significant, with X2 = 5.950 and p = 0.05. The 28 responses to the open question on modes of assessment were grouped into 12 categories. Six responses involved photogrammetry; four cases had already selected photogrammetry as an option; therefore, only two responses were added to categories determined by the closed questions. Similarly, the visual estimation data increased by a single response. Other types of posture assessment included X-ray (3/430), tactile methods (6/430) and other video/ software methods (4/430).
The usefulness of a tool for grading posture received 429 responses; however, three respondents gave two answers instead of one, such as 'yes/maybe' or 'maybe/no'. The responses for each professional are shown in Fig. 1.
Overall, 29% (125/432) said 'yes', 37% (160/432) 'maybe', and 34% (147/429) 'no' when asked if a posture grading tool would be useful. Interestingly, 49% of chiropractors reported 'yes' compared with 27% of physiotherapists and 23% of osteopaths. Similarly, among those who said 'no', 37% were physiotherapists, 33% osteopaths, and only 16% of chiropractors (Fig. 1). The Fisher's Exact test results were statistically significant with (p=0.011).
Objective (b) – MHPs' perspectives on objective posture assessment
Postural change
Of 431 respondents who answered whether posture can change, 66% (284) responded 'yes definitely', and 31% (133) responded 'maybe'. Nine of the 14 remaining respondents said that standing posture is still part of their assessment.
Only 19% of respondents thought changes were long-standing or short-term, not both. The remaining respondents considered the changes to be both long-standing and short-term. The percentage difference between the professions was not significant between professions with X2 = 0.827 and p = 0.66.
Postural management
A total of 429 respondents answered the importance of treating posture. Eight respondents provided two responses to the question, suggesting clinical opinions vary on the importance of treating postural asymmetry. The 'sometimes' answer was the most frequent, with a higher percentage of physiotherapists (76%) than chiropractors (67%) and osteopaths (60%). The difference between professions was X2 = 6.570 and p = 0.04.
Table 3 - insert
When treating posture, the top five attributes that change posture are Exercise, Education, Behavioural Change, Activity, and Work. Of the 429 respondents, 94% (404) chose the exercise modality, with a subset of 42% most important and another 28% ranking it second most important (Table 3). Education was the second most popular modality to change posture, with 89% (380/429) responses, out of which 46% chose it as most important, and 29% chose it as second most important. The third most popular modality was behavioural change (81%), with an even split of ranked choices. The fourth choice was activity, chosen by 78% of respondents. However, this was ranked lower overall, with 30% choosing it as third and 27% choosing it as fourth. Work as a modality had 49% of responses, with lower ranked responses; 29% mentioned it as their fourth choice and 35% as their fifth choice. Manual therapy as a modality had 40% responses with lower rated responses; 25% opted for it as the fourth choice, and 34% as the fifth choice. The proportion of chiropractors choosing manual therapy (87%) was substantially higher than that of osteopaths (63%) and physiotherapists (30%), The difference between the professions was significant with X2 = 63.205 and p < 0.001. Some of the other modalities were predominately in the lower ranked options and with fewer responses: Orthotics/ Bracing (24%), Medication (9%), Clothing (9%), Hydrotherapy (7%), Acupuncture (6%), and Electrotherapy (5%). However, psycho-social (18/429), ergonomics (7/429), pain (6/429) and body awareness (5/429) also had sufficient frequencies to warrant further description. In addition, several low-frequency codes described other modes, including taping, surgery, biofeedback, nutrition and footwear.
The wider context of posture
Much debate continues about the social construct of optimal posture. In response to the question about whether there is an optimal posture, there were 430 responses. Each of the six MHPs recorded two responses, again indicating that opinions vary among clinicians. A total of 62% of Chiropractors (28/45) answered 'yes' or 'maybe' compared to 57% (221/385) of osteopaths and physiotherapists. The difference between the professions was approaching significance with X2 = 3.597 and p = 0.058. The Osteopaths represented the most likely profession to answer 'maybe', whilst the physiotherapists were most likely to respond 'no'.
Of 423 respondents, 65% said there was a link between posture and pain; specifically, 71% were chiropractors, and only 61% were osteopaths.
Lastly, respondents were asked about the importance of posture in terms of function versus the aesthetic (visual) aspect. Out of 429 respondents, 75% considered that 'yes', function is more important than visual appearance, and 22% answered 'maybe'. Compared with the other professions, osteopaths displayed a predominance towards the function construct of posture.
Objective (c) – Attributes of mobile application for objective postural assessment
When asked which attributes could help develop a mobile application, out of 385 responses, 80% were from physiotherapists, 9% from osteopaths, and 10% from chiropractors. Some of the respondents did not give answers for all five attributes. The top 5 attributes listed by frequency were:
- Ease of use, 89% (95% chiropractors, 91% physiotherapists. and 75% osteopaths)
- Reliability/validity, 78% (80% physiotherapists, 75% osteopaths, and 73% chiropractors)
- Time efficiency, 72% (74% physiotherapists, 70% chiropractors, and 53% osteopaths)
- Low Cost, 64% (68% chiropractors, 65% physiotherapists, and 58% osteopaths)
The most common open-text response (12 respondents) suggested no need for a mobile application, with a higher percentage of osteopaths not answering this question compared to the other professions. A separate open question was included to facilitate freedom of expression about potential application attributes. Of 185 respondents, 22% reported they did not want a more objective measure, and 10% were unsure. Other responses (n>2) included patient epidemiology, the ability to link fixed and non-fixed pathologies, review local areas of postural discrepancy, compare with previous data sets, link to clinical reasoning, Beighton Scale, body type, pain score, and kinesiological variables.