Development and Validation of an Instrument for Upper Cross Syndrome: A Cross-sectional Study

Abstract

Introduction: A sedentary lifestyle causes muscular imbalances and may lead to upper cross syndrome. This syndrome occurs due to the muscular imbalance of tonic and phasic muscles. If left unidentified for long duration can lead to secondary complications. There is a paucity of reliable and valid tools to identify this syndrome. Aim: To develop a valid and reliable tool to identify upper cross syndrome. Materials and Methods: This cross-sectional study was conducted at the Amity Institute of Health Allied Sciences, Department of Physiotherapy, Amity University, Noida, Uttar Pradesh, India, from November 2023 to March 2024. The instrument for upper cross syndrome is a self-designed tool. After an extensive literature review and focus group discussions, items were identified, and rounds of Delphi were held until an agreement was reached. The psychometric properties of the instrument were assessed by content validity, construct validity, and reliability. The instrument was tested on 240 patients with upper cross syndrome. Statistical analysis for construct validity was done by exploratory factor method with principal component analysis and varimax rotation. Test-retest reliability and Cronbach’s alpha were calculated for reliability analysis. Results: The final version of the draft consisted of 20 items with satisfactory item-level Content Validity Index (I-CVI≥0.78) and scale-level Content Validity Index (S-CVI=0.90). Seven domains were identified, including postural alignment, movement patterns, muscle imbalance, joint dysfunction, pain, functional limitations, and psychosocial factors, with a total variance of 60.11% and good internal consistency (Cronbach’s alpha=0.81). Conclusion: This work contributes to the development of a novel, valid, and reliable technique for the identification of upper cross syndrome. Healthcare providers will find this tool useful in promoting health and creating an early rehabilitation plan, both of which will aid in the prevention of subsequent complications.

Keywords

• content validity
• factor analysis
• muscular imbalance
• postural dysfunction