Angular postural variables evaluated by photogrammetry in the sagittal plane: systematic review with meta-analysis of studies conducted with children and adolescents

Abstract

This systematic review with meta-analysis, registered in PROSPERO (CRD42019131055) and conducted according to MOOSE and PRISMA guidelines, aimed to identify posture assessment methodologies using sagittal-plane photogrammetry and to establish normative values for children and adolescents. Searches (November 21, 2024) across six databases (PubMed, EMBASE, BIREME, SCOPUS, Science Direct, Web of Science) and complementary sources identified 1,235 records. Two reviewers independently performed screening, data extraction, and assessment of methodological quality and risk of bias (Downs & Black checklist). Observational studies with healthy participants aged 7 to 17 years, assessed using sagittal-plane photogrammetry in an upright standing position, were included. Of the 22 studies included in the qualitative synthesis, seven (n=1,012 participants) were eligible for meta-analysis. All studies demonstrated high methodological quality. The meta-analysis revealed low heterogeneity (I²<50%) and enabled the establishment of normative values for: pelvic tilt (12.4º-14.9º for ages 7-9; 12.3º-13.6º for ages 10-14) and vertical trunk alignment (2.1º-2.6º for ages 10-14). Greater forward head position and pelvic tilt were observed in girls during the pubertal growth spurt. The certainty of evidence was moderate. As a limitation, methodological diversity restricted the possibilities for meta-analysis for some variables. It is concluded that photogrammetry is a valid method for postural assessment in this population, and the established normative values provide clinical references for the early detection of postural deviations.