1 Accuracy, precision and reliability in anthropometric surveys for ergonomics purposes in adult working populations: A literature review Viviani, C. (1)*, Arezes, P.M. (2), Bragança, S (3), Molenbroek, J. (4), Dianat, I. (5), Castellucci, H.I. (6)*. (1), Facultad de Ciencias, Escuela de Kinesiología, Pontificia Universidad Católica de Valparaíso, Chile (2) Research Centre on Industrial and Technology Management, School of Engineering, University of Minho, 4800-058 Guimarães, Portugal. (3) Research and Innovation, Southampton Solent University, Southampton, United Kingdom. (4) Delft University of Technology, Faculty of Industrial Design Engineering Section Applied Ergonomics and Design, Landbergstraat 15 2628 CE Delft, The Netherlands. (5) Department of Ergonomics, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran (6) Centro de Estudio del Trabajo y Factores Humanos, Escuela de Kinesiología, Facultad de Medicina, Universidad de Valparaíso, Chile. *Corresponding author: Tel.: +56-9-54123855; E-mail: [email protected]Tel.: +56-9-54123829; E-mail: [email protected]ABSTRACT Anthropometric surveys are the most common method of gathering human morphometric data, used to design clothing, products and workspaces. The aim of this paper was to assess how current peer reviewed literature addresses the accuracy, reliability and precision regarding manual anthropometric surveys applied to adult working populations in the field of ergonomics. A literature review was performed in two electronic databases for finding relevant papers. A total of 312 papers were reviewed, of which 79 met the inclusion criteria. The results shown that the subjects of these publications are poorly addressed, so that only 27 studies mentioned at least one of the terms and none of the studies evaluated all of the terms. Only one paper mentioned and assessed precision and reliability of the measurement procedure. Furthermore, none of the publications evaluated accuracy. Moreover, the reviewed papers presented large differences in the factors that affect precision, reliability and accuracy. This was particularly clear in the measurer technique/training, measurement tools, subject posture and clothing. Researchers in this area should take more rigorous approaches and explicit indicators with their results should be presented in any report. Relevance for industry: It is important that scientific literature related to manual anthropometric measurements uses methods for assessing measurement error, since these data are often used to design clothing and workspaces as well as to calibrate non manual methods such as 3D scanners. Keywords: Anthropometry, measures, physical ergonomics, quality control, measurement error.
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Accuracy, precision and reliability in anthropometric surveys forergonomicspurposesinadultworkingpopulations:Aliteraturereview
(4) Delft University of Technology, Faculty of Industrial Design Engineering Section AppliedErgonomicsandDesign,Landbergstraat152628CEDelft,TheNetherlands.
Anthropometricsurveysare themostcommonmethodofgatheringhumanmorphometricdata,used to design clothing, products and workspaces. The aim of this paper was to assess howcurrentpeerreviewedliteratureaddressestheaccuracy,reliabilityandprecisionregardingmanualanthropometric surveys applied to adult working populations in the field of ergonomics. Aliteraturereviewwasperformedintwoelectronicdatabasesforfindingrelevantpapers.Atotalof312 papers were reviewed, of which 79 met the inclusion criteria. The results shown that thesubjectsofthesepublicationsarepoorlyaddressed,sothatonly27studiesmentionedatleastoneofthetermsandnoneofthestudiesevaluatedallof theterms.Onlyonepapermentionedandassessed precision and reliability of the measurement procedure. Furthermore, none of thepublications evaluated accuracy.Moreover, the reviewed papers presented large differences inthe factors that affect precision, reliability and accuracy. This was particularly clear in themeasurer technique/training, measurement tools, subject posture and clothing. Researchers inthisareashouldtakemorerigorousapproachesandexplicitindicatorswiththeirresultsshouldbepresentedinanyreport.Relevanceforindustry:Itisimportantthatscientificliteraturerelatedtomanual anthropometric measurements uses methods for assessing measurement error, sincethesedataareoftenusedtodesignclothingandworkspacesaswellas tocalibratenonmanualmethodssuchas3Dscanners.
Anthropometry is the branch of the human sciences that deals with body measurements:measurements of body size, shape, strength and working capacity (Pheasant & Steenbekkers,2005).Thecharacteristicsofanygivenpopulationwilldependuponanumberoffactors,ofwhichthe most relevant ones from an ergonomics point of view are: gender, age, ethnicity andoccupation(Pheasant&Steenbekkers,2005).Alloftheseaspectsmustbeconsideredinordertomatchthedesignsofproducts,environmentsandsystems,asawhole.Thephysicalcharacteristicsof targetusers (Garneau&Parkinson,2016)havetobeconsideredtoallowtheworkplacesandproducts to be suited to theworkers’ body size andmotion (Kroemer&Grandjean, 1997). Thecriteria that define a successful outcome to the design process falls into three main groups:comfort,performance,andhealthandsafety.Thesethreefactorstogetherbenefitthecompanies’productivityandefficiency(Pheasant&Steenbekkers,2005).
Currently,anthropometryisconsideredasanimportantfactorforthepreventionofseveralwork-relatedproblems.Thismatterisbeingaddressedbyspecificinternationaltechnicalstandards(ISO,2008,2010a,2010b,2013)andother technical standards that take intoaccountanthropometryfor prevention of diseases and accidents (ISO, 2000, 2002, 2003). Additionally, there are evenstandardsforspecificindustrialsectorslikecontrolrooms(ISO,2011)andhealthcare(ISO,2012a).There are several large anthropometry databases, some of the most relevant ones beingmentioned in ISO (2010b), such as the CAESAR database that considered US and Europeanpopulations (Harrison&Robinette, 2002;Robinetteet al., 2002). Furthermore, ISO (2010b) alsoincludesdatabasesfromothercountrieslikeJapan,Korea,Thailand,Italy,Kenya.Allthedatabasespresented in ISO 7250-2 collected anthropometric measurements with either just manualtechniques(Thailand,Germany,Italy,Japan,Kenya,Korea),with3Dscans(US),orbothtechniques(Netherlands). Other highly relevant large sources of anthropometric data are the ANSUR,MC-ANSURandANSURIIsurveys,wheremilitarypersonnelweremeasured(Gordonetal.,1988;2012;2013). Likewise, NASA has collected large amounts of data, for their interspace shuttle designs(NASA, 1978) and even for specific sectors such as truck drivers (Guan et al., 2015). Similarresearch efforts have also produced large anthropometric databases using civilians of othercountriessuchasKorea(KoreanAgencyforTechnologyandStandards,2004)andJapan(ResearchInstituteofHumanEngineeringforQualityLife,2007).
Manualmeasurements of anthropometric characteristics are commonly used due to theirmainbenefits: relatively low cost compared to more automated equipment like 3D scans; ease ofmeasurements and the need for less complex equipment. However, manual anthropometrictechniquescanpresentissuesrelatedtohumanmeasurementerrors(Sicotteetal.,2010).Whenanthropometricalmeasuresarerepeatedthetwosourcesofvariationare:biologicalvariationofindividuals – that cannot be avoided – and technical variations – that can be avoided. Thevariability on the anthropometrical measurements caused by variations on the techniqueexecutionisresponsibleforahigherincidenceoferror(Perinietal.,2005).
Anthropometry is very sensitive to measurement error (Villamor & Bosch, 2014). To avoid thevariability of the measures and reduce measurement error, the World Health Organizationproposedthefollowingqualityassurancemeasures(WHO,2006):(i)standardizeddatacollectionmethodology,(ii)rigoroustrainingandmonitoringofdatacollectionpersonnel,(iii)frequentandeffectiveequipmentcalibrationandmaintenance,and(iv)periodicassessmentofanthropometricmeasurement reliability. Furthermore, the International Standard Organization (ISO) developedsome standards (ISO, 2008, 2013) that provide a description of anthropometric measurements
Published scientific literature use several terms to define anthropometric measurement error.Regardless of the terms used, the effects of measurement error can be mainly categorizeddependingby the extent towhich the repeatedmeasures give the same valueor the extent towhichameasuredepartsfromthetruevalue(Ulijaszek&Kerr,1999).
1.1.RepeatedMeasures:precisionandreliability
Whilethereareseveraldefinitionsofprecisionandreliabilityinthepublishedliterature(Habichtetal.,1979;Heymsfieldetal.,1984;Mueller&Martorell,1988;Norton&Olds,1996;Ulijaszek&Kerr,1999;Wongetal.,2008),theymayconfusereaderssincetheyareverysimilar,thus,forthepurposesofthispaper,wedefinedtheprecisionaccordingtoNortonandOlds(1996).Precisionisacharacteristicofa specificmeasurerexecutingaspecificmeasurement techniqueonaspecificbodydimension(Norton&Olds,1996).Reliabilityhasthesamefeaturesplusbeingdependentonthe individual differences (Norton & Olds, 1996). These individual differences are grouped bydependability term. Dependability is a function of physiological variation, such as biologicalfactors, thatcanmodify the reproducibilityof themeasure,even if the techniquedoesnotvary(Sicotte et al., 2010; Ulijaszek & Kerr, 1999). One example of dependability is the variation ofstatureinthesamesubject,betweenhoursoftheday,despiteofthetechniqueusedtotakeit,asstaturedecreasesthroughouttheday(Tillmann,2001).Sincereliabilityisusuallymeasuredusingcoefficients, its indicatorswill be, in general,more correlated in highly heterogeneous subjectsthan for a group of more similar ones (Pederson & Gore, 1996). Another difference is thatprecisionmeasurementsmaybeusedinsubsequentcalculations(i.e.confidenceintervals,samplesize), whilemeasures of reliability, conversely, are just technique indicators and should not beused for further calculations (Pederson& Gore, 1996). According to Pederson and Gore (1996)precisionisthemostbasicindicatorofananthropometrist'sexpertiseorability.Whenthelevelsofprecisionarequotedinatechnicalreport,thereadersshouldbegivenboththeresultsandtheacceptablestandardsinordertoassesstheprecisionofeachvariable(Norton&Olds,1996).Forexample,accordingtotheInternationalSocietyfortheAdvancementofKinanthropometry(ISAK),someanthropometricdimensions like skinfolds, shouldhaveanacceptedprecisionmeasured inmm, depending on the skinfold taken (Norton & Olds, 1996). Precision levels for several bodymeasurements can be found in Gordon et al. (1988; 2012) and other technical reports thatresearchers can use in order to establish a baseline. Regarding other differences betweenprecisionandreliability,Brutonetal.(2000)statethatreliabilityisrelatedtotherepeatabilityorconsistency of measurements, measurers or instruments, and it is usually assumed that thereliability of ameasurement relies on precision and dependability,where the former being themost importantdeterminant(Mueller&Martorell,1988).Finally, it is importanttomentionthatprecision and reliability evaluation can be performed to evaluate repeated measurers in twosituations e.g.: singlemeasurer in twoormoredifferent times (intra-measurer) or twoormoremeasurers(inter-measurers).
1.2.Truevalue:accuracy
Accuracy refers to the closeness of the measurements to some reference or standard valueacceptedasthe‘truth’andexpressesarelationtoavalueexternaltothemeasurementprocess(Roebucketal.,1975).Inanthropometry,accuracyisrelatedtothe“goldstandard”whichisused
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tocomparetheresultsofnewanthropometristsagainstexpertanthropometrists(Norton&Olds,1996). In general, true values are complicated to identify in anthropometrics. However, thosevaluesareusuallydeterminedbycomparingexperiencedmeasurers resultsagainst the researchteam,untilacertainstandardisachieved(Gordonetal.1988;Norton&Olds,1996).Despitethat,inpracticethiswouldimplythatthroughouttheprojecttheresultsobtainedbytheresearchteamshouldbe systematically comparedagainst a gold standard,whichmaybevery timeconsumingandexpensivetoachieve,sinceatleastasampleofsubjectsshouldbere-measuredbytheexpertsin order to assess accuracy. Roebuck et al. (1975) mention that accuracy is generally bestapproximatedbytheuseofpreciselycalibrated,rigidinstrumentscarefullypositionedbytrainedinvestigators under controlled environmental conditions. This statement implies that the best aresearchteamcandoistryingtobetheclosesttothetruevalue,sincethedifficultiesinherenttomeasurehumansisamajorobstacletoobtainatruevalue,asPheasant&Halsegrave(2006)havepointed out: “The human body has very few sharp edges—its contours are rounded and it is
generally squashy and unstable”, thus generally itmust be admitted that ‘true’ values are verydifficulttoobtainorcalculate(Ulijaszek&Kerr,1999).
Thisresearchstudy,carriedoutmainlythroughaliteraturereview,soughttoanswerthefollowingresearch question: ‘Did the currently existing anthropometric studies published only in peerreviewed journals of adult working populations, related to ergonomics, mentioned and/orevaluatedprecision,reliabilityoraccuracyofthemeasurementmethodsanddatacollected?
2.METHOD
In order to properly answer the research question, a Literature Review was used (Tranfield,Denyer,&Smart,2003).Thismethodology,besidesbeingreplicableandscientificallytransparent,it is also very useful to generate a basic framework for an in-depth analysis of the existingliterature(Tranfieldetal.,2003).
Twodatabases,SciVerseScopusandPubMed,wereusedforfindingrelevantpaperspublishedinthe field studies of anthropometric surveys for ergonomics purposes involving adult workingpopulation.
Regarding the search criteria, the search terms used were: ‘anthropometric characteristics’,‘anthropometricdimensions’and‘anthropometricmeasures’.Toavoidpapersnotfallingintothetopicunder study, the searchwasperformedusing theBooleanoperator ‘‘AND’’, togetherwiththe search term ‘ergonomics’. The following combination were used: ‘anthropometriccharacteristics’ AND ‘ergonomics’; ‘anthropometric dimensions’ AND ‘ergonomics’;‘anthropometricmeasures’AND‘ergonomics’.
Apart from the criteria mentioned above, the following additional inclusion criteria were alsoadopted:
• Original and review articles written in English published, or in press, in peer-reviewedjournals;
• Papers that focused on describing the execution of manual anthropometricsurveysinordertoestablishadatabase;
• Paperswithadultsamples,withagesbetween18and65yearsold.Studieswerealso considered and included if part of the study sample fell in the selected age range.Samplesthatincludedadultcollege/universitystudentswerealsoincluded.
Studies that merely presented anthropometric measures with focus in nutritional status, bodycompositionorsportsperformance(e.g.stature,weight,bodymassindex,skinfolds,hipandwaistcircumference) were excluded. Examples of exclusions are Salamat et al. (2015), Sett & Sahu(2016) and Gabbett (2005). Studies that presented exclusively 3D or photography methods tocollecteddatawerealsoexcluded,suchastheexamplesoftheworksfromBarrosoetal. (2005)andCoblentzetal. (1991). In caseswheremanualmethodswhereused togetherwithother3Dmethodsordigitizingarms,thepaperwasincluded,andthatwasthecaseofthepaperbyHsiaoetal. (2014). Exclusionwasalsoapplied to studies thataimed tovalidateanotheranthropometricsurvey method using traditional methods (Li et al., 2008; Meunier & Yin, 2000). Studies thatfocusedonlyonschoolchildren(Castelluccietal.,2015)orchildrenonly(Stoneetal.,2013)werealso excluded. Although some papers did use working adults anthropometric data in anergonomics context, they were not considered since they used some already availableanthropometricdatabasesanddidnottakeanymanualmeasurement,thusbasedtheirfindingsinpreviously executed surveys or technical reports (e.g.,Hong et al., 2014;Mavrikios et al., 2006;Snook&Ciriello,1991;VanVeelenetal.,2003).Studiesthatonlyusedspecialpopulations,suchaswheel chair/disabled subjects (Kozey & Das, 2004), elderly (Dawal et al., 2015) and pregnantwomen(Wuetal.,2015)werealsoexcluded.
Before starting the results and discussion process and to avoid misunderstandings, theterms/variables(e.g.accuracy,precision,reliabilityandtheirsynonymous)wereconsideredtobeevaluated when an equation or formula was applied and the results were presented. Anotheralternative forconsiderationofaparticular termwaswhentherewasaclearmentioningof theanalysisforthatterm/variable.Thereweresomecaseswherethetermswerementionedwithoutany evaluation, like the study of Chavalitsakulchai and Shahnavaz (1993): “the accuracy of themeasurements was checked and confirmed by rechecking measurements three times for eachsubject”. In these cases, although the accuracy was mentioned, it was not considered to beevaluated since neither formula nor results were presented (Table 1). Also, in the study ofChavalitsakulchaiandShahnavaz(1993)isimportanttonoticethataccuracywasnotconsideredas“truevalue”butasrepeatedmeasures,whichisconceptuallywrong.
Titles and abstracts were checked separately by two of the authors in order to select relevantpapersthatwere lateranalyzedfor their full text. Ifanypaperseemedsuitablebuttheabstractwasnotavailable,thenthefulltextwasdownloaded.Discrepanciesamongauthorswerereferredto the others three authors, in order to perform joint discussion of the publication; thus theparticularpublicationwasincludedorexcluded.Twoauthorsusingastandardizeddataextractionformreviewedfullversionsindependently,anddisagreementsbetweenthemwerereferredtotheother authors. Primary studies meeting the inclusion criteria were identified and thecorrespondingrelevantinformationrequiredwasanalyzed.
removalofduplicateentries.Afterscreeningthetitle,abstractandkeywordsofeacharticle,247papers were identified as being potentially relevant. Additionally, when trying to access anddownload the articles, nine of themwere not available. After reviewing the corresponding full-texts,79paperswereselectedonthebasisoftheinclusioncriteria.
-InsertFigure1nearhere-
3.1.Truevalue:Accuracy
TheresultsfromTable1showthatnineoutofthe79studiesmentionedthewordaccuracybutnone of them evaluated it. Other five authors mentioned accuracy but it was related to theinstrument accuracy, not the measurement procedure (Eksioglu, 2016; Hanson et al., 2009;Khadem & Islam 2014; Mahmoudi & Bazrafshan, 2013; Mousavifard & Alvandian, 2011). It isimportanttopointoutthatthisstudydidnotconsidertheaccuracyrelatedtoagoldstandard,asdefinedonthisreview,thusaccuracywasusedheretoillustratethattheusedinstrumentswerethe appropriate ones. Some of the authors mentioned that accuracy of measurements wasachievedbypracticingpriortothedatacollectionsessionsorthatitwasachievedbytakingmorethan one time andusing the average value, for example the papers fromChavalitsakulchai andShahnavaz, (1993)and Ismailaetal. (2013).Thisassumption is far frombeingcorrect, since theaveragevaluemaynotbenecessarilyaccurate,forexampleonecantake3measurementsofwristbreadthforaparticularsubjectandgettinganaveragevaluethatwasnotevenmeasured(e.g.:(7cm + 6 cm + 6 cm) / 3 = 6,3 cm). Therefore, it is difficult to state that using this procedure ofaveraging 3 measurements will, in fact, assure getting accurate or true measures (Pheasant &Haslegrave, 2006). Furthermore,most authors declared that the accuracyof themeasurementswasachievedbyundergoingtrainingandsupervision,suchasthepapersbyIsmailaetal.(2013)and Pourtaghi et al. (2014). In someway, the presented results of achieved accuracy could besupported by the ISO 15535 (ISO, 2012b), in which it is mentioned that "frequent and regularmeasurer training and quality control shall be carried out by persons experienced in
However, there are some issues that need to be addressed, considering that inaccuracy is asystematic bias, and could be associated with instrument or technique error (Ulijaszek & Kerr,1999):
a) Instruments:consideringtherecommendationfromISO7250-1 (ISO,2008),nineof the 79 studies that mentioned accuracy, used the recommended instruments(anthropometerorslidingcalliper) fordatacollection inthestudies.However,only fourspecifiedboththetypeandbrand,wheretheremaining fivedidnotspecifiedthebrand(Table2).Ontheotherhand,someauthors,usedplastictape(Hansonetal.,2009),steelmeasuringtape(Sadeghietal.,2015)orretractabletape(Bello&Sepenu,2013)tocollectlineardistances,suchasfootbreadth,hipbreadthandpoplitealheight,whichmayaffectthelevelofaccuracy(Table2).Otherauthors,suchasCai&Chen(2016),didnotspecifythetypeofinstrumentsusedfortakingaparticularsetofmeasures(Table2).Fivestudiesmentionedaccuracyinrelationtotheinstruments,butnottheprocedureofmeasurementitself(seeTable2).Amongthese,twostudiesmentionedthatequipmentwascalibratedortestedforaccuracy,butdidnotpresentanyindicatorsorresultsthatshowsthatitwastheactual measurement procedure that was under assessment and not the instruments(Eksioglu,2016;Mahmoudi,2013);twootherstudiesmentionedthattheequipmentwas
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also accurate did not present results or indicators for accuracy (Khadem& Islam, 2014;Mousavifard&Alvandian,2011)and finallyonlyone studyhasmentionedunit accuracylevels(i.e.,theaccuracylevelsforthemeasuringtapewasof2mm)(Hansonetal.,2009)butdidnotpresentanyequationorprocedureadoptedtodeterminethatspecificvaluethatmight have helped to know if themeasurement procedurewas under assessment.Instrument accuracy is an important issue that is related to the observer accuracy, andthoughitwasaconcernformanyauthors,thisissuewaspoorlyaddressedinthereviewedpapers.Adeeperanalysisofthemeasurementtoolsusedispresentedinsection3.3.2.
b) Measurement technique: assuming that the studies used a measurer that wasexperiencedinanthropometry,withoutapplyinganyequationorformulaitisverydifficultto calculate the differences between the expert anthropometrists (considered as "truevalue") with the new measurers. One solution to prove the level of accuracy wasdevelopedbytheInternationalSocietyfortheAdvancementofKinanthropometry(ISAK),which use the Technical Error of Measurement (TEM) as an evaluation index to theaccreditationofnewanthropometrists(Geetaetal.,2009;Perinietal.,2005).TheTEMisbasicallythesquarerootofmeasurementerrorvariance(Arroyoetal.,2010),andisusedtocomparetheresultsofthenewanthropometristsagainsttheexpertanthropometrists(ISAKlevel3or4).ItisimportanttomentionthatdespitethefactthatISAK,inlevels2and3,considersteachinganthropometryasanoptionintheergonomicsfield(Norton&Olds,1996), it does not consider the same measurements normally applied in the field ofergonomics stated in ISO 7250-1 (ISO, 2008). For example, they only included certainlengths and breadths and overlooked other dimensions, such as popliteal height andelbow height, both of which are critical for workplace design that might be not fullycovered by ISAK`s gold standards (Kroemer&Grandjean, 1997; Pheasant&Haslegrave,2006).
-InsertTable1nearhere-
3.2.RepeatedMeasures:PrecisionandReliability
The evaluation of the precision and reliability should be considered in every study as a directindicator of data quality. Also, a reduced number of errors in measurements will increase theprobability that any relationships among variables in a study are discovered (WHO, 2006).Furthermore, themeasurer error is themost troublesome source of anthropometric error. Thistypeoferrorcanevenbeaccentuatedbytheuseofmultiplemeasurers(Simmons&Istook,2003)– condition thatwaspresent in at least 12outof the79 studies reviewed (Table3),where theinter-measurerreliabilityandprecisionshouldhavebeencalculatedtoavoiderrors.Thissituationcouldalsobecome important for theother67 studies thatdidnotmention (NM)ornot specify(NS) the number ofmeasurers involved in themeasurement process. Regarding the number ofmeasurers,somestudieswereconsideredtobeNS,(seeTable3)sincetheymentionedtheuseofmore thanoneperson to collect themeasures,butdidnot specifyhowmanyof theevaluatorsactuallytookthemeasurements.AnexampleofthisisthestudybySadeghietal.(2014)wherethemeasurementswerecarriedoutbyateamof30engineersandoneanthropologist.Still,itwasnotspecifiediftheengineersortheanthropologisttookthemeasurementsorwhowasarecorderandwhowasthemeasureroriftheywereabletoswitchroles.
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Only three out of the 79 studies includedmeasurements by only onemeasurer (Cengiz, 2014;Ismailaetal.,2013;Zetterberg&Ofverholm,1999).
Regarding precision, only two of the studies reviewed mentioned it (Spasojević et al., 2015;Widyantietal.,2015), justonestudyevaluatedprecisionwithoutmentioningtheterm(Guanetal.,2012),andtwostudiesmentionedandevaluatedprecisionandpresentedtheresults (Leeetal.,2013;Marklinetal.,2010)(Table1).Thethreestudiesthatevaluatedprecisionuseditasanindicatororhadthefollowingprocedure:
• Minimum and maximum absolute difference between any two measurers, themeanandSDofabsolutedifferencesamongallmeasurers(Marklinetal.,2010),themeanoftheabsolutedifferencesrangedfrom2mmto18mm,exceptforweight(Guanetal.,2012).Marklinetal. (2010),wastheonlyoneof the79papers thatactuallymentionedandevaluatedbothprecisionandreliability,usingtwoteststoassessthelatter,providingalsotheresultsofthecalculationsusedforeachindicator.Furtheranalysiswillbemadeinsectionsbelow.Themeanabsolutedifference (MAD)canbeusedforassessingobserverprecisionsinceithasalowcorrelationwithdimensionalmagnitudeanditsownmagnitudecan be readily used as a standard against which measurer performance can be tested(Gordon & Bradtmiller, 1992). A limitation of the MAD is that, although it describesobservererrormagnitude,itdoesnotindicatetheproportionofobservationvariancethatisfreefromanyerror.Thisisrelevantinanthropometricsurveys,sinceadimensionwitharelatively highwithin-subject variability compared to between-subject variability has noutility fordescribingandcategorizinganthropometricdimensions (Gordon&Bradtmiller,1992).
• Use of two measurements per dimension, but additional measurements weremade until the difference between twomeasurements was 2mm, then, the average ofeachpairofmeasurementswasused(Leeetal.,2013).Thislevelisrigurous,speciallyforbiggermeasurements like theonesmeasured in this studyaiming forhelicopter cockpitdesign,suchassittingeyeheight.Thislevelmightworksinceitisverystrict,butitisoftenusedforsmallerdimensions,suchasfingers(Ulijaszek&Kerr,1999).
Itisrelevanttopointoutthatonlythreeoutofthe79papersevaluatedprecision,despitethefactthat precision is themost basic indicator of an anthropometrist’s expertise. The TEM is also acommonlyusedmeasureofprecision (Arroyoetal.,2010;Frisancho,2008)and isadvisedtobeusedtogetherwiththeMADbyGordonandBradtmiller (1992)and isalsopresented assuch intheISO7250-2(ISO,2010b)asfollows:"Thenumberofmeasurersandinformationontheskillof
or repeated measurements, are shown when such data are available. When more than one
measurer is involved, themethodsusedtocontrol thequalityof themeasurementtechniqueare
documented..."
It is important to highlight that 14 of the 79 studies mentioned reliability (Dawal et al., 2012;Ismaila et al., 2013; Khadem& Islam, 2014; Laing et al., 1999; Lavender et al., 2002;Mokdad,2002;Pourtaghietal.,2014;Sadeghietal.,2014;Sadeghietal.,2015;Widyantietal.,2015;Xionget al., 2008; Yang et al., 2007; Zetterberg & Ofverholm, 1999) or synonymous terms, such as,repeatability (Marklin et al., 2010). However, only six of the 79 studies evaluated repeatedmeasurementsusingreliabilitywhereonly Dawaletal. (2012);Laingetal. (1999);Marklinetal.(2010); Pourtaghi et al. (2014) and Xiong et al. (2008) provided results for their reliabilityindicators.Inthesestudies,severalindicatorswereused,suchast-test(Duetal.,2008);reliabilitycoefficient (Pourtaghi et al., 2014); Pearson correlation coefficient (Dawal et al., 2012);
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repeatability coefficient (Marklin et al., 2010), intraclass correlation coefficient (Marklin et al.,2010;Xiongetal.,2008)andcoefficientofvariance(Laingetal.,1999).
Atafirstglance,itseemsthatthereareasmallnumberofstudiesinthisreviewthatconsideredtheevaluationof reliability.Nonetheless, it is important tomentionthatonly twooutof thesixdatabasespresentedintheISO7250-2(ISO,2010b),thatusedmanualmeasurements,consideredtheevaluationof reliability. In the followingparagraphs,studies thatevaluatedreliabilitywillbediscussedbytheindicatorstheyused.
In the studies reviewed, only one used paired samples t-tests to assess the inter- and intra-measurerreliability(Duetal.,2008).TheuseofthistestisconsistentwiththeprocedureusedbySteenbekkers (1993) and reinforced by Goto and Mascie-Taylor (2007), who indicated thatinconsistencybetween twomeasurements canbeassessedusingapaired samples t-test,whichdetermines whether the mean is significantly different or not. However, Bruton et al. (2000),indicated that paired samples t-test, are better suited for obtaining systematic bias amongobservations and are commonly used in reliability testing, but they have the limitation of onlyprovidingresultsaboutsystematicdifferencesbetweenthemeansoftwogroupsofobservations,nottakingintoaccountindividualdifferences.
Abetteralternativeisusingthereliabilitycoefficient(R),asusedbyPourtaghietal.(2014).TheR,is useful since it can be readily calculated using random effects analysis of variance wheremeasurereffectsarenestedwithinsubjecteffects,thusprovidingresultsrelatedtotheerrorfreeproportion of variance (Gordon&Bradtmiller, 1992). In otherwords, this coefficient shows theproportion of between-subject variance free from measurement error (Arroyo et al., 2010).Additionally, because R is unit-free, it allows to perform observer variations among diversemagnitudevariables(Gordon&Bradtmiller,1992).
Therepeatabilitycoefficientcanalsobeusedtocalculateobservererrorovermeasurements. Inthis reviewonlyMarklin et al. (2010) used it. Care should be takenwhenusing this coefficient,sinceitmayconfusereaders,mainlybecausecoefficients, liketheR,areunit-freeandinarangefrom zero to one, while the repeatability coefficient has the units of the measurement, forexamplemillimeters. In general the reliability coefficient is not a very commonlyused indicator(Brutonetal.,2000)andliteraturerelatedtoanthropometricsshowsthattherearetwowaystocalculateit,varyingslightlybetweenthetwowaystodoit(BlandandAltman,1986;Bland,1987).
Pearsoncorrelationcoefficient(r)wasanothermethodusedinoneofthestudiesreviewed(Dawaletal.,2012).Therreflectstheextentofassociationbetweentwogroupsofmeasurements,ortheconsistencyofthepositionwithinthem.However,thiscoefficientfailstodetectsystematicerrors,thus reliability calculationsusing r canpresenthighlycorrelatedvariables thatat the same timearepoorlyrepeatable(Brutonetal.,2000).
The intra-classcorrelationcoefficient(ICC)canbeusedtobridgeovertherestrictionsofrand itwasusedintwoofthepapersreviewed,totesttheinter-andintra-measurerreliability(Marklinetal.,2010;Xiongetal.,2008).TheICCisanindicatorcomputedusingvarianceestimatesobtainedthroughtheseparationoftotalvarianceintobetween-andwithin-subjectvariance(ANOVA).Ithasthestrengthofshowingtheextentofconsistencyandagreementbetweenmeasurements(Brutonetal.,2000).
(1987)clearlyexplains it, theweaknessofpresentingobservererrorasapercentage, is that thepercentageofthesmallermeasurementresultwilldifferhighlyfromthepercentageofthelargestmeasurement. It is more suitable to use ICC instead of the CV since the ICC establishes therelationship of error size variation to the size of the variation studied (Chinn, 1991).Despite itslimitations,Brutonetal.(2000)mentionedthattheCVisapertinentindicatortoassessreliability.
DuringthelastthreedecadesagreatefforthasbeendonebymeansoftheISOstandardstohavemore accurate and reliable anthropometric measurements. Still, the results in the area ofanthropometric surveys for ergonomicspurposesdoesnotdiffer from the ideapresentedmorethan three decades ago by Ulijaszek and Mascie-Taylor (1994). These authors explained thatreportsofgrowthandphysiquemeasurementsinhumanpopulationsrarely includeestimatesofmeasurementerrorandthisissuecouldbeduetoalackofstandardizedterminologytodescribethereliabilityofmeasurementinaclearandunderstandableway.
Finally, the results from the present review shows that despite the fact that anthropometricmeasurementsneedtopresentdirectindicatorsofobservererrors(WHO,2006),only24ofthe79papers mentionedat leastoneofthetermsandonlynineevaluatedat leastoneofthem.Onlyonestudy(Marklinetal.,2010)bothmentionedandevaluatedreliabilityandprecision.Noneofthe reviewed studies mentioned and evaluated all the three terms accuracy, precision andreliability.
The results show that only a few studies have evaluated the level of accuracy, precision andreliability. Furthermore, a deeper analysis of the reviewed papers can be done through theexaminationofthreefactorsthatmayaffectthemeasurementerror,asdescribedinthefollowingsections:training,measurementtoolsandprocedures.
3.3.1.Training
Ofthereviewedstudies,Only16studiesconsideredtrainingprocedurebeforethedatacollection(Table3).Thisisaveryimportantaspectsinceconsistenttrainingcanreducedifferencesbetweenmeasurementstakenbydifferentpeople(Bragançaetal.,2016).Inmoststudies,trainingincludedatheoreticalapproachaboutanthropometry,aswellaspracticaltraining.Oneofthestudieshasalso considered training by showing a video of the anthropometricmeasurements and by test-measuringtherequireddimensions(Duetal.,2008).
Themajority of studies did not specify the timeframes used in training (Table 3). Nevertheless,withtheavailable information itcanbestatedthattherearesignificantdiscrepanciesrelatedtothetrainingtimeused.Forexample,Sadeghietal.(2015)usedatwodaytrainingsession,Khadem&Islam(2014)usedathreedaytrainingsession,whilstotherauthorsusedaone-weektrainingsession(Karmegametal.,2011;Mokdad,2002).
3.3.2.Measurementtools
In the reviewed literature,a largeamountofmeasurement toolswereused to collect thedata,where 38 of themusedmore than onemeasurement tool (Table 2). Themost frequently used
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measurementtoolwastheanthropometer (41outof the79).Themostusedanthropometer, in16outof the79 reviewed studies,wasMartin Type/Siber-HegnerGPM® (Figure2). The secondmost used toolwas the caliper,where 27 studies used a sliding caliper. On the other hand, 21studiesdidnotmention the typeofmeasurement toolusedduring theiranthropometric survey(Table2).
-InsertTable2nearhere-
Following the discussion presented in section 3.1, it is important to mention that there iscontradictory bibliography regarding instrument accuracy. One position is that the risk ofinaccuracy is greater when using complex instruments versus using more simple ones. Thus,inaccuracyofmeasurementswhileusingasimplemeasuringtapeismorelikelytobesmallerthanwhenusingslidingscales,suchasanthropometersandstadiometers(Ulijaszek&Kerr,1999).Ontheotherhand,Roebucketal.(1975)mentionthattheaccuracyisgenerallybestapproximatedbytheuseofpreciselycalibratedandrigid instrumentscarefullypositionedbytrained investigatorsundercontrolledenvironmentalconditions.
Considering the previous information, one should determine if it is better to measure with ameasuringtaperatherthanwithananthropometer.Theanswertothisquestionfirstly;dependson the specificmeasure tobecollected.Secondly, it is important tomention thatvalidity is thedegree to which an observationmeasures a characteristic, and is highly related with the termaccuracysince‘true’valuesareverydifficulttobecalculated(Ulijaszek&Kerr,1999).Onecouldalsoenquireaboutthevalidityofusingameasuringtapetocollectlineardistances(e.g.poplitealheightorelbowheightsitting).BasedontheISO7250-1,measuringtapesareonlyrecommendedforbodycircumferencesmeasurementsandnotforlineardistance.Nonetheless,asitisnotarigidinstrument, this recommendation could be acceptedor not, basedon the characteristics of themeasuringtapeandonthecharacteristicsofthebodymeasurementtobecollected.Forexample,whenmeasuringpoplitealheightitwouldbemoredifficulttopositiononeendofthemeasuringtapeinthetendonoftherelaxedbicepsfemorismuscleandtheotherendonthefloor,sincethisequipmentdoesnothavebladesorbranchesliketheanthropometer(Figure2)anditmaynotbeverystable,thuscompromisingtheresults.
Thepositioningofthelandmarksmightalsobeanissue,ashappenswhenusinga3Dscanneroraskinfoldsmeasuringdevice.Landmarking isaveryusefultool inordertoachievebetter levelsofaccuracy, precision and reliability. Landmarking has been applied successfully in large andinternationally knownanthropometric surveys suchasANSUR,MC-ANSUR,ANSUR II (Gordonetal., 1988; 2012; 2013),where all the subjectswere arm forcespersonnel. The samplesof thesestudiesmayfavorthelandmarkingprocessandfollowingmeasurementprotocols,mainlybecauseof the highly hierarchical organizational structure and rigor present in arm forces, it could beassumed that these subjects aremorewilling to cooperateand stripdown to light clothes thanciviliansubjects inotherstudies.Landmarkinghas,however, its limitationsmainlybecausewhenapplied in non-arm forceswork settings, landmarking can present issues related to privacy andcultural/religiousbeliefsthatmaydownsizesubject’sparticipation.Thus,justafewexposedareasareusuallymarkedandtherestofthelandmarksarelocatedbypalpationoverclothesandthenthemeasurement isperformed.Thisprocedurewas followedbyavery relevantanthropometricsurveybyGuanetal. (2015),wherethesamplewascomposedofonlyU.Struckdriversandthemeasurementswereperformedwithandwithoutsubject’sshoesinsomecases.
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-InsertFigure2nearhere-
Consideringthepreviousinformation,therearefourstudiesthatpresentinstrumentsthatmaybeinadequatetocollectedtherequiredmeasurements(Bello&Sepenu,2013;Hansonetal.,2009;Sadeghi et al., 2015; Stålhammar& Louhevaara, 1992). Forexample, all of these studiesusedameasuring tape to measure linear distances, breadths and depths, instead of using ananthropometer and/or sliding /spreading calipers. Finally, other authors (Hanson et al., 2009;Laingetal.,1999;Luceroetal.,2012;Stålhammar&Louhevaara,1992;Widyantietal.,2015;Yangetal.,2007)usedplasticmeasuringtape(tailor’smeasuringtapetype),whichmaybeconsideredas anunreliable instrument since it ismade fromamaterial that can stretchandgetdeformedovertime(Bragançaetal.,2016).
-InsertTable3nearhere-
3.3.3.Proceduresfordatacollection
Havingastandardizedprocedurefordatacollectionwillcertainlyminimizethemeasurementerrorandismorelikelytoallowcomparisonswithotheranthropometricmeasurementsfromdifferentpopulations.ISO7250-1(ISO,2008)providessomeinformationwiththepurposeofstandardizingthe data collection procedures: (i) description of anthropometricmeasurements, (ii) clothing ofsubject,(iii)bodysymmetry,(iv)posture,(v)instruments,and(vi)supportsurfaces(floororsittingsurfaces).
Itisrelevanttodiscussthatnoneofthereviewedpaperswerepublishedbeforethefirstversionofthe ISO 7250, 1988. Despite that, only ten of the reviewed studies mentioned that themeasurementswereperformedfollowingtherecommendationsonthestandard(Table3).Theseresultsshouldbeconsideredwithcautionsince:
a) 23 studies used the measurements defined by other relevant authors, such as:Pheasant(2003);KroemerandGranjean(1997);Gordonetal.(1988),Evansetal.(1988)and Hertzberg(1968).It is importanttohighlightthatthedimensionsfromthepreviousauthorspresenthighsimilaritieswiththedimensiondefinedbytheISO7250.
b) Other eight authors (Cais & Chen, 2016; Mazloumi & Mohammadreze, 2012;Mousavifard&Alvandian,2011;Sadeghietal.,2014;Wang&Chao,2010;Werneretal.,1998;Yangetal.,2007;Yunetal.,2002)onlygatheredmeasurementsthatarenotdefinedin the ISO 7250-1. It needs to be said that in itself this is not a problem, since the ISOstandard mentions that the basic list can be supplemented by specific additionalmeasurements.
c) 14authorsusedbothdimensionspresentinISO7250-1andadditionaldimensions(Duetal.,2008;Flyte&Perchard.,1999;Kawaharaetal.,1998;Nagetal.,2003;Leeetal.,2013;Oñateetal.,2012;Sadeghietal.,2015;Tahaetal.,2009;Thariqetal.,2010;Toro&Henrich,1997;Tunay&Melemez,2008;Ugurlu&Ozdogan,2011;Verhaertetal.,2011;Xiong et al., 2008). Furthermore, the ISO 15535 mentions that measurements that aredifferentfromthosespecifiedinISO7250-1canalsobecollectedaccordingtothepurposeof the investigation. In such cases, definitions,methods, instruments andmeasurement
13
unitsshallbeclearlyindicatedinthereport.ThiswasthecaseforOñateetal.(2012)thatusedtheISO8559standardforclothingdesign,wheremostmeasurementsarerelatedtogirthsandbodycurvatures.Theauthorsof this reviewbelieve thatwhenmeasurementshave not been extracted from ISO 7250-1, it is important to clearly defining them, thusindicating the relevant related anatomic points, and if possible bones, since these aremore easily located and represent a solid point to place themeasurement instruments.However, if measurements required do not consider bony body parts, it should clearlyspecifythelocationofinstrumentplacementinordertominimizethemeasurementerror.One example of this is thigh clearance, where one of the blades of the anthropometershouldbeplacedonthehighestpoint(onthetop)ofthethigh.AlthoughthighclearanceispartofISO7250-1,itshowsthatwhenmeasurementsconsidersoftparts,andclearanceisbeingsought,thetallest,biggestorwidestpartsshouldbeusedasreferencepoints.ThisapproachwasdoneinANSURII(Gordonetal.,2012)withsimilarmeasurementsthatuse“soft” landmarks, such as chest circumference or shoulder circumference, in order toactuallymeasure thewholespectrumof themeasurement,especially inbigger subjects.Theconsiderationofastandardpostureofthesubjectsandtheuseofproperinstrumentsselection isalsoakeyaspect,where theresearchercan follow ISO7250-1standardasaguidelineandcomplementitwithotherrelevanttechnicaltext inordertoaccommodatetheirrequiredmeasurementsforparticularneeds.
Consideringthepreviouspoints,thiscriticalsituationneedstobeaddressedsinceonlysixstudiesdefined themeasurements using text and figure, 45 studies used only text or figure and sevenstudies did not present any definition for theirmeasurements (see Table 3). It is important topoint out that 21 studies presented the dimensions in an unspecifiedmanner, thus they wereclassified as not specified (N/S) since the authors only presented the dimensions in the resultstables,notspecifyingreferentiallandmarksnoranyotherparticulardefinition(Table3).
Regarding the clothing of the subjects, there are four studies that need to be excluded of theanalysis since they considered measurements that are not affected by clothes such as: handdimensions and head/neck/face dimensions (Imrhan et al., 2009; Shah et al., 2015; Yang et al.,2007;Yunetal.,2002).Fortheremaining75studies,in23studiesthesubjectsweremeasuredint-shirts and shorts or lightly clothed. Is of interest the paper byOñate et al., (2012) thatmadereference to another ISO standard (ISO, 1989), where it is stated that the procedure ofmeasurementshouldbedonenudeor lightlyclothed.On theotherhand,12studiesperformedthe measurements with the participants wearing casual or working clothes (See table 3). AparticularstudywastheonebyHsiaoetal.(2014)sincetheyperformedthemeasurementswiththe subjects both wearing light clothes and working clothes. This paper actually shows a veryinterestingapproachthatshouldbegivenmoreconsideration,andshowsacleverwaytooverpassthe gap between standard measuring procedures (light clothing) and future practicaldesign/intervention implications. Since the sample used by Hsiao et al. (2014)were firefightersthatinherentlyuseseveralprotectiveequipmentsuchashelmets,masks,bootsandbulkyjackets;theprocedureusedinthispublicationallowscalculatingeasilyandrealisticallythevariationoftheanthropometricdimensionsexperiencedbysubjectswhilewearingrealworkprotectivegarments.Since humanwork in its essence is heterogeneous, the authors of this review believe that thisapproach in field anthropometric surveys should be more used in order to properly addressvariation in anthropometric dimensions among workers, especially for those who need to useprotective equipment, use complex tools orwork in adverse climate conditions, such as in coldenvironments. This is reinforced by Guan et al. (2015) who performed some measurements
Other threestudieswere labeledasN/Ssince theauthorsprovidedreferences tootherauthorsinsteadof stating a clearprocedure regarding clothing (Singhet al., 2015;Wibowoet al., 2013;Xiongetal.,2008).Thiswasdonesince referring toanauthor inparticulardoesnotnecessarilycommunicatetheactualprocedurefollowed.ForexampleinthecaseofWibowoetal.,2013,theyquoted Pheasant & Halsegrave 2006 regarding subject clothing. They measured Indonesianfarmers, where in this country the main religious tendencies might difficult to performmeasurementson“unclothed”women,assuggestedbyPheasant&Halsegrave2006.Theauthorsof this review think that without going into further detail, one can both cite the author anddescribebrieflytheclothesthesubjectusedandotherprocedurerelatedcircumstances.Finally,37studiesdidnotmentiontheclothingofsubjects.Itisrelevanttodiscussthatinsomecountriesreligionorcultureimplythatcertainmeasurementsmustbetakenwithclothes,especiallywhenwomenaretheonesbeingmeasured,asitwasstatedbyKarmegametal.(2011).Accordingtotheauthors’experience,itiscommonthatfieldanthropometricsurveysaretakenalsowithclothes(atleast shirt /dress/pants and no shoes). This happens because it is hard to convince people toundress at their jobs or to change into light clothes and then put again their regular clothes,especiallyiftherearenosuitablefacilitiesandforthetimelossthatmaycompromiseproductivity.ThiswasclearlystatedbyGuanetal.(2015)asthemainreasonwhytheymeasuredtheirsubjectswith their regular clothes. This can usually be solved with subject`s compensation, however indevelopingcountries,theauthorsofthisreviewrecognizethechallengesthatcanbefound,sincefunding can be an issue, thus the incentive for subjects to undress or participatemight not beenough.
The posture adopted by the participants is marked as being a factor that affects errors inanthropometry(Kouchi&Mochimaru,2011).Tominimizetheeffectofthis,manyofthestudiesreviewed (42 out of the 79)measured the participants sitting and/or on the standard standingposition.However,31studiesdidnotmentiontheadoptedpostureatall,andsixstudiesdidnotspecified thepostureusedorquotedanother in theirprocedure, thus theywere labeledasnotspecified N/S since no explicit description of the posture was made (Karmegan et al., 2011;Khadem& Islam 2014; Singh et al., 2015;Wibowo et al., 2013; Yang et al., 2007; Zujnic et al.,2015).
Furthermore, some authors evaluated measurements with participants wearing shoes,sucheyeheightstanding,shoulderheightstanding,elbowheightstanding(Lavenderetal,.2012;Lucero et al., 2012; Simeonov et al., 2012), upper leg height (Spasojević et al., 2015) and kneeheight sitting (Zujnic et al., 2015). Another author (Guan et al., 2012) was not explicit about ifsomemeasurements,suchaspoplitealheight,weremeasuredwithorwithoutshoes,sincetheysometimesmeasuredheightbothwith andwithout shoes, depending if the subjectswore theirtypical driving shoes. However, they based their measurements on the definitions present inANSUR(Gordonetal.,1989),whichstatesthatpoplitealheightshouldbemeasuredbarefoot. Inthisparticularcase,oneof theiraimswastodescribethetypesofshoesworntypicallybymaleand female truck drivers, which we believe is very useful for design/ergonomics purposes (i.e.actually knowing which type of shoes are worn by truck drivers). This paper derives from theextensivetechnicalreportofU.Struckdrivers’anthropometrics(Guanetal.,2015).Theprocedurefollowedbytheseauthorsisconsistentwiththeviewoftheauthorsofthecurrentreview,anditisagoodexampleonhowtopracticallyoverpassthehighvariabilityinshoetypes,beingsimilartothe approach previously made regarding clothing. Care should be taken if not following anddescribing the exact measurement definition nor procedure, since it may lead the reader to
15
believe that some typeoferrormightbepresentbecausemeasurementshavebeenmadewithshoes. This is the reasonwhy it is recommended to alwaysmeasure the participants barefoot,keeping inmindthatshoesmaynaturallyvaryaccordingtoculture, fashion,andcountry.Togetmorerepresentativevaluesofthesampleunderstudy,anoptionistomeasuretheshoeheeland,in the caseswhere this is not possible for the researchers, an alternativewould be to considershoecorrectionasavaluebetween2–3cm(Castelluccietal.,2014).Anotherauthor,Marklinetal.(2010), who measured relevant dimensions such as popliteal height with shoes, did applycorrectionsforbothclothingandshoes inordertomakecomparisonswithotherdatabasesthatmeasuredsubjectswith lightclothesasthestandardprocedurethatshouldbeusedwhendoingthosecomparisons.Alsowhenmeasuringpeoplewiththeirclothes,theresultsmaybeinfluencedbythegeographicallocationwherecolderorhotterweatherhasanimpactonthetypeofclothesusedbythesubjectsandthatmaynotbetheclothesactuallyusedattheirwork.Thusasstatedpreviously, while discussing the paper of Hsiao et al. (2014), a practical suggestion could be topresentactualdataofworkerswithandwithoutclothes,ideallymeasuringbothconditions.
Finally,basedon the findingsof this study it canbeconcluded thatmore importanceshouldbegiventotheprocedureofanthropometricsurveysinpeerreviewedjournals,notonlyonhowtocollect the data (measurement tools, training and data collection procedures) and test themeasurement error, but also on how the data is presented in a scientific paper, since manyauthors did not mention nor specified relevant information of the data collection process.Generally technical reports use very comprehensive and clear procedures, as those used byGordonetal.(1988;2012),wheretheyevenhadobservererrortesteddaily(Gordonetal.,2013).These reports should be used as a guideline in order to point out themost relevant parts thatshouldbeincludedinapeerreviewedpaperaddressingmanualanthropometricprocedures,suchas:detaileddescriptionsofmeasuring tools;anthropometricmeasurementdefinitionsspecifyingrelevant landmarks, subjects posture and clothing/shoes; number of observers with thecorresponding observer error testing results; and presenting error levels specifically for eachdimension. Technical reports offer a great guideline which should be transferred, in a moresummarized format, to any peer reviewed paper that takes anthropometric measurementsmanually,whereasmalltableshowingtheaboverecommendationscanbeconvenientlyincludedinthepaper.
Specificdimensionobservererrorlimitsarepresentinhighlyrigoroustechnicalreports(Gordonetal., 1988; 2012; 2013;Guanet al., 2015), but the readermight think about thepractical designimplicationsof,forexample,a5mmerror,inaparticulardimension.Theanswerdependsonthedimension itself. According to Norton andOlds (1996), the smaller themeasure, the lower theerrortoleranceshouldbe.Thismeansthat,forexample,whendesigninghighlyspecificgarmentsorequipmentforsmallerbodyparts(face,handsandfeet)a5mmerrordifferencecouldhaveacritical impacton theproduct´s fit.Forexample,aCPAPmask,aircraftmasks,gloves,protectivemasksor shoes thatarepoorly fitted,cancausediscomfortand/or injury,besidesnotachievingthedesiredperformance level.Conversely,biggerdimensionsmaybemorepermissive,but thatdoesnotmeanthatobservererrorshouldbeunaccountedfor.
Anotherrelevantconsiderationisthatmanualmeasurementsarestandards,whichcanbeusedtovalidate3Dscannedderiveddimensions(ISO,2010a).3Dscansmeasurementsarenotfreefromerror.Themainsourcesoferrorinthistypeofmeasurementarerelatedtothedevices(softwareandhardware)andtothemeasuredparticipants,mainlybecauseoftheiradoptedpostureandofthepoor landmarking (Kouchi&Mochimaru,2011).Thevalidationof3Dderivedmeasurementsusing traditionalmeasurements has been followed in peer-reviewed papers (Lu&Wang, 2010;Simsetal.,2012).However,ithasbeenacknowledgedthatthequalityparametersofthesestudies
16
arenotusually consistent,mainlybecauseof the lackof explicit accuracy standardsandqualityevaluationprotocol procedures (Kouchi andMochimaru, 2011). Thus, it couldbe implied that ifmeasurementerrorofmanualanthropometricmethods isnot tested,even theuseof themostadvancedtechnologycouldbeimproperlyvalidated,producingtheobviousnegativeoutcomes.Itis therefore relevant to evaluate, wherever possible, observer differences betweenanthropometristsandtoexplicitlyshowtheresultsinpeer-reviewedpapers.Itisalsorelevanttodesignateacriteriontobothassessanthropometristserrorandtrainingnovelanthropometrists,speciallythroughouttheexecutionoftheanthropometricsurveys inordertomaintainqualityofmeasurement, and to avoid deviations during long periods ofmeasurements (Ulijaszek & Kerr,1999).Sinceinanthropometryaccuracyisrelatedtothe“goldstandard”whichisusedtocomparethe results of the new anthropometrists against the expert anthropometrists (Norton & Olds,1996), the authors of this paper suggest that when significant discrepancies appear betweenexperiencedanthropometrists,bothmeasuringtechniquesandmeasuringinstruments,shouldbetested and compared to reduce the difference and establish an agreement among theanthropometristsonpracticalerrorlevels.
3.4.Limitations
A limitationof this study is the fact thatsomerelevantarticlesmighthavenotbeenconsideredduetothewidevarietyofterminologyusedtorefertothesameissues.Anotherlimitationisthefact that technical reportswereexcluded fromthisanalysisandonlyusedasa referenceguide,sinceingeneralthosereportsarenotpublicallyavailable,whichmakesthepeer-reviewedpaperspublished in scientific journal the most common source of information about the use ofanthropometricsinanergonomicscontext.
Thisworkhasalsosomeinherentlimitations,whichresearchersusingthisinformationshouldbeawareofwhen interpretingtheresultspresented inthispaper.This literaturereviewwasbasedon peer-reviewed journals found in only two specific bibliographic databases (Scopus andPubMed).Although it isknownthat thesedatabasescoveraverywide rangeofdifferentareas,searchingindifferentdatabases,suchasGoogleScholar,orconsideredconferencearticles,couldalsohavehadrelevantinformationthatmighthavebeenrelevanttothisreview.
4.CONCLUSION
Theobjectiveof thispaperwas toevaluate, thougha literaturereview,whether if thecurrentlyavailableanthropometricstudiesofworkingadultpopulations inthefieldofergonomics,take inconsideration precision, reliability or accuracy issues. After reviewing the 79 papers it can beconcluded that this topic is poorly addressed in the literature, as only 27 studiesmentioned atleastoneofthetermsandnoneofthestudiesevaluatesalloftheterms.
Regarding the variables that may affect precision, reliability and accuracy, the majority of thepapers reviewed presented great differences in terms of the measurement tools used.Furthermore, there is a clear lack of information regarding the training and procedures foranthropometricdatacollection.
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Finally,moreattentionshouldbegiventotheproceduresusedtocollectanthropometricdataforergonomicspurposes. They should take in consideration theproceduresdefined in the relevantstandards and technical reports, test formeasurement error and report the entire informationexplicitlywhenpresentingthecollecteddata.
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Mahmoudi&Bazrafshan,2013 N=47,between18and48yearsold. ü* X X X X XMahoneyetal.,2015 N=21collegestudents(agesN/S) X X X X X XMarklinetal.,2010 N=187,between22and44yearsold. X X ü ü ü üMatiasetal.,1998 N=100VDToperators.(agesN/S) X X X X X XMazloumi&Mohammadreze,2012 N=30maleIraniandrivers.(agesN/S) X X X X X XMokdad,2002 N=514,between15and75yearsold. X X ü X X XMousavifard&Alvandian,2011 N=256,between15and65+yearsold. ü* X X X X XNagetal.,2003 N=95,between16and58yearsold. X X X X X XNicolay&Walter,2005 N=51,between18and33yearsold. X X X X X XOñateetal.,2012 N=447,averageage38.9yearsold.(agesN/S) X X X X X XOsquei-Zadehetal.,2012 N=267,between18and26yearsold. X X X X X XPennathur&Dowling2003 N=notspecified,between20and85yearsold. X X X X X XPourtaghietal.,2014 N=12635,between18and30yearsold. ü X ü ü X XReisetal.,2012 N=200,averageage33.5yearsoldfemaleand35.7yearsoldmale. X X X X X XSadeghietal.,2014 N=3436,between20and60yearsold. ü X ü X X XSadeghietal.,2015 N=3720,between20and60yearsold. ü X ü X X XShahetal.,2015 N=200,between25and45yearsold. X X X X X XShresthaetal.,2009 N=444,between25and50yearsold. X X X X X XSimeonovetal.,2012 N=40,averageage42.7and37.2yearsold.(agesN/S) X X X X X XSinghetal.,2015 N=940,between20and60yearsold. X X X X X XSpasojevićetal.,2015 N=64,averageage47.64yearsold.(agesN/S) X X X X ü XStålhammar&Louhevaara,1992 N=18,averageage33.8yearsold.(agesN/S) X X X X X XSudhakaran&Mirka,2005 N=24,between18and26yearsold. X X X X X XSutjanaetal.,2008 N=124,between18and23yearsold X X X X X XSyuaib,2015a N=141palmoilmaleworkers(agesN/S) X X X X X XSyuaib,2015b N=371, average age 39,3 years old female and 43,7 years old
male.(agesN/S) ü X X X X X
Tahaetal.,2009 N=887,between20and30yearsold X X X X X XThariqetal.,2010 N=385,between20and28yearsold. X X X X X XToro&Henrich,1997 N=281puertoricanworkers,(agesN/S) X X X X X XTunay&Melemez,2008 N=1049universitystudents,(agesN/S) X X X X X XUgurlu&Ozdogan,2011 N=770,between18and25yearsold X X X X X XVanDrieletal.,2013 N=8,between18and28yearsold X X X X X XVerhaertetal.,2011 N=17,averageage24.3yearsold(agesN/S) X X X X X XWang&Chao,2010 N=30,between18and60yearsold X X X X X XWerneretal.,1998 N=727,between25and69yearsold X X X X X X
34
Wibowoetal.,2013 N=321indonesianfarmers,(agesN/S) X X X X X XWidyantietal.,2015 N=1133universitystudents,(agesN/S) X X ü X ü XXiongetal.,2008 N=50,between19and24yearsold X X ü ü X XYangetal.,2007 N=461,between23and43yearsold ü X ü X X XYunetal.,2002 N=8collegestudents,(agesN/S) X X X X X XZetterberg&Ofverholm,1999 N=564,between20and61yearsold X X ü X X XZujnicetal.,2015 N=64craneoperators,averageage46.6yearsold(agesN/S) X X X X X XM:mention;E:evaluated
Measurementsconsidered MeasurementDefined MeasurementprocedureISO7250 NotISO7250 Text Figure Lightclothes Noshoes Posture*
Ademolaetal.,2014 N/M N/M ü ü X N/S X N/M ü ü
Akhteretal.,2009 N/M N/M X ü X ü X N/M N/M üBello&Sepenu,2013 N/M N/M X ü X ü X ü N/M ü
Bylund&Burstrom,2006 N/M N/M X ü X ü X N/M N/A ü
Cais&Chen,2016 N/M N/M X X ü ü ü N/M N/A üCastilhoetal.,2012 N/M N/M X ü X ü X N/M N/M N/M
Cengiz,2014 ü 1 ü ü X ü X ü ü üChavalitsakulchai&Shahnavaz,1993
N/M N/M X ü X X ü ü ü ü
Chietal.,2012 N/M N/M X ü X ü X ü N/A üChuangetal.,1997 N/M N/M X ü X ü X ü ü ü
Dawaletal.,2012 ü N/S,atleast2 X ü X X ü ü ü üDerosetal.,2011 N/M N/M X ü X X ü N/M N/M N/MDerosetal.,2009 N/M N/M ü ü X X ü ü ü üDewanganetal.,2010 N/M N/M ü ü X X X ü ü ü
Dharaetal.,2016 N/M N/M X ü X X X N/M N/M N/MDuetal.,2008 ü N/M X ü ü ü X N/M N/M N/MEksioglu,2016 N/M N/M ü ü X ü X ü ü üFlyte&Perchard.,1999 N/M N/M X ü ü ü X N/M N/M N/M
Genaidyetal.,1995 N/M N/M X ü X X X N/M N/M N/M
Giletal.,1998 N/M N/M X ü X X X N/M N/M N/MGuanetal.,2012 ü N/S,atleast2 ü ü X X X X X üGuntheretal.,2008 ü N/S,atleast2 X ü X ü X N/M N/A ü
Hansonetal.,2009 ü N/M ü ü X X X N/M N/M N/M
Hoqueetal.,2014 N/M N/M X ü X X ü ü ü ü
38
Hsiaoetal.,2005 N/M N/M X ü X X ü ü ü ü Hsiaoetal.,2014 N/M N/M X ü X ü X X X üImrhan&Sundararajan,1992 N/M N/M X ü X ü X N/M N/M N/M
Imrhanetal.,2009 N/M N/M X ü X ü ü N/A N/A üIsmailaetal.,2013 ü 1 X ü X ü X ü ü üKarmeganetal.,2011 ü N/S,atleast2 X ü X ü ü ü ü N/S
Kawaharaetal.,1998 N/M N/M X ü ü X ü N/M N/M N/M
Khadem&Islam2014 ü 2 X ü X N/S X X ü N/S
Kumar&Garand,1992 N/M N/M X ü X N/S X N/M N/M N/M
Laingetal.,1999 ü 2 X ü X N/S X ü N/M N/MLavenderetal.,2002 N/M N/M X ü X ü X X X ü
Leeetal.,2013 N/M N/M X ü X X ü N/M N/M üLuceroetal.,2012 N/M N/M X ü X N/S X X X N/MMahmoudi&Bazrafshan,2013 N/M N/M X ü X X ü ü ü ü
Mahoneyetal.,2015 N/M N/M X ü X X ü N/M N/M ü
Marklinetal.,2010 N/M 2 X ü X ü ü X X ü
Matiasetal.,1998 N/M N/M X ü X N/S X N/M N/M N/MMazloumi&Mohammadreze,2012
N/M N/M X X ü X ü N/M N/M N/M
Mokdad,2002 ü N/S,atleast2 X ü X X ü N/M N/M üMousavifard&Alvandian,2011 N/M N/M X X ü ü X N/M N/M N/M
Nagetal.,2003 N/M N/M X ü ü X ü N/M N/A üNicolay&Walter,2005 N/M N/M X ü X ü X N/M N/A N/M
Oñateetal.,2012 N/M N/M X ü ü+ N/S X ü ü üOsquei-Zadehetal.,2012 N/M N/M X ü X ü X ü ü ü
Pennathur&Dowling2003 N/M N/M X ü X X ü N/M N/M ü
39
Pourtaghietal.,2014 ü N/M ü ü X X ü ü ü ü
Reisetal.,2012 N/M N/M X ü X ü X N/M N/M üSadeghietal.,2014 ü N/S,atleast2 X ü X N/S X N/M N/M ü
Sadeghietal.,2015 ü N/S,atleast2 ü ü X X ü ü ü ü
Shahetal.,2015 N/M N/M X X ü ü X N/A N/A N/MShresthaetal.,2009 N/M N/M X ü ü N/S X ü ü ü
Simeonovetal.,2012 N/M N/M X ü X N/S X X X N/M
Singhetal.,2015 N/M N/M X ü X N/S X N/S N/S N/SSpasojevićetal.,2015 ü N/S,atleast2 X ü X N/S X X X ü
Stålhammar&Louhevaara,1992 N/M N/M X ü X ü X ü ü ü
Sudhakaran&Mirka,2005 N/M N/M X ü X N/S X N/M N/M N/M
Sutjanaetal.,2008 N/M N/M X ü X X ü X ü ü
Syuaib,2015a N/M N/M X ü X N/S X N/M N/M N/MSyuaib,2015b N/M N/M X ü X X ü N/M N/M N/MTahaetal.,2009 N/M N/M ü ü X ü X ü ü üThariqetal.,2010 N/M N/M X ü X X ü X ü üToro&Henrich,1997 N/M N/M X ü X ü ü N/M N/M N/M
Tunay&Melemez,2008 N/M N/M X ü X ü X X N/M N/M
Ugurlu&Ozdogan,2011 N/M N/M X ü X X X N/M N/M N/M
VanDrieletal.,2013 N/M N/M X ü ü ü X N/M N/M N/M
Verhaertetal.,2011 N/M N/M X ü ü N/S X N/M N/M N/M
Wang&Chao,2010 N/M N/M X ü ü X ü N/M N/M N/M
Werneretal.,1998 N/M N/M X ü ü N/S X N/M N/M N/M
Wibowoetal., N/M N/M X ü ü N/S X N/S N/S N/S
40
2013Widyantietal.,2015 ü N/M X ü X X ü ü ü ü
Xiongetal.,2008 N/M 2 X ü ü N/S X N/S N/S üYangetal.,2007 N/M N/M X X ü ü ü N/A N/A N/SYunetal.,2002 N/M N/M X X ü N/S X N/A N/A N/MZetterberg&Ofverholm,1999 N/M 1 X ü X N/S X N/M N/M N/M
Zujnicetal.,2015 N/M N/M X ü X N/S X X X N/SN/S:notspecified,authorquotedinsteadofprovidingaclearprocedureorifdimensionsmentionedinresultstablebutwerenotexplainedindetail;N/S,atleast2:numberofmeasurersnotspecified,onlyreferencetoatleast2teams;N/M:notmentioned;N/A:notapplicable,i.e:hand,faceorothermeasurementsthatarenotaffectedbyclothesorshoes*Itisrelatedtothestandardpostureofsitting:kneesandhipsflexedat90°(rightangle),supportingthefeetflatonthefloorandheadorientedintheFrankfurtplane.Also,wasconsideredforthestandardstanding/sittingposture+AuthorquotedISO8559
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