Evaluation of a Prototype Soft-Structured Thoracic Posture Support Garment

Abstract

A prototype soft-structured thoracic posture support garment was evaluated for postural alignment effectiveness, wearer acceptability, ease of movement and fit as compared to a sports bra (no posture support) and a commercial soft-structured posture support garment. Fifteen female participants conducted a wear protocol in each of the garments, were evaluated for posture, and provided wearer assessments of the other three variables. Results indicated that the prototype was as effective as the commercial support garment in improving posture but was more acceptable to wearers, easier to move in and fit less tightly than the commercial support garment. Wearer assessments of the prototype were not significantly different from the sport bra, indicating success in developing an effective posture support garment with potential for better wear compliance than existing posture support solutions.

Keywords

bra fit functional design posture movement

The design of functional clothing begins with identifying a problem. The impetus for this project occurred when one of the female researchers suffered repeated upper back pain and back fatigue while working as a custom apparel designer and became aware that poor working posture may have contributed to her problems. During the researcher’s quest to find solutions, an orthopedic back specialist (J. E. Isaza, personal communication, April 12, 2007) expressed dissatisfaction with available upper back posture support products for women and indicated low patient compliance with existing products. A market search confirmed the need for an improved female foundation (base layer) garment with potential to reduce back fatigue and associated musculoskeletal complications by supporting the thoracic (upper back) part of the spine for improved posture. A soft-structured thoracic support garment prototype was developed by applying DeJonge’s (1984) functional design process. The final stage of that process involves formal evaluation of the prototype for its success in addressing the problem. The focus of this article is to address this stage of the process, namely, the evaluation of the prototype.

The Committee on Advancing Pain Research, Care, and Education (2011) asserts that “Musculoskeletal pain, especially joint and back pain, is the most common single type of chronic pain” (p. 62). The same report indicates that the direct cost of medical treatment for back pain was $34 billion in 2008 (p. 312). Womersley and Stephen (2006) studied two groups, one with reported backaches and one without reported backaches. They found that for subjects with previously reported backaches of all types, episodes were triggered by flexed relaxed (slouching) postures during sitting activities.

One method for improving posture is the use of posture support products. The market scan revealed that most posture support products were rigid braces; few soft-structured support products were found. Also, most posture support products focus on the cervical (neck) and lumbar (lower) regions or on multiple regions of the back rather than on the thoracic (upper) area where our researcher experienced pain. Rigid posture support braces employ plastic or metal to force the neck or torso into a particular alignment and have the potential to be uncomfortable and restrict movement (Lou et al., 2011; Pham et al., 2008; Ugwonali et al., 2004). Two items that could be identified as soft-structured support products for the upper back were found in the search but neither were intended to be worn alone as base garments. Instead, they were designed as harnesses to be worn over other baselevel garments and, if needed, over street wear. To reduce the bulkiness of an added garment, researchers developed a prototype posture support garment to provide sufficient body coverage to be worn alone (similar to a sports bra) or as a foundation garment. Details regarding the materials and design of the prototype are provided in the Method section.

Purpose

The purpose of this study was to evaluate the postural alignment effectiveness, wearer acceptability (WA), ease of movement, and fit of a prototype soft-structured thoracic support garment as compared to a sports bra and a commercial soft-structured posture support product. Specific questions that guided the study are identified after each related section of the literature review.

Review of Literature

A review of the literature provided information on posture but limited information regarding garments that provide posture support. Additionally, a review of functional clothing studies provided information on critical factors common to a variety of functional apparel.

Postural Alignment

“Posture is defined as the relative arrangement of the parts of the body” (Kendall, McCreary, Provance, Rodgers, & Romani, 2005, p. 51). The spinal column comprises a total of 31 vertebrae grouped into 5 areas: the cervical or neck area, thoracic or upper back, lumbar or lower back, sacral or pelvic area, and coccygeal or tailbone (Rodts & Malanga, 2011). Proper postural alignment is established by the relationship between and among the vertebrae (Werrell, 2000). Dwyer and Davis (2008) indicate that optimal postural alignment occurs when a “line of gravity … falls through the center of most joint axes, evenly distributing body weight throughout the body’s joint structures” (p. 78). The thoracic (upper back) region of the spine is made up of the middle 12 vertebrae starting at the base of the neck.

One method for assessing postural alignment is the New York Posture Rating (NYPR) Scale originally published in The New York Physical Fitness Test (New York State Education Department, 1958) and later published with minor modifications by Howley and Franks (1992). The NYPR is a quantitative scale that assigns scores for proper and improper alignment of various body segments. A set of three figure drawings for each body segment represents good, fair, and poor alignment. Live subjects, photographs of subjects, or 3-D body scans of subjects are assessed in comparison with the figure drawings (McRoberts, Cloud, & Black, 2013). Scores for each segment are summed to provide a value for overall postural alignment. The body segment illustrations include posterior views of the head, shoulders, spine, hips and feet, and lateral (left side) views of the neck, upper back, trunk, abdomen, and lower back (see Figure 1).

Research Question 1: Will participants exhibit better postural alignment scores from the NYPR while wearing the prototype posture support garment as compared to wearing a sports bra alone and exhibit at least as effective postural alignment as wearing a commercial support with a sports bra?

Figure 1.

New York posture rating chart. Body segment with corresponding schematic drawings and descriptions for ranking posture. Reprinted by permission of the State Education Department, The University of the State of New York, Albany, NY.

Wearer Acceptability

WA scales regularly appear in studies assessing individuals’ perceptions of functional garment properties. The WA scale assesses critical factors identified as important in the prototype design including comfort, ease of movement, and fit. Additionally, WA scales include broader assessments of overall acceptability. Huck and McCullough (1988) used a WA scale to assess firefighters’ perceptions of turnout clothing using 23 bipolar word pairs including comfortable/uncomfortable, acceptable/unacceptable, and heavy/light. Later Huck (1991) evaluated WA of firefighters’ turnout gear with different sleeve designs using 14 word pairs. Results indicated significant differences for 13 of the scale items, allowing researchers to determine acceptable and unacceptable aspects of the sleeve designs.

Word pairs used in various studies are selected by researchers based on particular functions or issues with the garments under study. Rutherford-Black and Khan (1995) and Black and Cloud (2008) evaluated police bicycle officers’ satisfaction with the physical aspects of their patrol uniforms using 18 word pairs and 25 word pairs, respectively. Barker and Black (2009) used a 13-item scale to investigate selected comfort aspects of police officers’ standard issue ballistic vests. In a subsequent study, Barker, Black, and Cloud (2010) used eight word pairs to compare officers’ perceptions of the comfort performance of a standard issue ballistic panel with their perceptions of an experimental ballistic panel for insertion in ballistic vests.

Nam and Branson (2012) assessed the WA of different body armor systems using eight adjective pairs for participants to make assessments after five movements. Significant differences among the armor were reported for comfort, flexibility, and resistance to movement. As indicated by these studies, the WA scale can be used in product development to assess particular performance aspects of a garment and also can be used to critically compare multiple products for selected properties.

Research Question 2: Will participants report better WA while wearing the prototype posture support garment than while wearing a commercial support with a sports bra and report WA approaching that of a sports bra alone?

Ease of Movement

Body movement is an important component of WA. Mitchka, Black, Heitmeyer, and Cloud (2009) found ease of movement and performance enhancement to be critical needs of dance practice wear users. Over 50% of the adolescents in Holland’s (2007) study were dissatisfied with the ease of movement when wearing their soccer uniforms.

Functional clothing research often includes assessments of ease of movement using other scales in addition to WA ratings. Barker et al. (2010) assessed ballistic vests by observing subjects doing movements associated with police officers’ daily tasks while wearing the two types of vests and by having officers rate the ease of doing each movement. Choi and Ashdown (2002) had experts and participants evaluate working movements of female pear farmers. Movement protocols can demonstrate whether a garment is causing an impediment, and, if a garment restricts movement, where on the body the resistance is located. For the prototype support garment to be successful, issues with ease of movement need to be addressed.

Research Question 3: Will participants perceive better or at least as effective ease of movement while wearing the prototype posture support garment as compared to wearing a sports bra alone or wearing a commercial support with a sports bra?

Fit

Fit is defined as the body–garment relationship (Lamb & Kallal, 1992). Fit has been reported as one of the most important attributes regarding WA for functional garments including bicycle wear (Casselman-Dickson & Damhorst, 1993), dance practice wear (Mitchka, Black, Heitmeyer, & Cloud, 2009), sailing apparel (Bye & Hakala, 2005), and tennis wear (Chae, Black, & Heitmeyer, 2006).

While WA scales can reveal overall perceptions of fit issues, further methods are often employed to assess specific fit issues. Fit of sports bras during physical activity and sports performance has been studied by several researchers (Bowles & Steele, 2013; Bowles, Steele, & Chaunchaiyakul, 2005; McGhee & Steele, 2010; Starr et al., 2005). Krenzer, Starr, and Branson (2005) developed a sports bra for large-busted women and assessed its ability to reduce breast displacement while participants exercised in a controlled environmental laboratory. Chen, LaBat, and Bye (2011) explored the relationship between bust prominence and bra fit problems with everyday bras. Results indicated a lack of bra support, tight bra cups, and loose bra bands as the prevailing fit problems. Costantakos and Watkins (1982) conducted pressure analysis for six nursing bras. Their research demonstrated that design features can be incorporated that help maintain body support and distribute pressure more evenly over the body, increasing WA.

Research Question 4: Will participants report better or at least as effective fit while wearing the prototype posture support garment than when wearing a sports bra alone or when wearing a commercial support with a sports bra?

Method

A wear study was conducted to solicit wearer perceptions of test garments. Fifteen premenopausal female volunteers, aged 40 to 55 years, participated in the study following university e-mail recruitment. Female participants in this age range were selected because occurrence of occupationally related upper body pain increases with age (Sansone, Bonora, Bolia, & Meroni, 2014). Premenopausal women were selected because they were less likely than menopausal or postmenopausal women to have osteoporosis, which may produce porous bones, bone fractures, and/or collapsed vertebrae resulting in a curvature in the spine (National Osteoporosis Foundation, 2015). Participants with reported back problems were excluded. Previous wear study research and power analyses using G*Power were used to determine the sample size. The total sample size required to ensure a power (1 − b) > .95 is 10. Published wear studies of new products typically use 10 to 15 participants (McRoberts et al., 2013; Nam & Branson, 2012; Park et al., 2011). We included more participants than suggested by the power analysis to account for potential attrition; however, all participants completed the study with each of the three garments.

Participants engaged in three controlled wear trials: one for the sports bra, one for the commercial support garment worn over the sports bra, and one for the prototype garment. The garments were assessed and compared for the following dependent variables: postural alignment, WA, ease of movement, and fit. Institutional review board approval was received prior to the study. For ease of discussion, the terms sports bra, commercial support, and prototype will be used to refer to the three test garments in the Method and Results sections.

Test Garments

For evaluation purposes, the prototype was compared to a sports bra similar in design, but not intended to provide posture support, and one of the commercial soft-structured, harness-type posture support products that was worn over a sports bra. The sports bra was 97% nylon and 3% spandex knit fabric with a short vest front and racerback construction. The commercial support was 79% nylon and 21% Lycra® spandex knit power net fabric with an additional layer of power net overlaid in bands that crisscrossed the back of the product, came over the shoulders, and down the side of the breast next to the armscye. The increased spandex content of this fabric and the bands were intended to pull the wearer’s shoulders back and align the spine. It was made to be worn over a bra with an open area over the breasts and hooks at center front under the breasts; therefore, participants wore a sports bra under the commercial support during the wear study (see Figure 2).

Figure 2.

Front, back, and side photographs of test garments. Direct visual representations of test garments. A. Sports bra. B. Commercial support garment (over sports bra). C. Prototype (patent application pending, photographs by author).

The prototype was designed to be worn alone (similar to a sports bra) and was pulled on over the head, eliminating the need for hooks. The fabrication table in Krenzer et al. (2005) and the interior fabrics used by Starr et al. (2005) informed fabric selection for the prototype. The main fabric of the prototype was a 79% Dry-Tech™ Supplex nylon/21% Lycra spandex knit. Dry-Tech is a moisture-wicking finish. A nylon/Lycra spandex, high-density, power mesh fabric was sewn over the base fabric beginning above the bust, crossing the shoulders, and crisscrossing the back in 3-inch bands that joined a side panel overlay under the arms. The power mesh overlays provided stability with the intent to encourage proper posture. Seam allowances were finished with a narrow, flesh-color, knit seam binding to be aesthetically pleasing and interact well with other clothing.

With the sports bra, commercial support, and prototype garments, participants wore bike shorts (95% cotton/5% spandex) over their own lower body underwear. During wear testing, the participants also wore a 100% cotton jersey T-shirt for modesty purposes. The T-shirt was removed for posture assessments but was worn during other assessments.

Wear Protocol

A wear protocol was established to standardize the performance evaluation. Participants donned the test garment and completed a 100-min wear protocol that included activities and movements that might be employed by women in an office environment (see Table 1). The wear protocol began with a reading period intended to acclimate participants to the test garments and concluded with a rest period. Between these times, participants completed fine (typing) and gross (lifting empty boxes) motor movements. Participants completed garment evaluations at various points in the wear protocol depending on the test. Body scans were conducted in a TC² NX-12 body scanner after the wear protocol for use in assessing postural alignment effectiveness of the garments.

Table 1.

Wear Protocol.

Activity	Position	Time (min)
Reading (acclimation)	Sitting	20
Typing	Sitting	30
Removing boxes from a shelf	Standing	5
Filing	Standing	10
Gross movement sequence		20
Sit from standing	Standing–sitting
Reaching forward	Sitting
Rise from sitting to standing	Sitting–standing
Walking	Standing
Raise and lower arms overhead	Standing
Bend torso back and forth, touch toes	Standing
Bend torso side to side	Standing
Turn torso left to right and look over shoulder	Standing
Raise arms and spread open	Standing
Rest period	Sitting	15

Postural Alignment

Postural alignment, as used in this study, refers to the extent to which various body segments are in the position required for ideal posture as assessed by three expert evaluators using the NYPR chart and 3-D body scans of participants in each test garment per McRoberts, Cloud, and Black (2013). Scores for the 10 segments were summed to provide an overall postural alignment score with a potential range from 0 (very poor posture) to 100 (ideal posture). The Cronbach’s coefficient α for NYPR postural alignment was .72.

Wearer Acceptability

Wearers evaluated the test garments using a WA scale consisting of 15 bipolar word pairs with a positive anchor and a negative anchor selected to represent critical wear factors: comfort, ease of movement, and fit. The word pairs included two global assessments, seven assessments of comfort or factors affecting comfort, four assessments related to movement, and two assessments of fit. All word pairs are provided in the results tables. Word pair scales were randomly ordered during data collection, but for ease of reporting results, they are presented in order of the discussion of critical factors. WA was assessed 2 times during the wear protocol: at the end of the acclimation period and during the rest period at the end of the wear protocol. Cronbach’s coefficient α for WA was .92.

Ease of Movement

The WA scale included 4 items related to ease of movement: easy/hard to put on, easy/hard to move in, freedom/restriction of arm movement, and freedom/restriction of torso. While wearing each test garment, participants also rated the ease associated with 12 movements using a 9-point Likert-type scale from 1 (easy to do) to 9 (hard to do). A similar scale was used by Huck and Kim (1997) to assess firefighters’ perceptions of wildfire-protective overalls after an exercise protocol. The scores for each movement were reported separately and averaged for a single-average movement rating score. Cronbach’s coefficient α for individual movement assessments was .96.

Fit

Fit was assessed through the WA scale and by having participants provide perceptions of fit for specific garment areas after activities. An index originally developed to evaluate fit on live models (McRoberts, 2005) was modified to be self-reported by participants who assessed fit of specific garment areas on a 5-point scale from extremely tight to extremely loose. Cronbach’s α for fit perceptions was .93.

Data Analysis

Analysis of variance (ANOVA) was used to assess differences in postural alignment, WA, ease of movement, and fit for participants wearing the sports bra, commercial support, and prototype. A priori significance level was set at p ≤ .05. Tukey’s honestly significant difference (HSD) post hoc test was used to determine differences in specific means.

Results

Postural Alignment

The summed NYPR scores (overall postural alignment) ranged from 50 to 100 on the scale of 0 (poor posture) to 100 (ideal posture), with 50 representing fair posture. The overall scores ranged from 50 to 90 for the sports bra, 60 to 90 for the commercial support, and 60 to 100 for the prototype. Mean overall postural alignment scores (and SD) for participants in each test garment were 70.0 (13.2) for the sports bra, 78.0 (11.0) for the commercial support, and 82.0 (12.5) for the prototype. ANOVA indicated a significant difference among the three garments in postural alignment, F(2, 42) = 3.7, p = .03. Tukey’s HSD revealed a significant difference (p ≤ .05) between the sports bra and the prototype, indicating that the prototype provided more postural alignment than the sports bra. There was no significant difference between the commercial support and the prototype, F(1, 28) = .87, indicating that the prototype performed as effectively as the commercial support.

Across all participants, individual scores for the 10 body segments covered the full range of the NYPR scale from 0 (poor) to 10 (good). ANOVA values, means, and SDs for postural alignment of each body segment in the three test garments are presented in Table 2. Mean postural alignment for body segments ranged from 3.0 to 10.0. Although mean scores for the prototype were higher for almost all segments, results of ANOVAs revealed a significant difference (p ≤ .001) only for postural alignment of the shoulder. Tukey’s HSD indicated that the participants wearing the prototype had significantly better shoulder segment posture rating than when wearing the commercial support and sports bra. This indicates that the prototype successfully improved postural alignment for the women in the study, both overall and for a segment very closely related to the thoracic part of the spine. Therefore, Research Question 1 was answered affirmatively.

Table 2.

Postural Alignment Effectiveness of Garments by Body Segments in the NYPR.

Body Segment	Sports Bra		Commercial Support		Prototype
Body Segment	M	SD	M	SD	M	SD	F(2, 42)	p
Head	9.0	2.1	9.3	1.8	9.7	1.3	0.6	.580
Shoulder	6.3_a	2.3	6.7_a	2.4	9.3_b	1.8	8.5	.001***
Spine	10	0.0	10	0.0	10	0.0	0.0
Hips	8.0	2.5	8.7	2.3	9.7	1.3	2.4	.105
Ankles	7.3	2.6	7.3	2.6	8.0	2.5	0.3	.716
Neck	6.0	2.1	7.3	2.6	7.3	2.6	1.5	.232
Upper back	7.0	2.5	8.0	2.5	9.0	2.1	2.6	.084
Trunk	7.7	2.6	8.7	2.3	9.3	1.8	2.1	.134
Abdomen	3.7	3.6	3.0	3.7	3.7	3.6	0.2	.841
Lower back	5.0	3.8	4.7	4.0	6.0	3.4	0.5	.598

Note. Ratings were made on the NYPR scale with 0 as poor posture and 10 as ideal posture. For those body segments showing a significant effect by garment, means having the same subscript are not significantly different at p ≤ .05 in the Tukey’s honestly significant difference comparison. NYPR = New York Posture Rating.

***p ≤ .001.

Wearer Acceptability

ANOVAs indicated no significance difference in WA assessments of the prototype before activity as compared to after activity for any of the 15 word pairs. Overall, the prototype was as acceptable to the wearer when it was first put on as it was after being worn for a set of activities.

WA ratings for the sports bra and commercial support after activity were compared to WA ratings for the prototype after activity. ANOVAs revealed significant differences for 8 of the 15 word pairs when comparing the three garments (see Table 3). Ratings for acceptable/not acceptable were not significantly different, but ratings for like (1)/dislike (9) indicated significantly more dislike for the commercial support (M = 4.3) than for the sports bra (M = 2.3) or the prototype (M = 2.7), which were not significantly different from each other.

Table 3.

Wearer Acceptability of Garments After Activity.

	Sports Bra		Commercial Support		Prototype
Attributes	M	SD	M	SD	M	SD	F(2, 24)	p
Acceptable/unacceptable	2.5	1.6	4.3	3.4	3.2	2.7	1.6	.21
Like/dislike	2.0_a	1.5	4.3_b	3.2	2.7_a	2.2	3.8	.03*
Comfortable/uncomfortable	2.6	1.8	2.5	2.0	2.5	2.0	2.3	.11
Absorbent/nonabsorbent	3.2	2.1	4.5	2.2	4.0	2.4	1.6	.21
Cold/hot	3.5	1.6	4.5	2.0	4.2	1.8	1.1	.34
Flexible/stiff	2.5_ab	1.8	4.5_b	3.2	1.9_a	1.4	5.2	.01**
Soft/harsh to the skin	1.8_a	1.7	3.9_b	2.4	2.3_ab	1.4	4.9	.001***
Not bulky/bulky	3.3_a	2.0	5.5_b	2.5	2.8_a	1.6	6.8	.003**
Lightweight/heavyweight	1.8_a	0.9	4.5_b	2.3	2.5_a	1.6	9.7	.001***
Easy/hard to put on	2.9	2.5	4.5	2.8	3.2	2.6	1.5	.24
Easy/hard to move in	1.7_a	1.3	3.5_b	2.7	1.8_a	1.2	4.6	.02*
Freedom/restricts arm movement	1.8_a	1.4	3.5_b	2.9	1.7_a	1.2	4.1	.02*
Freedom/restricts torso	1.9	1.6	3.4	2.4	2.1	1.8	2.6	.09
Satisfactory/unsatisfactory fit	2.2	1.5	4.3	3.3	2.8	2.2	3.1	.06
Tight/loose	4.6_b	1.9	2.9_a	1.6	4.7_c	2.3	20.5	.001***

Note. Ratings were made on a 9-point bipolar word scale with the first word or phrase in the pair (shown above) as 1 and the second word or phrase as 9. For those attributes showing a significant effect by garment, means having the same subscript are not significantly different at p ≤ .05 in the Tukey’s honestly significant difference comparison.

*p ≤ .05. **p ≤ .01. ***p ≤ .001.

An important aspect of a wearer’s acceptance of a garment is the level of comfort. Ratings of comfortable/uncomfortable, absorbent/nonabsorbent, and cold/hot were not significantly different. Ratings for the sensorial comfort aspects of flexible/stiff and soft/harsh were significantly different, with the prototype perceived as more flexible than the commercial support and not significantly different from the sports bra. The sports bra was rated as softer than the commercial support, but the mean rating for the prototype fell between the other two garments and was not significantly different from either of them. These findings suggest that the prototype was similar in these sensorial comfort ratings to the sports bra worn alone.

The prototype and sports bra were rated significantly less bulky and lighter weight than the commercial support and not significantly different from each other. Bulkiness and weight ratings for the commercial support may partially relate to the fact that the commercial support is worn over the sports bra. Additional WA items that were rated significantly different are discussed in the results for ease of movement and fit. For most items on the WA scale, the prototype was rated similarly to the sport bra. Therefore, the second question was also answered affirmatively.

Ease of Movement

WA ratings related to movement indicated significant differences for easy/hard to move in and freedom/restricts arm movement, but not for easy/hard to put on or freedom/restricts torso movement (see Table 3). Although ratings for each garment were at the positive end of the scale, post hoc tests indicated that the participants found the commercial support significantly harder to move in and more restrictive when moving their arms than the prototype and sports bra, which did not differ. The reinforced area next to the armscye of the commercial support likely contributed to its more negative ratings.

Participants evaluated 12 individual movements from 1 (easy to do) to 9 (hard to do) while wearing the three garments (see Table 4). For individual movements, the ranges of mean ratings were 1.1 to 2.3 for the sports bra, 2.1 to 3.0 for the commercial support, and 1.1 to 1. 6 for the prototype. Only two movements showed no significant difference across garments: typing and standing up. Although all ratings are closer to the “easy to do” end of the scale, ratings by participants indicated greater ease of movement for the prototype than the commercial support for 9 of the 12 activities. In these same activities, the prototype was not rated significantly different from the sports bra. For the torso bend side-to-side movement, the prototype was not significantly different from the sports bra or the commercial support, but the sports bra was rated as significantly easier to move in than the commercial support. An average movement rating was calculated across the 12 individual ratings and across all participants. Overall, the prototype and sports bra were significantly easier to move in than the commercial support and were not significantly different from each other. Research Question 3, therefore, was answered affirmatively. The prototype was successfully designed to be similar to the sports bra for ease of movement.

Table 4.

Ease of Movement Ratings for Garments After Activity.

	Sports Bra		Commercial Support		Prototype
Activity	M	SD	M	SD	M	SD	F(2,42)	p
Typing	2.3	1.6	2.1	1.3	1.5	0.5	1.9	.17
Moving boxes	1.5_a	0.7	3.0_b	2.8	1.3_a	0.5	4.9	.01**
Standing up	1.4	0.6	2.3	2.1	1.3	0.5	3.0	.06
Sitting down	1.2_a	0.4	2.6_b	2.4	1.2_a	0.4	4.9	.01**
Walking	1.1_a	0.4	2.1_b	1.8	1.1_a	0.4	3.9	.03*
Arm curls	1.3_a	0.5	2.9_b	2.2	1.3_a	0.5	7.2	.001***
Torso bend forward and back	1.7_ab	0.9	3.0_b	2.5	1.5_a	1.1	3.8	.03*
Torso bend side to side	1.3_a	0.5	2.4_b	1.9	1.4_ab	0.6	4.2	.02*
Torso twisting	1.3_a	0.5	2.6_b	1.9	1.5_a	0.5	5.4	.01**
Reaching arms forward	1.6_a	0.6	3.0_b	2.6	1.3_a	0.5	5.0	.01*
Reaching arms overhead	1.3_a	0.5	3.0_b	2.4	1.6_a	2.9	0.7	.01**
Reaching arms to side	1.3_a	0.5	2.7_b	2.0	1.5_a	0.5	5.6	.01*
Average Movement Rating	1.4_a	0.5	2.6_b	1.8	1.4_a	0.3	6.1	.004**

Note. Ratings were made on a 9-point scale from (1) easy to do to (9) hard to do. For those activities showing a significant effect by garment, means having the same subscript are not significantly different at p ≤ .05 in Tukey’s honestly significant difference comparison.

*p ≤ .05. **p ≤ .01. ***p ≤ .001.

Fit Analysis

The WA scale included two word pairs for fit: satisfactory/unsatisfactory and tight/loose. There was no significant difference in fit satisfaction, but participants rated the commercial support as significantly tighter than the sports bra or prototype, which received neutral ratings (see Table 3).

The fit of the test garments were assessed by participants for specific areas of the garments using a 5-point scale from 1 (extremely tight) to 5 (extremely loose). The neutral rating of 3 indicates that a garment is neither tight nor loose in a selected body area, which could be considered proper fit (see Table 5). Ratings for the sports bra were consistently very close to this neutral rating, while ratings for the commercial support were on the tight side of neutral and for the prototype were slightly looser than neutral. ANOVAs indicated that the commercial support was rated significantly tighter than the prototype in the following areas: across the bust, below the bust, across the back shoulder, under the arm, and garment length. For all of these measures, except across back shoulder, the sports bra was not significantly different from the prototype or the commercial support. These results confirm the assessment of tight/loose fit using the WA scale.

Table 5.

Fit Ratings by Garment.

	Sports Bra		Commercial Support		Prototype
Garment Area	M	SD	M	SD	M	SD	F(2, 42)	p
Across the bust	3.1_ab	0.7	2.6_a	0.8	3.5_b	0.7	4.9	.01*
Below the bust	3.0_ab	1.0	2.2_a	1.0	3.4_b	0.8	6.1	.004**
Around the neck	3.1	1.1	2.7	1.0	3.5	0.6	2.5	.097
Across back shoulder	3.0_b	1.1	2.3_a	0.6	3.4_b	0.6	8.8	.001***
Under the arm	3.1_ab	1.0	2.3_a	0.8	3.2_b	0.8	4.5	.02*
Armhole	2.9	1.0	2.4	1.0	3.1	1.0	2.1	.13
Garment length (shoulder to hem)	2.8_ab	0.9	2.1_a	0.9	3.5_b	0.6	9.6	.001***

Note. Ratings were made on a 5-point scale from (1) extremely tight to (5) extremely loose. For those garment areas showing a significant effect by garment, means having the same subscript are not significantly different at p ≤ .05 in Tukey’s honestly significant difference comparison.

*p ≤ .05. **p ≤ .01. ***p ≤ .001.

For across back shoulder, the commercial support was significantly tighter than the sports bra and prototype. The tightness of the commercial support, particularly in this area, is likely an intentional aspect of the design to achieve posture support. The design of the prototype was successful in achieving similar posture support without the sensation of tightness. Research Question 4 was also answered affirmatively.

Conclusions and Implications

The prototype provided sufficient posture support of the thoracic spine to improve postural alignment as compared to the sports bra and exhibited equivalent effectiveness in posture support as in commercial support. These effects were statistically significant for both overall posture and for posture of the shoulder segment. The findings are encouraging with regard to the opportunity to further develop a posture support garment that can be worn alone as a base garment. The two soft-structured posture support products that were identified in the market scan must be worn over other base and/or outer garments adding to overall garment bulk and potentially affecting outer garment fit, a variable that was not included in this assessment.

Although the prototype was designed to improve alignment in the thoracic area of the spine, it also affected overall posture, providing potential for the garment to be useful for both upper back and overall posture issues. The design of the prototype allows for it to be used either beneath clothing during everyday life or work activities or alone as an active wear and/or exercise garment.

Participants’ ratings for like/dislike indicated the participants did not like the commercial support as well as the prototype or sports bra. This supports the contention of the physician that patients are not happy with existing posture support solutions. Overall, comfort and thermal comfort were not distinguishing factors for these garments; however, the prototype was perceived as more flexible and less bulky than the commercial support. The ability to wear the prototype as a base garment likely contributed to these more favorable ratings. Please see figure 3.

Figure 3.

Examples of body scan segments with grid overlay for postural alignment assessments. Left for upper back. Right for trunk.

Participants rated the prototype and sports bra as easier to move in, less restrictive for arm movement, and less tight than the commercial support. This provides further support for continuing the development of the prototype as an alternative to less acceptable products currently on the market. Researchers in previous studies of wearer compliance of rigid braces attribute noncompliance to discomfort and movement restriction (Lou et al., 2011; Ugwonali et al., 2004), suggesting that a well-fitting and comfortable posture support garment with better ease of movement could increase wearer compliance. The prototype provided limited support for the breasts, as this was not the focus of the garment development. Future prototype development could include improvements in breast support following the recommendations of Krenzer et al. (2005) for cup support and encapsulation. This development could lead to a dual-function garment that would provide both posture support and bust support.

The positive results of the prototype evaluation for posture support and WA suggest that a next step is to conduct clinical trials, in collaboration with a physician, to determine whether the level of posture improvement provided by the prototype is sufficient to reduce the occurrence of back pain from poor posture. With positive results from clinical trials, this prototype design could become a market replacement for existing commercial posture garments to provide a better solution for women with upper back pain.

We have also demonstrated that soft-structured back support garments can be effective; however, we limited our study to the thoracic region of the back. Future researchers could address other regions of the back. The NYPR is specifically designed to measure standing posture, but Womersley and Stephen (2006) found that problems with sitting posture may be more critical than standing postures, especially for the many workers who have sedentary jobs. A search of the literature revealed no sitting posture scales. Therefore, a scale for sitting posture is needed to further evaluate the benefits of a thoracic support garment on sitting postures.

Footnotes

Declaration of Conflicting Interests

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

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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