Ihandy level

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Age 45) in a standing position. Beardsley et al (2016) found good inter-rater reliability (ICC=0.81-0.88), good test-retest reliability within a single session (ICC=0.88-0.95) and moderate to good reliability for test-retest reliability between sessions (ICC=0.65-0.85) when using a digital pelvic inclinometer and assessing 18 healthy subjects (6 females, age 23.6 +/- 4.7) in a standing position. Hagins et al (1998) found excellent intra-rater (ICC=0.98) and good inter-rater (ICC=0.89) reliability and a high SEM (3.6) using the PALM palpation meter pelvic inclinometer with 24 healthy subjects (15 female; age 27) in a standing position. The measurements in this study were done over clothing. Crowell et al (1994) found high degree of agreement as compared to a roentgenographic measure (ICC=0.93) when using a non-commercialized caliper-based inclinometer and assessing 26 healthy males (average age 45) in a standing position. Hayes et al (2016) found good correlation between pelvic tilt measurements with the PALM palpation meter and radiographic measures in 50 healthy subjects (age 18-79, sex not reported) for total pelvic tilt (r=.509; p Smartphone Application Koumantakis et al (2016) found excellent intra-rater reliability (ICC=0.97; SEM=1.61) using an Android smartphone with the “iHandy Level” application with 183 healthy subjects (100 f; age 26.1 +/- 10.04) for measuring the standing pelvic position. No studies ICC: Intraclass Correlation Coefficient. SEM: Standard Error of Measurement.Visual assessment is commonly described in physical therapy examination textbooks.41,42 The patient stands in a relaxed stance position, and the practitioner observes from the side. The practitioner visually observes the angle formed by an imaginary line bifurcating the ASIS and the PSIS. The resting posture is compared to a predefined “normal” posture. The practitioner can palpate the aforementioned bony landmarks in attempt to confirm their assessment. The ASIS being lower than the PSIS in the sagittal plane is defined as an “anterior pelvic tilt,” and the ASIS being higher than the PSIS in the sagittal plane is defined as a “posterior pelvic tilt.” If they are level, it is defined as “neutral.” There have been no known attempts to assess the reliability, validity, or clinical usefulness of this method. Visual assessment of lumbar lordosis, a postural measure in close proximity and directly related to pelvic tilt49 has fair intrarater reliability and poor inter-rater reliability.50Use of a hand-held inclinometer to assess pelvic tilt has been described.43 To assess pelvic tilt, the practitioner aligns the inclinometer in the sagittal plane and places it firmly on the sacrum. The angle is interpreted as the amount of pelvic tilt, with higher numbers corresponding to greater anterior pelvic tilt and vice versa. When assessing anterior, posterior, and total pelvic tilt in males and females, reliability has been found to be moderate to excellent (ICC: 0.60 – 0.94).43 There have

Useful. A valid and reliable 3-D motion capture analysis system may be required if the goal is to understand pelvic excursion during high-speed athletic tasks due to the nature of the movement and precision required. This may not be practical for smaller clinics with a limited budget based upon currently available options.Figure 3.Assessment of pelvic tilt during a step-down maneuver. A smartphone with an application that can assess change in spatial angulation (such as iHandy Level) is secured onto the subject’s sacrum via a running belt. The initial angle is recorded, and the change in angle at the lowest point of the step-down is recorded. The difference between the two angles is the change in pelvic tilt during the stepdown.There is limited research demonstrating an association between improving pelvic tilt during sporting maneuvers and a successful recovery from a musculoskeletal injury.56 It is not clear if the change in pelvic tilt leads to the reduction in symptoms or the other way around. It is also not known what interventions, if any, can be attributed to the change in pelvic tilt. Increased hip extensor strength is correlated with improved pelvic mobility during functional tasks which may suggest a potential intervention target.57 Core muscle function has also been associated with the ability to control pelvic tilt.38 Improving hip flexor flexibility has also been proposed as a target, although limited research suggests that addressing hip flexor flexibility in isolation does not lead to carryover in functional tasks.58 Training specific movements with improved pelvic motor control may be of benefit,23,59,60 however generalized strength and flexibility interventions may produce similarly beneficial patient-reported outcomes60 and more research is needed in this area. While there are several potential targets, it is not established if pelvic tilt can be changed because of a specific or generalized rehabilitation plan, or if specifically tracking the change in pelvic tilt might be a useful prognostic factor for a successful outcome.In consideration of the limitations, the physical therapist or other rehabilitation clinician may consider assessing pelvic tilt in order to individualize assessment and treatment. There appears to be some variability among those who are symptomatic and not, with some presenting with a pelvic tilt that theoretically could be contributing to an increase in symptoms and some presenting with a pelvic tilt that may reflect an adaptive movement strategy to reduce symptoms.4 Assessment of pelvic tilt may be best performed in a manner that has the potential to capture the subtle differences between symptomatic and asymptomatic population, and for this reason visual assessment alone would not be helpful to guide clinical decisions. Caliper-based pelvic inclinometers offer a valid, reliable, and precise measurement and may be a superior option, although the full clinical usefulness

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