Tragus-to-wall: A systematic review of procedures, measurements obtained, and clinimetric properties

Objective Our purpose was to summarize the literature on the applicability, procedures for performing, and clinimetric findings related to the measurement of tragus-to-wall (TTW) distance. Method Pubmed, Scopus, and CINAHL databases were systematically searched using the key words "tragus" AND "wall". Articles were examined for information on the participants whose TTW distance was measured, the procedures used for measuring TTW, and findings regarding TTW distances measured and the clinimetric properties of the measurements. Results Thirty-nine articles were identified that described use of the TTW test. Most used the test with patients with ankylosing spondylitis. We found evidence for the convergent and known groups validity and reliability of the TTW measurements. Limited support for the responsiveness of TTW measurements was found. Two studies provided normative reference values. Conclusions The TTW test is a simple objective indicator of forward flexed posture supported by research on its validity and reliability. More specific information on responsiveness and age-specific norms would increase the value of this nonspecific postural indicator.