Optimizing reliability of digital inclinometer and flexicurve ruler measures of spine curvatures in postmenopausal women with osteoporosis of the spine: an illustration of the use of generalizability theory.

The study illustrates the application of generalizability theory (G-theory) to identify measurement protocols that optimize reliability of two clinical methods for assessing spine curvatures in women with osteoporosis. Triplicate measures of spine curvatures were acquired for 9 postmenopausal women with spine osteoporosis by two raters during a single visit using a digital inclinometer and a flexicurve ruler. G-coefficients were estimated using a G-study, and a measurement protocol that optimized inter-rater and inter-trial reliability was identified using follow-up decision studies. The G-theory provides reliability estimates for measurement devices which can be generalized to different clinical contexts and/or measurement designs.