Validity and Reliability of 2 Goniometric Mobile Apps: Device, Application, and Examiner Factors

Analysis of the concurrent validity and reliability of five common clinical goniometric devices

Measurement errors play an important role in the development of goniometric equipment, devices used to measure range of motion. Reasonable validity and reliability are critical for both the device and examiner before and after to testing in human subjects. The objective is to evaluate the concurrent validity and reliability of five different clinical goniometric devices for the purpose of establishing an acceptable measurement error margin for a novel device. We explored the validity and inter- and intrarater reliability scores of five goniometric devices namely (i) the universal goniometer (UG), a two-armed hand-held goniometer, (ii) the inclinometer (IC), featuring a single base, fluid level, and gravity-weighted inclinometer, (iii) the digital inclinometer (DI), functioning as both a DI and dynamometer, (iv) the smartphone application (SA), employing gyroscope-based technology within a smartphone platform application and (v) the modified inclinometer (MI), a gravity pendulum-based inclinometer equipped with a specialized fixing apparatus. Measurements were obtained at 12 standard angles and 8 human shoulder flexion angles ranging from 0° to 180°. Over two testing sessions, 120 standardized angle measurements and 160 shoulder angle measurements from 20 shoulders were repetitively taken by three examiners for each device. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable change (MDC) were calculated to assess reliability and validity. Concurrent validity was also evaluated through the execution of the 95% limit of agreement (95% LOA) and Bland-Altman plots, with comparisons made to the UG. The concurrent validity for all device pairs was excellent in both study phases (ICC > 0.99, 95% LOA - 4.11° to 4.04° for standard angles, and - 10.98° to 11.36° for human joint angles). Inter- and intrarater reliability scores for standard angles were excellent across all devices (ICC > 0.98, SEM 0.59°-1.75°, MDC 1°-4°), with DI showing superior reliability. For human joint angles, device reliability ranged from moderate to excellent (ICC 0.697-0.975, SEM 1.93°-4.64°, MDC 5°-11° for inter-rater reliability; ICC 0.660-0.996, SEM 0.77°-4.06°, MDC 2°-9° for intra-rater reliability), with SA demonstrating superior reliability. Wider angle measurement however resulted in reduced device reliability. In conclusion, our study demonstrates that it is essential to assess measurement errors independently for standard and human joint angles. The DI is the preferred reference for standard angle testing, while the SA is recommended for human joint angle testing. Separate evaluations across the complete 0°-180° range offer valuable insights.

Mechanical traction from different knee joint angles in patients with knee osteoarthritis: A randomized controlled trial

OBJECTIVE

To compare the effect of mechanical traction from different knee angles on pain, physical function, and range of motion in patients with knee osteoarthritis.

DESIGN

A single-blinded, randomized controlled trial.

SETTING

Outpatient public and governmental Hospital clinics.

PARTICIPANTS

One hundred and twenty patients with knee osteoarthritis were randomly assigned into 4 equal groups with 30 patients in each group.

INTERVENTIONS

Group (A) received conventional physiotherapy(CPT) treatment; group (B) received CPT with knee traction from full extension, group (C) received CPT with knee traction from 90° flexion, while group (D) received CPT with knee traction from 20° flexion. Interventions were applied 3 sessions a week for 4 weeks.

OUTCOME MEASUREMENTS

Visual analog scale (VAS), knee passive range of motion and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were measured at baseline, immediately after 4 weeks of intervention, and after 4 weeks of no intervention as a follow-up.

RESULTS

After eight weeks, the mean (SD) for VAS scores were 30.97 ± 8.68, 24.0 ± 8.8, 15.43 ± 6.31, and 16.17 ± 6.11 mm; for total WOMAC scores were 26.77 ± 9.19, 20.3 ± 8.52, 13.27 ± 6.25, and 13.43 ± 7.14 for groups A, B, C and D, respectively. The three traction groups showed statistically significant changes in pain scores, physical function, and total WOMAC, but not for knee passive range of motion, in favor of traction groups C and D than the conventional group (P < 0.05).

CONCLUSIONS

Traction from 90°and 20° of knee flexion was found superior to full extension knee in improving pain and physical function, but not for knee passive range of motion, in patients with knee osteoarthritis.

Development of a clinical prediction model to inform clinical decision making for classification of patients with sciatica, based on their clinical characteristics, in the Greek health system: protocol for a prospective predictive exploratory study

INTRODUCTION

Sciatica is one of the most common reasons for seeking healthcare for musculoskeletal pain. Sciatica is primarily considered as neuropathic in nature when neural tissue in the low back is compromised, but sometimes other non-neural structures may be involved. Appropriate assessment and management are important for patients with sciatica. Therapists use several outcome measures to assess patients to inform selection of the most suitable treatment. There is limited evidence for the best treatment of sciatica, and this is likely contributed to by having no reliable algorithm to categorise patients based on their clinical characteristics to inform physiotherapy treatment. The purpose of this study is to develop a clinical prediction model to categorise patients with sciatica, in terms of early clinical outcome, based on their initial clinical characteristics.

METHODS AND ANALYSIS

A prospective observational multicentre design will recruit consecutive patients (n=467) with sciatica referred for physiotherapy. Each patient will be evaluated to determine whether or not they will be accepted into the study by answering some questions that will confirm the study's eligibility criteria. Patients' basic characteristics, patient-reported outcome measures and performance-based measures will be collected at baseline from multiple sites in the Greek territory using this same protocol, prior to commencement of treatment. The main researcher of this study will be responsible for data collection in all sites. On completion of the standard referred physiotherapy treatment after 3 weeks' time, participants will be asked by telephone to evaluate their outcome using the Global Perceived Effect Scale. For the descriptive statistical analysis, the continuous variables will be expressed in the form of 'mean' and 'SD'. In order to assess the prognostic value of each predictor, in terms of the level of improvement or worsening of the symptoms, multiple variable regression analysis will be used.

ETHICS AND DISSEMINATION

Τhis study is approved from the Ethics and Deontology Committee of the University of West Attica, Athens, Greece, protocol number: 38313-09/06/2020, 10226-10/02/2021. The study's findings will be published in a peer-reviewed journal and disseminated at national and international conferences and through social media.

PROSPERO REGISTRATION NUMBER

CRD42020168467.

Knee Flexion Angle Measurement Using Virtual Assessment Tools: Correct Procedure and Potential Pitfalls

Virtual patient assessment will inevitably require smartphone technology to remotely measure knee range of motion. We conducted an experiment to analyze the impact of observer position relative to the flexed knee on the perceived angle measured using an electronic application (Dr. Goniometer) for iPhone. Two observers measured the apparent knee flexion angle from 7 different positions at 3 different heights relative to the center of the knee joint. Intraclass correlations were calculated to evaluate the intraobserver and interobserver variability using two-way mixed-effects models. The intraclass correlation for interobserver variability was excellent at 0.804 (95% confidence interval 0.663-0.889). When the observer was greater than 15° from the knee perpendicular, the true angle of knee flexion (90°) was not observed in any of the measurements. This was the case when observed from both proximal (range 95°-121°) and distal (range 92°-108°) directions. Ideally the camera lens should be perpendicular to the long axis of the lower limb in the proximal-distal direction and at the same height. However, if the camera lens is within 15° of the perpendicular, then at 90° of true flexion, the perceived angle will not be greater than 95° in 94% of cases.

Validation of a smartphone application and wearable sensor for measurements of wrist motions

We developed a smartphone application to measure wrist motion using the mobile device's built-in motion sensors or connecting it via Bluetooth to a wearable sensor. Measurement of wrist motion with this method was assessed in 33 participants on two occasions and compared with those obtained with a standard goniometer. The test-retest reproducibility in healthy individuals ranged from good to excellent (intraclass correlation (ICC) 0.76-0.95) for all motions, both with and without the wearable sensor. These results improved to excellent (ICC 0.90-0.96) on the second test day, suggesting a learning effect. The day-to-day reproducibility was overall better with the wearable sensor (mean ICC 0.87) compared with the application without using sensor or goniometer (mean ICC 0.82 and 0.60, respectively). This study suggests that smartphone-based measurements of wrist range of motion are feasible and highly accurate, making it a powerful tool for outcome studies after wrist surgery.

[Test-retest reliability of standard goniometry and the G-pro smartphone in shoulder flexion-extension]

BACKGROUND AND OBJECTIVE

Currently, the lack of tools for physiotherapists, and the quality of these tools when physiotherapists assess patients does not allow a good diagnosis. Accurate joint range evaluation is an essential task in the daily work of physiotherapists in order to correctly assess treatment progress. In this study, we examined the reliability and safety of an Android system application called G-Pro to evaluate its characteristics and observe its usefulness as a goniometer to measure joint angles in a clinic.

MATERIAL AND METHODS

The standard goniometer and G-pro smartphone with the application were used to passively and bilaterally measure shoulder flexion and rotation and elbow flexion in 30 participants able to tolerate standing.

RESULTS

The G-pro smartphone application showed good to excellent reliability (r=0.998 to 0.896, P<.01), while the universal goniometer showed acceptable to questionable reliability (r=0.757 to 0.609) in active shoulder flexion-extension movement.

CONCLUSIONS

The results obtained in this study show that these devices represent an additional resource to assess joint mobility ranges. Due to technological progress, we can improve, innovate, and demonstrate the results of joint assessments to ensure their accuracy. This, in turn, ensures that the treatment provided is appropriate and specific to each patient. This tool is low cost and is accessible for health care professionals; moreover, it is easy to use since it has an incliniometer that is reliable both visually and evaluatively.

Test-Retest Reliability of an iPhone® Inclinometer Application to Assess the Lumbar Joint Repositioning Error in Non-Specific Chronic Low Back Pain

Background: The joint position sense (JPS) has been used as an indirect marker of proprioception in subjects with non-specific chronic low back pain (NSCLBP), showing impairment in previous studies. It seems necessary to devise reliable tests to measure proprioceptive deficits in subjects with NSLBP. The objective of this study was to analyse the test-retest reliability and smallest real difference (SRD) of lumbar proprioception through the JPS indicator in a sample of patients with NSCLBP. Methods: Fifty participants with NSCLBP performed three repetitions of 30° lumbar flexion while standing and sitting using the iPhone^® inclinometer application to measure the lumbar joint repositioning error. For the reliability analysis, we performed an intra-session test-retest. Results: The total sample ICC values were excellent for standing (0.96) and sitting (0.93) 30° lumbar flexion. In addition, our results showed that, for the total sample, an SRD < 12% can be considered as a true change in proprioception concerning this procedure. On the other hand, men have better reliability than women in both standing and sitting positions. Additionally, the sitting position has better reliability than the standing position. The standard error of measurement (SEM) percentage was 4.2 for standing and 3.8 for sitting. The SRD percentage was 11.6 for standing and 10.4 for sitting. Conclusions: The iPhone^® inclinometer seems reliable for assessing proprioceptive ability through the lumbar joint repositioning error in subjects with NSCLBP in both standing (ICC = 0.96) and sitting (ICC = 0.93) positions. This technological device showed a lower measurement error for sitting position (SRD < 12%).

Reliability and criterion validity of the "Gyroscope" application of the iPod™ for measuring lumbar range of motion

BACKGROUND

Recent technologies, such as the iPod, are often equipped with an accelerometer and magnetometer, which, through software applications, can perform various inclinometric functions. These applications have the potential to measure and quantify range of motion (ROM).

OBJECTIVE

The purpose of this study was to estimate the iPod "Gyroscope" application intra- and inter-rater reliability as well as its criterion validity in healthy participants lumbar ROM assessment.

METHODS

The sample consisted of 29 healthy participants. For the estimation of intra- and inter-reliability, two examiners measured the lumbar ROM of each participant twice using the iPod. To estimate the criterion validity, the measures were compared to those obtained with the Back Range of Motion Device (BROM; lateral flexion) and the double inclinometer (flexion and extension). Reliability and validity were then established using the intraclass correlation coefficient (ICC).

RESULTS

We observed a moderate to high intra-rater reliability (ICCs = 0.67-0.91) and a moderate to high inter-rater reliability for each movement (ICCs = 0.72-0.89). For the criterion validity, the ICCs were all high (ICCs = 0.65-0.89).

CONCLUSION

Our results provide evidence that the iPod "Gyroscope" application can be used to assess lumbar ROM for all movements.

Intelligent Rehabilitation Assistance Tools for Distal Radius Fracture: A Systematic Review Based on Literatures and Mobile Application Stores

Objective

To systematically analyze the existing intelligent rehabilitation mobile applications (APPs) related to distal radius fracture (DRF) and evaluate their features and characteristics, so as to help doctors and patients to make evidence-based choice for appropriate intelligent-assisted rehabilitation.

Methods

Literatures which in regard to the intelligent rehabilitation tools of DRF were systematic retrieved from the PubMed, the Cochrane library, Wan Fang, and VIP Data. The effective APPs were systematically screened out through the APP markets of iOS and Android mobile platform, and the functional characteristics of different APPs were evaluated and analyzed.

Results

A total of 8 literatures and 31 APPs were included, which were divided into four categories: intelligent intervention, angle measurement, intelligent monitoring, and auxiliary rehabilitation games. These APPs provide support for the patients' home rehabilitation guidance and training and make up for the high cost and space limitations of traditional rehabilitation methods. The intelligent intervention category has the largest download ratio in the APP market. Angle measurement tools help DRF patients to measure the joint angle autonomously to judge the degree of rehabilitation, which is the most concentrated type of literature research. Some of the APPs and tools have obtained good clinical verification. However, due to the restrictions of cost, geographic authority, and applicable population, a large number of APPs still lack effective evidence to support popularization.

Conclusion

Patients with DRF could draw support from different kinds of APPs in order to fulfill personal need and promote self-management. Intelligent rehabilitation APPs play a positive role in the rehabilitation of patients, but the acceptance of the utilization for intelligent rehabilitation APPs is relatively low, which might need follow-up research to address the conundrum.

Multifactorial individualised programme for hamstring muscle injury risk reduction in professional football: protocol for a prospective cohort study

Introduction

Hamstring muscle injuries (HMI) continue to plague professional football. Several scientific publications have encouraged a multifactorial approach; however, no multifactorial HMI risk reduction studies have been conducted in professional football. Furthermore, individualisation of HMI management programmes has only been researched in a rehabilitation setting. Therefore, this study aims to determine if a specific multifactorial and individualised programme can reduce HMI occurrence in professional football.

Methods and analysis

We conducted a prospective cohort study over two seasons within the Finnish Premier League and compare the amount of HMI sustained during a control season to an intervention season. Injury data and sport exposure were collected during the two seasons (2019–2020), and a multifactorial and individualised HMI risk reduction programme will be implemented during intervention season (2020). After a hamstring screening protocol is completed, individual training will be defined for each player within several categories: lumbo-pelvic control, range of motion, posterior chain strength, sprint mechanical output and an additional non-individualised ‘training for all players’ category. Screening and respective updates to training programmes were conducted three times during the season. The outcome will be to compare if there is a significant effect of the intervention on the HMI occurrence using Cox regression analysis.

Ethics and dissemination

Approval for the injury and sport exposure data collection was obtained by the Saint-Etienne University Hospital Ethics Committee (request number: IORG0007394; record number IRBN322016/CHUSTE). Approval for the intervention season was obtained from the Central Finland healthcare District (request and record number: U6/2019).

Concurrent Validity of 2D and Inertial Goniometer Motion Assessment

Context: The validity and reliability of manual goniometry is highly dependent on the examiner’s expertise. Technological advances can overcome these problems to some extent. Inertial goniometry, for instance, could bridge the gap between 2D and manual goniometry, but its validity remains to be studied. Participants: 40 healthy individuals (mean ± SD: 31 men, age = 23.9 ± 4.1 years, 184 ± 6 cm, 80.7 ± 10.0 kg; 9 women, age = 23.6 ± 3.6 years, 170 ± 4 cm, 60.6 ± 5.1 kg). Measurements: 2D and inertial goniometry by mobee med™ were used to measure active and passive single straight-leg raise mobility performance. Intracorrelation coefficients (ICCs) and typical error of the estimate (TEE) inform the reliability and quality of the measurement by the rater. Results: The relationship of the inertial goniometry for active and passive mobility of the single straight-leg raise was practically perfect (r = .95–.98). Based on the Bland-Altman plots, the means of the difference between the 2D and inertial based goniometry were small (2–3°). Conclusion: Due to its high concurrent validity, ease of use, and efficiency with regard to time and personnel requirements, this inertial goniometer device is an effective and efficient approach to measuring range of motion. However, additional validity and reliability studies should investigate joints with more degrees of freedom.

Psychometric Properties of the iHandy Level Smartphone Application for Measuring Lumbar Spine Range of Motion and Lordosis: A Systematic Review of the Literature

CONTEXT

Advent of smartphones has brought a wide range of clinical measurement applications (apps) within the reach of most clinicians. The vast majority of smartphones have numerous built-in sensors such as magnetometers, accelerometers, and gyroscopes that make the phone capable of measuring joint range of motion (ROM) and detecting joint positions. The iHandy Level app is a free app which has a visual display alike with the digital inclinometer in regard to numeric size.

OBJECTIVE

The purpose of this systematic review was to evaluate available evidence in the literature to assess the psychometric properties (ie, reliability and validity) of the iHandy Level app in measuring lumbar spine ROM and lordosis.

METHODS

PubMed/MEDLINE, Scopus, Ovid, Google Scholar, and ScienceDirect were searched from inception to September 2018 for single-group repeated-measures studies reporting outcomes of lumbar spine ROM or lordosis in adult individuals without symptoms of low back pain (LBP) or patients with LBP. The quality of each included study was assessed using the Quality Appraisal of Reliability Studies checklist.

RESULTS

A total of 4 studies with 273 participants were included. Two studies focused on measuring active lumbar spine ROM, and 2 studies evaluated lumbar spine lordosis. Three studies included asymptomatic subjects, and one study recruited patients with LBP. The results showed that the iHandy Level app has sufficient psychometric properties for measuring standing thoraco-lumbo-sacral flexion, extension, lateral flexion, isolated lumbar spine flexion ROM, and lumbar spine lordosis in asymptomatic subjects. One study reported poor concurrent validity with a bubble inclinometer (r = .19-.53), poor intrarater reliability (intraclass correlation coefficient = .19-.39), and poor to good interrater reliability (intraclass correlation coefficient = .24-.72) for the measurement of active lumbar spine ROM using the iHandy Level app in patients with LBP.

CONCLUSIONS

This review provided a valuable summary of the research to date examining the psychometric properties of the iHandy Level app for measuring lumbar spine ROM and lordosis.

Effects of low-level laser therapy on hamstring strain injury rehabilitation: A randomized controlled trial

OBJECTIVES

To evaluate the effects of low-level laser therapy (LLLT) on functional rehabilitation following hamstring strain injury (HSI) in amateur athletes treated with an exercise-based rehabilitation program.

DESIGN

Randomized controlled trial.

METHODS

Male athletes (18-40 years old) who sustained HSI were randomized in LLLT or placebo groups. All patients were engaged in the same exercise-based rehabilitation program until they met specific criteria to return to sport. Hamstring muscles were treated with LLLT or placebo immediately after each rehabilitation session. The primary outcome was time-to-return to sport. Secondary outcomes were the number of rehabilitation sessions, hamstring flexibility, hamstring strength, and re-injury rate.

RESULTS

Twenty-four athletes began rehabilitation, and 22 (11 per group) completed the study schedule. Participants of LLLT and placebo groups had similar age, body size, injury characteristics, and baseline levels of hamstring flexibility and strength. The two groups increased flexibility and strength similarly throughout the rehabilitation program. Time-to-return to sport was the same for athletes treated with LLLT (23 ± 9 days) and placebo (24 ± 13 days). There were no re-injuries within 6 months after return to sport.

CONCLUSION

LLLT, as used in this study, did not optimize functional rehabilitation following HSI in amateur athletes treated with an exercise-based rehabilitation program.

Intra-rater and inter-rater reliability of cervical active range of movement in young asymptomatic adults using inertial sensors

Objectives: Current literature is scarce about the use of an inertial sensor to measure cervical active range of motion (aROM). The objective of the present study is to determine inter- and intra-reliability in the measurement of cervical aROM using inertial sensors in asymptomatic individuals.Materials and methods: Twenty asymptomatic individuals participated in the study. Two different physiotherapists measured each participant for cervical aROM (6 movements). The sequence of movements and the explanations given were standardized. The rater's order of measurement was randomized.Results: For the intra-rater results, the intraclass correlation coefficient (ICC) values for all cervical movements were good for Rater A (ICC >0.90) and Rater B (ICC >0.90). For the inter-rater results, the ICC values were above 0.75 for all movements, indicating a good level of reliability. Also, values obtained in SEM, MDC₉₀ and LOA indicate good agreement.Conclusion: The data obtained in this study suggest that inertial sensors can be used in clinics due to their high intra- and inter-rater ICC (>0.80). Also, its low economic cost, easy handling, and various utilities make this tool a useful alternative in the measurement of cervical aROM.

The Relationship Between a Jump-Landing Task and Functional Movement Screen Items : A Validation Study

Kraus, K, Schütz, E, and Doyscher, R. The relationship between a jump-landing task and functional movement screen items : a validation study. J Strength Cond Res 33(7): 1855-1863, 2019-Sports injuries and athletic performance are complex areas, which are characterized by manifold interdependencies. The landing error scoring system (LESS) is a valid screening tool to examine bilateral jump-landing mechanics, whereas the Functional Movement Screen (FMS) items are thought to operationalize flexibility and motor behavior during low-intense bodyweight patterns. The aim of the study was to explore possible interdependency of the diagnostic information of these screening tools. Fifty-three athletes (age 23.3 ± 2.1 years) were tested in a sport scientific laboratory. In detail, 31 professional soccer players (third division) and 22 collegiate athletes were studied. Linear, partial correlational, and cluster analysis were performed to examine possible trends. Generally, the sportsmen achieved a LESS score of 6.6 ± 2 and a jumping height of 37 ± 7.8 cm. Partial correlational analysis indicates that trunk control (r = 0.4; p < 0.01) is moderately related to landing mechanics, which in turn was negatively related on LESS height (r = -0.67, p < 0.01). In addition, clustering showed by trend that a higher active straight leg raise (ASLR) score is related to better landing mechanics (ASLR score 1: LESS 6.9 ± 1.8; n = 15 vs. ASLR score 3: LESS 5.6 ± 2.1; n = 10). On the task-specific level, jump-landing mechanics were directly related to jumping performance in this cohort with poor mechanics. On unspecific analysis level, kinetic chain length (ASLR) and trunk control have been identified as potential moderator variables for landing mechanics, indicating that these parameters can limit landing mechanics and ought to be optimized within the individual's context. A potential cognitive strategy shift from internal (FMS) to external focus (LESS) and different muscle recruitment patterns are potential explanations for the nonsignificant linear relationship between the FMS and LESS data.

An observational study of the maintenance of the 30° side-lying lateral tilt position among aged care residents at risk of developing pressure injuries when using the standard care pillow and a purpose-designed positioning device

The aim of the study was to evaluate the maintenance of the 30° side-lying lateral tilt position among aged care residents at the risk of developing pressure injuries when using the standard care pillow and a purpose-designed positioning device. An observational study was conducted. Participants were monitored during positioning under two conditions, with pillows and with a fluidised positioner. Body angle measurements were taken at three time points (baseline, 1 hour, and 2 hours) on 10 occasions. Repeated-measures analysis assessed the difference in the degree of the angle of the body. The sample (n = 12) had an average age of 83 years, and the participants were immobile when in bed. The average angle with the pillow condition was 26.7° at baseline, 21.5° at 1 hour, and 16.6° at 2 hours. The average angle with the fluidised positioner condition was 30.7° at baseline, 29.3° at 1 hour, and 26.8° at 2 hours. The main effects of Condition and Time were significant: Condition: F(1,11) = 14.378, P < .001, Time: F(2,22) = 45.858, P < .001. There was a statistically significant interaction between the effects of Condition and Time on the average lateral tilt position, F(2,22) = 15.574, P < .001. The lateral tilt body position was better maintained with the positioning device than the pillow. Further research is required to determine the effectiveness of the fluidised positioner for pressure injury prevention.

Immediate Effects of Simultaneous Application of Transcutaneous Electrical Nerve Stimulation and Ultrasound Phonophoresis on Active Myofascial Trigger Points: A Randomized Controlled Trial

OBJECTIVE

The aim of the study was to investigate the efficacy of phonophoresis with combined therapy on active myofascial trigger points.

PARTICIPANTS

One hundred participants with acute mechanical neck pain and at least one active myofascial trigger point in the upper trapezius were randomly assigned into four equal groups.

INTERVENTION

Groups consisted of diclofenac phonophoresis with combined therapy, diclofenac phonophoresis, ultrasound (US) with coupling gel, and sham US and applied for 10 mins over myofascial trigger points.

MEASUREMENTS

Measurements included pressure pain threshold and active cervical lateral flexion.

RESULTS

There were statistically significant improvements in postintervention pressure pain threshold and range of motion values in treatment groups (P < 0.0001). As for the sham US, no significant difference was found between the preintervention and postintervention values (P > 0.05). Bonferroni correction test revealed that there was a significant difference between all the four groups in pressure pain threshold values (P < 0.0001); however, it was nonsignificant (P > 0.05) for range of motion.

CONCLUSIONS

Diclofenac phonophoresis with combined therapy, phonophoresis, and US were all effective in increasing pressure pain threshold values and range of motion. In addition, phonophoresis with combined therapy was shown to be superior over phonophoresis, and phonophoresis was superior over US in terms of reducing pain sensitivity. However, none of the treatment groups were found to be superior over the other in increasing range of motion.

Reliability of Smartphone Inclinometry to Measure Upper Cervical Range of Motion

Context: Assessment of upper cervical range of motion (UCROM) and mobility is commonly performed in the clinical setting for patients suffering from headache, neck pain, and vestibular dysfunction. Reliable and reproducible measurement of this motion is often difficult or too expensive to perform in the clinical setting. Smartphone applications using the device’s internal gyroscope offer an easy and inexpensive means of measuring UCROM, but their reliability has not been reported in the literature. Objective: To assess the reliability of an inclinometer application installed on 2 different devices (iPhone 6 [IP] and android [AN]) and to measure UCROM in a healthy population. Design: Two examiners assessed passive UCROM. Each examiner was assigned to a specific smartphone, and a repeated-measures design consisting of 3 trials for each examiner–phone was performed. The order of testing was randomized, and the examiners were blinded to UCROM measures. Setting: Laboratory. Participants: A total of 38 subjects (19 females and 19 males; age: 23.8 [1.2] y) without pain or injury to the neck or spine for at least 3 months. Intervention: Each examiner passively flexed the head fully, rotated the head fully in 1 direction, and then in another. Peak rotation measures were recorded from each smartphone. Three trials were performed for each phone, with a 2-minute break between examiners/phones. Main Outcome Measures: Intraclass correlation coefficient using a 2-way mixed, absolute agreement model was obtained (1) between each examiner–phone and (2) within each examiner–phone for the measurements in each rotation direction. Results: Interphone/examiner reliability comparing average peak and total UCROM for each device was excellent (.87, .81). Intraphone/examiner reliability, determined across 3 trials, was also excellent (AN right rot. = .91, AN left rot. = .96; IP right rot. = .98, IP left rot. = .95). Conclusion: UCROM can be reliably measured using a smartphone inclinometer application.

The smartphone inclinometer: A new tool to determine elbow range of motion?

BACKGROUND

There are easily accessible tools on smartphones (APP) for measuring elbow range of motion (ROM). The purpose of this study is to evaluate the validity of a particular APP in determining elbow ROM in comparison with the commonly used goniometer (GON), surgeon estimation of range (EST) and measurement on X-ray (XR).

METHODS

The study included 20 patients (40 elbows). Flexion, extension, pronation and supination were measured using three different methods: EST, GON and APP. Radiographic measurements were taken using the average humeral diaphysis axis and dorsal midthird of ulna in flexion and extension.

RESULTS

The accuracy of the three different methods has been compared to GON using statistical analysis (ANOVA and paired samples test). There was no statistically significant difference for XR flexion measurement (mean of 2.8° ± 1.5°). The APP overestimated flexion (mean of 6.4° ± 1.0°), and EST underestimated it (mean of - 7.9° ± 1.1°). For extension, the mean difference was 2.8° ± 0.7° for EST and - 26.8° ± 3.1° for XR. The APP method did not significantly differ from GON. Supination accuracy was greater with EST (2.7° ± 1.7°) than with APP (5.9° ± 1.9°). There was no difference for pronation measurement with both EST and APP.

CONCLUSIONS

This study is the first comparing four measurement techniques of elbow ROM. Our results showed that EST was only accurate for forearm rotation. The XR scored the best for flexion but is less reliable for extension. Surprisingly, compared to GON, APP did not correlate as we expected for flexion and supination, but the other methods were also inaccurate. We found APP to be very useful to measure complete arc of motion (difference between maximal flexion and maximal extension).

LEVEL OF EVIDENCE

III, Retrospective review of a prospective cohort of elbow fracture patients: Diagnostic Study.

Validity of a smartphone protractor to measure sagittal parameters in adult spinal deformity

BACKGROUND CONTEXT

Smartphones have become an integral tool in the daily life of health-care professionals (Franko 2011). Their ease of use and wide availability often make smartphones the first tool surgeons use to perform measurements. This technique has been validated for certain orthopedic pathologies (Shaw 2012; Quek 2014; Milanese 2014; Milani 2014), but never to assess sagittal parameters in adult spinal deformity (ASD). This study was designed to assess the validity, reproducibility, precision, and efficiency of using a smartphone protractor application to measure sagittal parameters commonly measured in ASD assessment and surgical planning.

PURPOSE

This study aimed to (1) determine the validity of smartphone protractor applications, (2) determine the intra- and interobserver reliability of smartphone protractor applications when used to measure sagittal parameters in ASD, (3) determine the efficiency of using a smartphone protractor application to measure sagittal parameters, and (4) elucidate whether a physician's level of experience impacts the reliability or validity of using a smartphone protractor application to measure sagittal parameters in ASD.

STUDY DESIGN/SETTING

An experimental validation study was carried out.

METHODS

Thirty standard 36″ standing lateral radiographs were examined. Three separate measurements were performed using a marker and protractor; then at a separate time point, three separate measurements were performed using a smartphone protractor application for all 30 radiographs. The first 10 radiographs were then re-measured two more times, for a total of three measurements from both the smartphone protractor and marker and protractor. The parameters included lumbar lordosis, pelvic incidence, and pelvic tilt. Three raters performed all measurements-a junior level orthopedic resident, a senior level orthopedic resident, and a fellowship-trained spinal deformity surgeon. All data, including the time to perform the measurements, were recorded, and statistical analysis was performed to determine intra- and interobserver reliability, as well as accuracy, efficiency, and precision. Statistical analysis using the intra- and interclass correlation coefficient was calculated using R (version 3.3.2, 2016) to determine the degree of intra- and interobserver reliability.

RESULTS

High rates of intra- and interobserver reliability were observed between the junior resident, senior resident, and attending surgeon when using the smartphone protractor application as demonstrated by high inter- and intra-class correlation coefficients greater than 0.909 and 0.874 respectively. High rates of inter- and intraobserver reliability were also seen between the junior resident, senior resident, and attending surgeon when a marker and protractor were used as demonstrated by high inter- and intra-class correlation coefficients greater than 0.909 and 0.807 respectively. The lumbar lordosis, pelvic incidence, and pelvic tilt values were accurately measured by all three raters, with excellent inter- and intra-class correlation coefficient values. When the first 10 radiographs were re-measured at different time points, a high degree of precision was noted. Measurements performed using the smartphone application were consistently faster than using a marker and protractor-this difference reached statistical significance of p<.05.

CONCLUSIONS

Adult spinal deformity radiographic parameters can be measured accurately, precisely, reliably, and more efficiently using a smartphone protractor application than with a standard protractor and wax pencil. A high degree of intra- and interobserver reliability was seen between the residents and attending surgeon, indicating measurements made with a smartphone protractor are unaffected by an observer's level of experience. As a result, smartphone protractors may be used when planning ASD surgery.

The concurrent validity and reliability of the Leg Motion system for measuring ankle dorsiflexion range of motion in older adults

Background

New reliable devices for range of motion (ROM) measures in older adults are necessary to improve knowledge about the functional capability in this population. Dorsiflexion ROM limitation is associated with ankle injuries, foot pain, lower limb disorders, loss of balance, gait control disorders and fall risk in older adults. The aim of the present study was to assess the validity and reliability of the Leg Motion device for measuring ankle dorsiflexion ROM in older adults.

Methods

Adescriptive repeated-measures study was designed to test the reliability of Leg Motion in thirty-three healthy elderly patients older than 65 years. The subjects had to meet the following inclusion and exclusion criteria in their medical records: older than 65 years; no lower extremity injury for at least one year prior to evaluation (meniscopathy, or fractures) and any chronic injuries (e.g., osteoarthritis); no previous hip, knee or ankle surgery; no neuropathic alterations and no cognitive conditions (e.g., Alzheimer’s disease or dementia). Participants were recruited through the person responsible for the physiotherapist area from a nursing center. The subjects were evaluated in two different sessions at the same time of day, and there was a break of two weeks between sessions. To test the validity of the Leg Motion system, the participants were measured in a weight-bearing lunge position using a classic goniometer with 1° increments, a smartphone with an inclinometer standard app (iPhone 5S^®) with 1° increments and a measuring tape that could measure 0.1 cm. All testing was performed while the patients were barefoot. The researcher had ten years of experience as a physiotherapist using goniometer, tape measure and inclinometer devices.

Results

Mean values and standard deviations were as follows: Leg Motion (right 5.15 ± 3.08; left 5.19 ± 2.98), tape measure (right 5.12 ± 3.08; left 5.12 ± 2.80), goniometer (right 45.87° ± 4.98; left 44.50° ± 5.54) and inclinometer app (right 46.53° ± 4.79; left 45.27° ± 5.19). The paired t-test showed no significant differences between the limbs or between the test and re-test values. The test re-test reliability results for Leg Motion were as follows: the standard error of the measurement ranged from 0.29 to 0.43 cm, the minimal detectable difference ranged from 0.79 to 1.19 cm, and the intraclass correlation coefficients (ICC) values ranged from 0.97 to 0.98.

Conclusions

The results of the present study indicated that the Leg Motion device is a valid, reliable, accessible and portable tool as an alternative to the classic weight-bearing lunge test for measuring ankle dorsiflexion ROM in older adults.