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Evaluation of the New York Posture Rating Chart for Assessing Changes in
Postural Alignment in a Garment Study

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Article
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Research Journal

Evaluation of the New York 31(2) 81-96

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DOI: 10.1177/0887302X13480558
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Alignment in a Garment Study

Lisa Barona McRoberts1, Rinn M. Cloud2, and

Catherine M. Black3

Abstract
The New York Posture Rating (NYPR) was evaluated for assessing postural alignment changes in a
garment study as captured in photographs and body scans. The posture of 15 pre-menopausal
females aged 40 to 55 were assessed while wearing a control and a posture support garment. The
scale was successfully applied with good rater reliability for photographs (0.77) and body scans
(0.91). Overall photographic posture assessments were not significant, however, two body
segments showed improvement. Overall body scan posture assessments revealed significant
improvement for the posture support garment, and improvement in one body segment (neck).
Paired t –test comparison of NYPR from photographs and body scans were not significantly different
in the posture support garment and significantly different for the control. Possible solutions are
discussed. Overall results, support the potential use of the NYPR in studies of garment effects on
posture and the body scans as an assessment tool.

Keywords
body scanning, New York Posture Rating, design

Proper postural alignment is vital to maintaining a healthy back (Rhodes, 1996). According to
Rhodes, the majority of people are born with proper postural alignment but begin exhibiting impro-
per postural alignment past age 2 for a variety of reasons. Over time, improper postural alignment
may result in a variety of physical, physiological, and psychological problems (Vieria & Kumar,
2004). In contrast, Carlson, Eisenstat, and Ziporyn (2004) indicate that ‘‘practicing proper posture
[may] boost young girls’ self-image’’ (p. 531).

1
Department of Textiles, Apparel Design and Merchandising, Louisiana State University, Baton Rouge, LA, USA
2
Department of Textiles & Consumer Sciences, Florida State University, Tallahassee, FL, USA
3
Apparel, Merchandising, Design & Textiles, Washington State University, Pullman, WA, USA

Corresponding Author:
Lisa Barona McRoberts, Department of Textiles, Apparel Design and Merchandising, Louisiana State University, 130 Human
Ecology Building, Baton Rouge, LA 70803, USA.
Email: lmcrob1@lsu.edu
82 Clothing and Textiles Research Journal 31(2)

One approach for maintaining or improving postural alignment is the use of braces or support
garments (MayoClinic.com, 2007). Although braces and posture support garments are available and
their use encouraged (Carlson et al., 2004), assessments of their effectiveness are lacking. Personal
communication with an orthopedic back specialist (Dr. Jorge Isaza, MD) indicated that compliance
with braces or posture support garments is low. In our larger study of posture support garments, the
researchers became aware of the need for a method to quantitatively assess postural alignment so that,
among other things, it could be applied to determine the effectiveness of posture support garments.
An extensive review of the literature for a method assessing posture revealed the New York
Posture Rating (NYPR) scale. The NYPR was originally published in 1958 as part of a battery of
assessments (The New York Physical Fitness Test, New York State Education Department, 1958)
to measure children’s physical fitness in New York State public schools. A modified version of the
NYPR with fewer items and different scoring was later published in the Health Fitness Instructors
Handbook by Howley and Franks (1992). While used extensively in clinical settings, the NYPR has
had more limited application in research, and no studies were found applying it to assess the influ-
ence of garments on posture. The scale was originally developed for real-time assessments in clinical
settings, but recent studies (e.g., Guariglia & Paccini, 2011) have reported successful use with
photographs of participants. Another approach that may have merit, but was not found in the liter-
ature, is the use of the scale with body scans.

Purpose of Study
This study describes the application and evaluation of the NYPR published by Howley and Franks
(1992) for use in assessing the postural alignment of participants wearing and not wearing a posture
support garment. The scale was applied to photographs and body scans of participants to determine
the usefulness of these approaches. The following research questions were developed to address the
purpose of the study:

Research Question 1: Can the NYPR be used to assess postural alignment differences for those
wearing and not wearing a postural support garment?
Research Question 2: Can body scans be used in place of photographs with the NYPR to assess
postural alignment?

Literature Review
A review of the literature from a variety of disciplines provided information for defining and
measuring postural alignment, identifying the types of posture support products available, and
describing previous studies that quantified posture through the use of the NYPR. Studies of posture
using body scanners are also addressed.

Defining Postural Alignment

Vieria and Kumar (2004) indicated that posture may be defined in four ways: ‘‘biomechanical align-
ment; the spatial arrangement of body parts; the relative position between segments; and the body
attitude to perform tasks’’ (p. 144). Kendall, McCreary, Provance, Rodgers, and Romani (2005)
credit the 1947 Posture Committee of the American Academy of Orthopaedic Surgeons with devel-
oping a definition of good posture as ‘‘that state of muscular and skeletal balance which protects the
supporting structures of the body against injury or progressive deformity, irrespective of the attitude
(erect, lying, squatting, or stooping) in which these structures are working or resting’’ (p. 51).
Optimal postural alignment occurs when the center of mass of the head, thorax, and pelvis are in
a vertical alignment line in respect to gravity (Santos, Kanekar, & Aruin, 2010).
McRoberts et al. 83

Posture Support Products

A market search revealed several types of posture support products with the majority made of rigid
plastic with metal or plastic stays. Because rigid support garments limit range of motion and may
increase the difficulty of daily activities, they are considered to decrease quality of life (Pham
et al., 2008). Previously demonstrated relationships between comfort and wearer acceptability in
other products (Huck & Kim, 1997; Krenzer, Starr, & Branson, 2005; Rutherford-Black & Khan,
1995) suggest that more comfortable garments may increase wear compliance. Two types of less
restrictive, soft-structured posture support products were identified in the market scan, but no studies
were found reporting their effectiveness in improving posture. Of the two soft-structural posture
support garments, the researchers selected the one that was most focused on upper body posture for
assessing the usefulness of the NYPR in this study.

Measuring Postural Alignment

Posture tests are used in clinical settings to detect body alignment deviations and to prescribe
corrective exercises or procedures to improve posture or alignment. Vieria and Kumar (2004) pro-
vide a summary of methods used by ergonomists to measure working postures including the use of
goniometry, inclinometers, electrogoniometers, and movement recording systems. These methods
involve geometrical measurements or subjective assessments of angles between body segments or
of joint flexion, extension, and rotation of individuals in various stances or working positions. Inter-
pretation of the measurements with regard to good or ideal posture is not presented. Very early work
by Wickens and Kiphuth (1937) provided information on measuring body angles related to posture
from back and side photographs of individuals. Interpretations were provided based on the degree to
which angles approached or departed from 180 or were greater or less than 90 depending on the
angle being measured.
Kendall et al. (2005) provide a thorough explanation and illustrations of various deviations of
body segments from ideal posture for use by physical therapists in qualitatively assessing postural
alignment using a posture examination chart provided by the authors. The assessments include
segmental alignment of the head/neck, shoulder, upper back, chest, abdomen, spine, lower back,
pelvis, knees, and feet facilitated by the use of a plumb line hung between the patient and the rater.
The information is intended for use by physical therapists in determining treatment interventions
related to the different types of postural deviations. Dwyer and Davis (2008) present a more succinct
version of similar qualitative assessments of segmental alignments facilitated by taking photographs
of the individual standing in front of a grid.

New York Posture Rating Scale. The NYPR was originally published in 1958 (The New York Physical
Fitness Test) and later published in a modified form by Howley and Franks (1992). The NYPR
applies a quantitative approach to assess proper and improper alignment of various body segments
for an individual in the anatomical position (see Figure 1). The NYPR published in 1958 includes a
set of three figure drawings for each of 13 body alignment segments contributing to overall postural
alignment. The 13 body alignment segments include posterior views of the head, shoulders, spine,
hip, feet, and arches, and lateral (left side) views of the neck, chest, shoulders, upper back, trunk,
abdomen, and lower back. Short verbal descriptions are provided to indicate the visual cues to use
as criteria in deciding the score. In this original version, each body segment was scored 5 (correct
posture), 3 (slight deviation), or 1 (pronounced deviation).
The version of the NYPR published by Howley and Franks (1992) differs from the original NYPR
in two distinct ways. First, the number of body segments was reduced from 13 to 10. Second, the
scoring was changed to 10 (correct posture), 5 ( fair posture), and 0 ( poor posture). The three body
84 Clothing and Textiles Research Journal 31(2)

Figure 1. Posterior view segments from the New York Posture Rating Chart (left). Side view segments from
the New York Posture Rating Chart (right). (Both reprinted by permission of the State Education Department,
The University of the State of New York, Albany, NY. Items marked with an asterisk (*) are not included in the
version published by Howley and Franks (1992), which also changed the items scores to 10-5-0).

alignment segments not included in the modified version were arches (of the feet, illustrated similar
to a foot print) and the lateral (left side) views of the chest and shoulders. The views for these latter
segments were very similar to the views for the upper back and may have been eliminated for that
reason. The scores of the remaining 10 body alignment segments are summed, allowing a range of
overall score between 0 and 100, with a score of 100 representing ideal posture. No explanations for
the modifications were provided by the authors.
Instructions for use of the NYPR were provided in The New York Physical Fitness Test manual
(New York State Education Department, 1958) and directed an evaluator to rate a participant stand-
ing in front of a plain background. The participant stood with his back (posterior view) to the rater
who was positioned 10-feet away and then turned 90 to provide side view for the second half of the
evaluations. A plumb line suspended between the participant and the rater (very close to the parti-
cipant) represented the vertical reference line in the illustrations and assisted the evaluator in asses-
sing the relative position of the body parts (see Figure 2).
The NYPR and its procedure were set up for clinical assessments in real time. The rater scored the
body segments then summed the scores to get an overall assessment of postural alignment. The use
of real-time assessments limited the ability to document the results or to reanalyze the data if needed.
Johnson and Nelson (1986) reported reliability coefficients for the NYPR of .93 to .98 for various
grades levels between 4 and 12 based on the clinical assessments collected in New York public
schools over several years.
McRoberts et al. 85

Figure 2. Posture assessment viewing set up. (Reprinted by permission of the State Education Department,
The University of the State of New York, Albany, NY.).

Studies Incorporating the New York Posture Rating. The review of literature revealed that researchers
have used the NYPR to assess children (Jones, 1974; Pankey, Woosley, & Glendenning, 2004), ado-
lescents (Briedenhann, 2004; Watson, 1983), and adults (Arnold, Beatty, Harrison, & Olszynski,
2000; Guariglia & Paccini, 2011). The NYPR has also been used to assess athletes from various
sports (Hennessey & Watson, 1993; Watson, 1983), often before and after fitness periods (Brieden-
hann, 2004; Paccini, Cyrino, & Glaner, 2007). Posture of participants has been assessed through
real-time observations (Arnold et al., 2000; Hennessey & Watson, 1993) and photographs (Guariglia
& Paccini, 2011; Jones, 1974; Paccini et al., 2007).
Use of the NYPR has included variations in the number of body segments assessed, ranging from
5 to 15, and variations in scoring the individual body segments. For example, Arnold et al. (2000)
used the original 13 segment NYPR and 5, 3, 1 scoring to assess overall posture of postmenopausal
women with osteoporosis. Paccini et al. (2007) used the 5-3-1 scoring from the 1958 NYPR but
added two segments to the original 13 to study changes in posture after resistance training of college
women. In contrast, Briedenhann (2004) used the Howley and Franks scoring (10-5-0) to assess five
segments of the NYPR (shoulder, spine, hip, upper back, and lower back) to determine effects of a
training program on the posture of 20 high school athletes.
86 Clothing and Textiles Research Journal 31(2)

Hennessey and Watson (1993) used the Howley and Frank (1992) 10-segment NYPR to assess
posture of injured and noninjured athletes and based scores on a continuous scale from 0 to 10, with
0, 5, and 10 representing poor, fair, and good posture, respectively. Pankey et al. (2004) assessed
posture of third- and fifth-grade students based on 11 body segments and modified the scoring to
a continuous scale with 5 (excellent) to 1 (problematic).
Two studies provided reliability measures for the NYPR. Arnold et al. (2000) concluded that the
NYPR was a practical tool with a moderate intrarater correlation coefficient (.70) but lower inter-
rater correlation coefficient (.57), indicating that the NYPR is more reliable if the same rater is used
during repeated evaluations. Hennessey and Watson (1993) conducted test–retest reliability for the
posture scale and reported an acceptable method error coefficient of variation of 1.9%.

Studies of Posture Using Body Scans

In clothing research, recent work related to posture has been conducted using body-scanning tech-
nology to capture body shapes with a high degree of specificity. In 2005, Takabu, Takahashi, and
Matsumoto evaluated shoulder slope angles associated with normal standing positions. They used
cross sections from body scans of the shoulder to measure the 3-dimensional coordinates and angles
of the shoulder to understand the relationship between the shoulder slope and front bending angle.
Cho, Komatsu, Inui, Shimizu, and Park (2006) used body scanning to develop an alterable inter-
active body model to match body sizes and postures for the purpose of pattern making. Body shapes
relating to posture were determined by extracting nine points from human participants: neck point,
bust point, waist point, stomach point, hip point, and three points between the neck, waist, and hip
points. The data were used to develop fitting forms that replicated the postures of the human
participants.
In 2008, Ashdown and Na used a body scanner to detect differences in bilateral symmetry of
women in two age groups and found significant differences between mature and younger women.
They also measured the length of the back, showing that it was longer for older women when cur-
vature sets in.
Although these studies allow comparisons of posture from one participant or group of participants
to another based on body scans, they do not establish what measurements, angles, or shapes consti-
tute ‘‘good’’ or desirable postural alignment. The ability to operationally define good posture and
compare participants to that standard is necessary to assess the postural alignment effectiveness
of garments developed to improve posture. Because body scans provide a visual representation of
the body, they may be able to replace photographs when using the NYPR to assess posture.

Method
This study applied and evaluated the NYPR published by Howley and Franks (1992) for use in asses-
sing the postural alignment of participants wearing and not wearing a posture support garment in
photographs and body scans. Participants completed two wear trials, one wearing the control
garment only and one wearing a commercially available posture support garment over the control
garment. During each trial, participants completed a wear protocol to acclimate to the garment and
then were assessed for postural alignment. The following sections provide detailed explanations of
the methods.

Participants
Fifteen premenopausal volunteer female participants aged 40–55 years participated in the study. The
selection of age and health status for participants was established based on motivations of a larger
McRoberts et al. 87

Figure 3. Front and back views of sports bra (top) and posture support garment (photograph by Author,
2012).

study (reported elsewhere) of posture support garments for women in the workforce who perform
repetitive motions in a sitting or standing position. Institutional Review Board approval was
obtained for the use of human participants who were recruited via mass e-mailings to the staff and
faculty of two universities in a metropolitan area in the southeastern United States.

Test Garments
Test garments included (a) a control condition consisting of a sports bra and bike shorts and (b) a
commercial, soft structural posture support garment worn over the control garments (treatment).
Figure 3 provides front and back views of the sports bra and posture support garment. The sports
bra was made from 97% nylon/3% spandex fabric. The bike shorts were made from 95% cotton/
5% spandex knit fabric and were worn over the participant’s own lower body underwear. The pos-
ture support garment had a Velcro1 front closure and was made of 85% nylon/15% spandex.
88 Clothing and Textiles Research Journal 31(2)

Barrow, McGee, and Tritschler (1989) point out that the NYPR provides better results when sub-
jects wear close-fitting clothing. Each of the garments worn during the postural alignment assess-
ment was close fitting, including the posture support garment. Assessments were conducted after
a wear protocol described below. During the wear protocol, participants also wore gray 100% cotton
knit t-shirts over the control or treatment conditions for modesty and comfort purposes. The t-shirts
were removed for the photographs and body scans to allow clear viewing of the body’s postural
alignment. Two wear trials were conducted. The control was worn for the first wear protocol and
assessment, and the posture support garment (treatment) was added for the second wear protocol and
assessment.

Wear Protocol
Once participants donned the control or treatment garments, they completed a 90-min wear protocol,
which included activities and movements that might be employed by women in an office environ-
ment. The wear protocol was intended to acclimate participants to the test garments and included
sedentary periods (reading) as well as fine (typing) and gross (lifting empty boxes) motor move-
ments. Photographs were taken immediately after the wear protocol, and body scans were completed
immediately after the photographs.

Posture Data Capture Procedures

Photographs and body scans were assessed using the 10 body alignment segments and scoring sys-
tem published by Howley and Franks (1992). These 10 body segments were most commonly used in
previous research and therefore selected for the current study. The 10-5-0 discreet scale was used
due to the commonality of 3-value, discreet scales in previous studies and also to provide an easily
interpreted range for the summed score from 0 (poor posture) to 100 (ideal posture).
The procedure for use of the NYPR, provided in The New York Physical Fitness Test manual
(New York State Education Department, 1958), was applied using photographs and body scans
rather than performing a real-time assessment, allowing us to retain the data for future analysis. The
photographic methods used by previous researchers (Guariglia & Paccini, 2011; Jones, 1974;
Paccini et al., 2007) to capture participants’ posture established a precedent for this study. The use
of body scans was unique to this study and was included to explore the potential application of this
increasingly important technology.

Photographs. A 100 grid backdrop was placed behind the participant as reported by Dwyer and Davis
(2008) and as used in recent studies employing the NYPR (Guariglia & Paccini, 2011; Paccini et al.,
2007). The grid aided in establishing vertical and horizontal position of the participant in the photo-
graph. A box marked on the floor indicated where the participant was to stand. Participants were
asked to stand as comfortably and naturally as possible, with their feet comfortably apart. Full-
length photographs of the individuals (including head and feet) were taken to ensure the body
segments needed for assessment with the NYPR were fully visible.
The camera, a digital Canon Powershot S500, was situated on a tripod 10 feet from the participant
on the opposite side from the grid, where the live observer was positioned according to the original test
instructions (The New York Physical Fitness Test; New York State Education Department, 1958). A
vertical reference line was superimposed on the printed photographs to represent the vertical line in
the NYPR drawings and in drawings of correct posture described by Kendall et al. (2005). The refer-
ence line was added using a clear ruler that ensured the line was parallel to grid lines and intersected
the appropriate landmarks on the body (see Figure 4). The reference line was drawn to approximate the
position of the frontal or sagittal plane of the body. For a body with excellent posture, the line in the
McRoberts et al. 89

Figure 4. Placement of the reference line on photographs and body scans (photograph by Author, 2009).

sagittal plane would go through the ear lobe, tip of the shoulder, center of the hip and knee, and slightly
anterior to the external malleolus (ankle protrusion). The line in the frontal plane dissects the body
from a center point between the feet, perpendicular to the floor (Schafer, 1983).

Body Scans. An NX-12 white light body scanner with nonmoving scan heads was used to produce the
body scans. Proprietary measurement extraction software from TC2 (Cary, North Carolina) was used
to translate the output into 3-dimensional body scans. The software program allowed the placement
of a grid on each scan to provide consistency with the use of background grids in the photographs
(see Figure 4). Vertical reference lines were added to the scans in the same manner as the
photographs.

Evaluation of the Photographs and Body Scans

Three medical professionals scored postural alignment of participants as captured in the photographs
and scans. Each medical professional had a specialization in orthopedics, one with an emphasis in
spinal disorders. The raters reviewed the 10-segment NYPR published by Howley and Franks (1992)
and the referenced instructions from The New York Physical Fitness Test manual (New York State
Education Department, 1958) prior to conducting practice ratings. They also reviewed illustrations
and information in Dwyer and Davis (2008) regarding the assessment of photographs of individuals
in front of grids. Sample photos and scans that would not be part of the formal study were used for
the practice assessments. As recommended by Arnold et al. (2000), the same raters evaluated all
photographs and body scans to improve reliability.
Photographs and scans of the 15 participants in the two garment conditions were separated for
analysis but arranged in the same random order to prevent introduction of an order effect between
90 Clothing and Textiles Research Journal 31(2)

the two types of images. Raters assigned a score for each body segment of 10 (correct posture), 5
(fair posture), or 0 (poor posture). No intermediate scores were allowed in order to be consistent
with most previous research. After scoring all photographs, then all body scans, the raters negotiated
any differences to arrive at the most appropriate postural alignment score for each body segment in
each photograph or scan. Scores were then summed to provide the overall postural alignment score
for each participant in each condition (control and treatment).

Data Analysis
Statistical Package for the Social Sciences was employed to conduct paired t-tests comparing over-
all and segmental postural alignment of participants wearing the control garments and wearing the
posture support garment over the control garments (treatment—referred to hereafter as posture sup-
port garment). The dependent variable was postural alignment score. Separate analyses were con-
ducted for assessing differences in postural alignment as evaluated from photographs and as
evaluated from body scans. In a subsequent paired t-test analysis, postural alignment as captured
in photographs was compared to postural alignment as captured in body scans.

Results
The participants’ overall (summed) NYPR scores ranged from 55 to 95 on the scale of 0 (poor
posture) to 100 (ideal posture), with 50 representing fair posture. No subject had an overall posture
rating lower than fair (50). Individual body segment postural alignment scores covered the full range
of the NYPR scale from poor (0) to correct (10).
The Cronbach’s coefficient a for postural alignment (NYPR) scores was .77 for photographs and
.91 for body scans, indicating that ratings of photographs had an acceptable internal consistency and
ratings of body scans had excellent internal consistency (George and Mallery, 2003, p. 231). Relia-
bility was enhanced by the repeated use of the same raters as suggested by Arnold et al. (2000) and
by having raters who were medical professionals with orthopedic expertise.

Postural Alignment Assessment Using Photographs

Mean overall postural alignment scores for photographs were 68.7 (SD ¼ 8.3) for the control
and 72.7 (SD ¼ 10.2) for the posture support garment. Raw scores for the 15 participants ran-
ged from 55 to 80 for the control condition and from 55 to 90 for the posture support garment.
Results of the paired t-test for overall postural alignment of the control and the posture support
garment in photographs approached significance, t(14) ¼ 1.92, p ¼ .075, but did not meet the
a priori criterion (p  .05).
Means and standard deviations, as well as paired t-test results for postural alignment of individual
body segments in photographs, are presented in Table 1. Means for the individual body segments
ranged from 3.3 to 9.7. Standard deviations indicate that some segments varied more among parti-
cipants than others. Paired comparisons revealed a significant difference (p  .05) in postural align-
ment for two body segments. For the hip segment, postural alignment was significantly better for the
posture support garment (M ¼ 8.7) than for the control (M ¼ 7.0). Similarly, for the trunk segment,
postural alignment was significantly better for the posture support garment (M ¼ 8.7) than for the
control (M ¼ 7.3).

Postural Alignment Assessment Using Body Scans

Mean overall postural alignment scores for participants from the body scans were 72.3 (SD ¼ 11.8)
for the control and 76.3 (SD ¼ 12.7) for the posture support garment. Raw scores ranged from 55 to
McRoberts et al. 91

Table 1. Paired Comparisons (Control vs. Treatment) for Postural Alignment of Individual Body Segments as
Captured in Photographs.

Treatment M SD t p

Head
Control 9.3 1.7 0.56 .847
Posture support garment 9.7 1.2
Shoulder
Control 5.7 1.7 1.47 .164
Posture support garment 7.0 3.1
Spine
Control 9.7 1.2 1.00 .334
Posture support garment 8.7 2.2
Hip
Control 7.0 2.5 2.65 .019*
Posture support garment 8.7 2.2
Feet
Control 8.0 2.5 1.00 .334
Posture support garment 8.3 2.4
Neck
Control 6.3 2.2 0.00 1.00
Posture support garment 6.3 2.2
Upper back
Control 8.3 2.4 0.56 .582
Posture support garment 8.0 2.5
Trunk
Control 7.3 2.5 2.26 .041*
Posture support garment 8.7 2.2
Abdomen
Control 3.7 3.5 1.00 .334
Posture support garment 3.7 3.5
Lower back
Control 3.3 3.0 0.00 1.00
Posture support garment 3.7 2.9
*p  .05.

90 for the control garment and from 55 to 95 for the posture support garment. The paired t-test for
overall postural alignment in body scans revealed a significant improvement in postural alignment
when wearing the posture support garment, t(14) ¼ 2.18, p ¼.047.
Means and standard deviations, as well as paired t-tests for postural alignment of individual body
segments as captured in body scans, are presented in Table 2. Mean postural alignment for individual
body segments ranged from 3.3 to 10.0. Results of paired t-test comparisons revealed a significant dif-
ference (p  .05) in postural alignment of the neck segment between the control (M ¼ 6.3) and the
posture support garment (M ¼ 8.0). Differences in means of other segments were not significant.
As with the photographs, mean postural alignments for the abdomen (M ¼ 3.7, M ¼ 3.3) and lower
back (M ¼ 5.0, M ¼ 5.0) were lower than means for other segments. High standard deviations indicate
large variability in postural alignment for participants in these body segments.

Comparison of Results From Photographs and Body Scans

Postural alignment in photographs was compared to postural alignment in body scans for the control
and for the posture support garment. No significant difference (p  .05) was found between
92 Clothing and Textiles Research Journal 31(2)

Table 2. Paired Comparisons (Control vs. Treatment) for Postural Alignment of Individual Body Segments as
Captured in Body Scans.

Treatment M SD t p

Head
Control 9.0 2.0 1.00 .334
Posture support garment 9.7 1.2
Shoulder
Control 7.0 2.5 2.92 .774
Posture support garment 7.3 2.5
Spine
Control 10.0 0.0 0.00 1.00
Posture support garment 10.0 0.0
Hip
Control 8.7 2.2 1.47 .164
Posture support garment 9.3 1.7
Feet
Control 7.7 2.5 0.81 .443
Posture support garment 7.0 3.1
Neck
Control 6.3 2.2 2.65 .019*
Posture support garment 8.0 2.5
Upper back
Control 7.0 2.5 1.38 .189
Posture support garment 8.0 2.5
Trunk
Control 8.0 2.5 1.47 .164
Posture support garment 8.7 2.2
Abdomen
Control 3.7 3.5 1.00 .334
Posture support garment 3.3 3.6
Lower back
Control 5.0 3.7 0.00 1.00
Posture support garment 5.0 3.7
*p  .05.

photographs and body scans for overall postural alignment of participants wearing the posture sup-
port garment, t(14) ¼ 1.17, p ¼ .263. However, there was a significant difference, t(14) ¼ 2.44,
p ¼ .028, for participants in control garments with mean postural alignments in body scans
(M ¼ 72.3, SD ¼ 11.8) higher than those in photographs (M ¼ 68.7, SD ¼ 8.3).

Discussion
Variations in the overall postural alignment scores indicate that the NYPR differentiated partici-
pants’ overall posture from fair to correct when assessed using photographs and body scans. Indi-
vidual body segments also differentiated the participants’ posture from poor (0) to correct (10)
using the NYPR.
Overall (summed) postural alignments captured in photographs were not significantly different
between the control and posture support garment. Although it was expected that the posture support
garment would have an effect on posture, no study was available to verify the effectiveness of the
garment. Differences were approaching significance, and the means varied in the expected direction
with higher postural alignment for the posture support garment. The small sample size and
McRoberts et al. 93

substantial variability in posture indicated by the large standard deviations may have masked differ-
ences that would have been verified by a larger sample. The use of a 3-point scale also limited the
ability of raters to identify nuances of postural deviation and may have influenced the lack of sig-
nificant differences found. Scores of individual body segments in photographs indicated that the par-
ticipants exhibited better postural alignment in the hip and trunk areas when wearing the posture
support garment as compared to the control. For the trunk segment, these results indicate that parti-
cipants wearing only the control garment were more likely to exhibit a trunk leaning toward the rear.
Because the posture support garment was intended to address posture in the thoracic region of the
back, the improvement in postural alignment of the trunk area is logical. It is not clear that the
garment would have an effect on hip alignment except as a side effect of other improvements in body
alignment. No significant differences were found for the upper back or chest, which are other areas
that might be expected to improve.
Postural alignment scores for body scans indicated a significant improvement in posture for
participants wearing the posture support garment as compared to wearing the control. Individual
segment analysis identified a significant difference for the neck segment with a better NYPR for the
posture support garment than for the control. The neck segment rating indicates the neck was thrust
forward more for the participants wearing the control than for those wearing the posture support gar-
ment. One might expect this result for an effective posture support garment. The trunk, upper back,
and chest area scores were not significantly different. These are areas expected to be affected by a
garment that encourages better upper body posture. Differences in postural alignment results for the
body scans and the photographs could be attributed to the use of handholds in the scanning booth,
which may have encouraged a more erect upper body.
A direct comparison with photographs to body scans for each of the garment conditions indicated
no significant difference in ratings of the participants when wearing the posture support garment but
did indicate a significant difference in the control garment. The magnitude of differences in the
means was the same, suggesting that variability within the ratings was influencing the statistical
results. Higher means for postural alignment in body scans support the contention that the position-
ing of the body for scanning encourages better postural alignment by altering the position of
shoulders and arms. However, these effects were not sufficient enough to completely mask the
effects of the posture support garment on postural alignment.
Overall posture scores may not be the most useful data in determining the effect of a posture
support garment targeting upper body posture. Analyses of individual segments of the scale were
significant even when the overall comparison was not. Future studies of garments targeting specific
areas of posture may benefit from using segments of the scale that match those areas.
Although most segments in the photographs and body scans did not show a significant difference
between the control and posture support garment, the mean scores for both garment conditions var-
ied considerably from segment to segment. Mean scores for the abdomen and lower back area were
less than or equal to 5 in both photographs and body scans, indicating posture problems in this area
for most respondents.

Conclusions and Recommendations

The NYPR has been used in several previous studies related to health and fitness. The current study
explored the feasibility of using the NYPR to assess the effects of garments on postural alignment of
participants (Research Question 1). The NYPR was successfully applied to assess postural alignment
of female participants wearing control and posture support garments in photographs and in body
scans. No previous studies have been reported using the NYPR to assess the effects of garments
on postural alignment. Although photographs did not reveal improvement in overall posture based
on the posture support garment, the improvement was verified in body scans. Significant differences
94 Clothing and Textiles Research Journal 31(2)

between control and posture support garment conditions for a limited number of individual segments
indicate that the scale should be customized to examine specific areas of postural alignment and that
these scores may be more useful than overall scores. A larger sample size may be useful in estab-
lishing the feasibility of the scale; however, garment-wear studies are often conducted with samples
of 15 or fewer participants. It is important to know whether the effects of a garment on posture can be
detected in this size group. Results of this study suggest that it is possible.
No previous study has applied the NYPR to assess postural alignment in body scans (Research
Question 2). Body scan assessment revealed differences in posture that were not identified by assess-
ments in photographs. Because there is no previously established performance of the posture support
garment, it is unclear whether the body scan assessments were more or less accurate than the assess-
ments of photographs. However, the internal consistency of the body scan ratings was better than
that of the photographs, suggesting that the body scans may provide an improvement over photo-
graphs. This finding may be related to having handholds in the scanning booth that assisted in the
consistency of positioning of the arms and shoulders. In future research, consideration should be
given to having participants stand with their arms by their side (slightly abducted) to prevent any
effects of the change in position required to grasp the handholds.
While the NYPR was most often used in previous research with three discreet scores, Pankey
et al. (2004) applied the NYPR using a continuous scale from 1 to 5, and Watson (1983) expanded
the ratings to 5 discreet levels instead of 3 (allowing the use of intermediate ratings of 2 or 4). These
modifications to the NYPR should be studied further to determine whether they would allow iden-
tification of subtle differences in posture.
Posture is a very important health issue. Results of this study can be used by researchers to estab-
lish a procedure for applying the NYPR to a variety of studies of posture characterization and/or
improvement and related factors of garment design or fit.

Acknowledgments
Authors would like to thank Dr. Grace Namwamba and Southern University for generously providing us with
the use of their computer-aided lab and body scanner.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or
publication of this article.

Funding
The authors received no financial support for the research, authorship, and/or publication of this article.

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Author Biographies
Lisa Barona McRoberts, PhD, is an entrepreneur and assistant professor in apparel design, in the Department
of Textiles, Apparel Design and Merchandising at Louisiana State University. She conducts both traditional
research and creative apparel design. Her areas of research consist primarily of aesthetic and functional design
research with focus on posture, fit, body shape analysis, body scanning, product development, creativity, cou-
ture techniques, sustainability, and Hispanic studies.
Rinn M. Cloud, PhD, professor and Mary Gibbs Jones Endowed Chair in Textile Science, teaches and conducts
research in textile product development at Baylor State University in the Department of Family and Consumer
Sciences. Her research areas of specialization include protective clothing development and performance, cloth-
ing comfort and its role in protection compliance, task enhancement or interference by clothing, and functional
product development and wear testing.
Catherine M. Black, PhD, is an associate professor in the Department of Apparel, Merchandising, Design, and
Textiles at Washington State University. She conducts traditional scholarly research. Also, she creates design
works for juried exhibitions. Her traditional research program encompasses both functional and special needs
clothing design.

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