Reliability and validity of clinically accessible smartphone applications to measure joint range of motion: A systematic review

Reliability of range of motion measurements obtained by goniometry, photogrammetry and smartphone applications in lower limb: A systematic review

OBJECTIVES

To systematically review studies involving the reliability of the lower limbs joint range of motion (ROM) by goniometer, photogrammetry and smartphone applications in young and healthy subjects.

DATA SOURCES

The search was conducted between December 2020 and January 2021 in PubMed, Embase, LILACS, OVID, and SciELO databases.

STUDY SELECTION OR ELIGIBILITY CRITERIA

Studies that evaluated the reliability of the lower limb joints ROM measurements.

STUDY APPRAISAL AND SYNTHESIS METHODS

The studies were independently selected and classified by two reviewers according to the COSMIN checklist. A narrative synthesis of the included studies was performed.

RESULTS

Twelve studies were included. The intraclass correlation coefficient of ROM measurements ranged from 0.18 to 0.99 for goniometer; 0.78 to 1.00 for photogrammetry and 0.33 to 0.98 for smartphone.

LIMITATIONS

Number of goniometry studies included was higher than photogrammetry and smartphone applications studies.

CONCLUSION

The goniometry showed the lowest reliability values. Photogrammetry obtained the highest reliability values, but its clinical application is not widely used. Smartphone applications are relatively new and have average reliability values.

SYSTEMATIC REVIEW REGISTRATION NUMBER

CRD42021225396.

CONTRIBUTION OF PAPER

1) Goniometry reliability is variable but could be useful in clinical field due accessibility and acquisition time; (2) Smartphone apps reliability range median-excellent but depends of cell phone size and acess/validation in some countries; (3) Photogrammetry is recommended for researchers due to better reliability but for clinicals require software' knowledge and time; 4) We recommend familiarization of ROM techniques to reduce reliability variability.

Rotator Cuff Tendinopathy Diagnosis, Nonsurgical Medical Care, and Rehabilitation: A Clinical Practice Guideline

This evidence-based clinical practice guideline (CPG) aims to guide clinicians with recommendations covering the assessment, treatment, and prognosis of adults with shoulder pain with suspected rotator cuff (RC) tendinopathy, the nonsurgical medical care and rehabilitation of adults with RC tendinopathy, as well as the return to function and sport for elite and recreational athletes. This CPG includes recommendations for managing RC tendinopathy with or without calcifications and partial-thickness RC tears. J Orthop Sports Phys Ther 2025;55(4):235-274. Epub 30 January 2025. doi:10.2519/jospt.2025.13182.

Assessment of Pelvic Motion During Single-Leg Weight-Bearing Tasks Using Smartphone Sensors: Validity Study

Background

Clinicians and athletic training specialists often assess the performance of single-leg, weight-bearing tasks to monitor rehabilitation progress and guide exercise progression. Some of the key metrics assessed are excessive pelvic motion, balance, and duration of each repetition of the exercise. Motion can be objectively characterized using motion capture (MOCAP); however, MOCAP is often not available in clinics due to the high costs and complexity of the analyses. Smartphones have built-in sensors that can be used to measure changes in body segment orientation and acceleration, which may make them a more feasible and affordable technology to use in practice.

Objective

This study aimed to determine if, compared to gold-standard MOCAP, smartphone sensors can provide valid measures of pelvic orientation, acceleration, and repetition duration during single-leg tasks in healthy individuals.

Methods

Overall, 52 healthy participants performed single-leg squats and step-down tasks from heights of 15 and 20 cm. Pelvic motion was assessed using MOCAP and a smartphone placed over the sacrum. The MATLAB (MathWorks) mobile app was used to collect smartphone acceleration and orientation data. Individual repetitions of each exercise were manually identified, and the following outcomes were extracted: duration of the repetition, mediolateral acceleration, and 3D pelvic orientation at peak squat. Validity was assessed by comparing metrics assessed with a smartphone and MOCAP using intraclass correlation coefficients (ICCs) and paired Wilcoxon tests. Differences between tasks were compared using 1-way ANOVA or the Friedman test.

Results

Across the 3 single-leg tasks, smartphone estimates demonstrated consistently high agreement with the MOCAP for all metrics (ICC point estimates: >0.8 for mediolateral acceleration and frontal plane orientation; >0.9 for squat duration and orientation on the sagittal and transverse plane). Bias was identified for most outcomes (multiple P<.001). Both smartphone and MOCAP recordings identified clear differences between tasks, with step-down tasks usually requiring larger changes in pelvic orientation and larger mediolateral sways. Duration did not differ between tasks.

Conclusions

Despite a consistent bias, the smartphone demonstrated good to excellent validity relative to gold-standard MOCAP for most outcomes. This demonstrates that smartphones offer an accessible and affordable tool to objectively characterize pelvic motion during different single-leg weight-bearing tasks in healthy participants. Together with earlier reports of good between-day reliability of similar measures during single-leg squats, our results suggest that smartphone sensors can be used to assess and monitor single-leg task performance. Future studies should investigate whether smartphone sensors can aid in the assessment and treatment of people with musculoskeletal disorders. More user-friendly interfaces and data analysis procedures may also facilitate the implementation of this technology in practice.

Test-Retest Reliability and Validity of TecnoBody D-Wall to Assess the Range of Motion During Overhead Squat in Healthy Individuals

This study evaluated the validity and reliability of the TecnoBody D-Wall system in assessing joint range of motion (ROM) during overhead squat movements in healthy individuals, using Kinovea as a reference tool for data comparison. A total of 29 participants (16 males, 13 females) with a mean age of 28.41 ± 6.66 years were included. Measurements were conducted for hip and knee joint angles in the sagittal plane, with three repetitions per participant analyzed using both systems. The D-Wall system employed a 3D Kinect V2 camera and force platform, while Kinovea used 2D video-based motion analysis. The results demonstrated excellent agreement between the two systems, with intra-class correlation coefficients (ICC) ranging from 0.79 to 0.99. For the knee joint, the test-retest ICC values were 0.99 (95% CI: 0.97-0.99) for Kinovea and 0.98 (95% CI: 0.95-0.99) for the D-Wall on the right side, and 0.98 (95% CI: 0.97-0.99) for Kinovea and 0.88 (95% CI: 0.79-0.94) for the D-Wall on the left side. For the hip joint, test-retest ICC values were 0.99 (95% CI: 0.97-0.99) for Kinovea and 0.94 (95% CI: 0.88-0.97) for the D-Wall on the right side, and 0.98 (95% CI: 0.97-0.99) for Kinovea and 0.93 (95% CI: 0.87-0.97) for the D-Wall on the left side. Bland-Altman plots confirmed good agreement, with no significant systematic bias observed. Both systems showed statistically insignificant differences (p > 0.05) between measurements, and correlation values ranged from 0.83 to 0.99, indicating strong associations. These findings highlight the high validity and reliability of both TecnoBody D-Wall and Kinovea systems in measuring joint angles during dynamic movements. The comparable accuracy between systems suggests that either system can be effectively utilized in clinical or research settings, depending on specific needs and resource availability.

Assessing Active and Passive Glenohumeral Rotational Deficits in Professional Tennis Players: Use of Normative Values at 90° and 45° of Abduction to Make Decisions in Injury-Prevention Programs

(1) Background: Glenohumeral internal and external rotational range-of-movement deficits (GIRDs and GERDs) are some of the primary outcomes used to determine the risk of injury in overhead athletes, such as tennis players. Nevertheless, the current testing position does not consider the fact that most tennis actions are repeated at 45° of abduction, and actively. The aim of this study was to establish normative values of pathological GIRDs and GERDs in tennis players and to provide normative values for both the passive and active rotational range of motion of the glenohumeral joint at 90° and 45° of abduction. (2) Methods: Forty-three tennis players voluntarily participated in this study (19.1 ± 2.75 years). The dominant and non-dominant total glenohumeral rotational range of motion (TRROM), external rotation (ER), and internal rotation (IR) at 90° and 45° under active and passive conditions were evaluated. The GIRD and GERD were calculated in both positions and under both conditions. (3) Results: There were significant differences in all of the passive measurements between the 45° and 90° testing positions. The ER and TRROM at 90° and 45° showed significant differences under both passive and active conditions and on the dominant and non-dominant sides. Actively, there were no significant differences in the IR or TRROM for either the dominant or non-dominant side at 90° or 45°. (4) Conclusions: It is necessary to evaluate ER under the same conditions at 90° or 45°. Practitioners should consider assessing the ER for the angle at which most actions are repeated in tennis (45°) as a method to monitor GERDs. Evaluating GERDs in asymptomatic tennis players could help avoid future biomechanical and GIRD problems. Both GIRDs and GERDs should be considered as a percentage of the athlete's own deficit in IR or ER, instead of referencing specific degrees that have been observed in baseball pitchers.

Augmented Reality-Based Finger Joint Range of Motion Measurement: Assessment of Reliability and Concurrent Validity

PURPOSE

This study aimed to determine the reliability and concurrent validity of finger joint range of motion (ROM) measurement using augmented reality (AR)-based hand tracking in a sample of healthy hands. Additionally, the study aimed to determine which camera view of the hand provided ROM measurements with the highest concurrent validity at each joint.

METHODS

A web application developed for smart devices using Google's MediaPipe Hands framework converted AR-generated hand landmark coordinates from camera feed into ROM angle measurements in real time for all joints. From each of five camera views, we recorded five sets of AR-based flexion and extension measurements at the metacarpophalangeal (MCP), proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints of normal index to small fingers. Test-retest reliability of the five AR-based measurements in each view was evaluated as was concurrent validity of AR-based measurements relative to manual goniometry, considered the reference standard. Given accepted inter-rater reliability of manual goniometry is 10°, we considered AR-based measurements within 10° of goniometry measurements to have "acceptable" concurrent validity.

RESULTS

Forty-eight healthy hands (median age 31, 50% left, varying ethnicities) were measured. All joints demonstrated excellent test-retest reliability (intraclass correlation coefficient >0.75) in all views in flexion and ≥2 views in extension. AR-based flexion measurements were within 10˚ of goniometry in ulnar views of the index MCP, PIP, and DIP; the long MCP and PIP; and the ring PIP and DIP. In extension, multiple views at each joint consistently yielded AR-based measurements within 10° of goniometry.

CONCLUSIONS

AR-based measurement has high concurrent validity and reliability; however, optimal camera views vary joint to joint. Validation in pathologic hands is required.

CLINICAL RELEVANCE

Given its excellent reliability, AR-based measurement has potential for use in monitoring changes in finger ROM after intervention, either by clinicians in-person or by patients performing remote measurements independently.

Concurrent Validity of Wearable Nanocomposite Strain Sensor with Two-Dimensional Goniometer and its Reliability for Monitoring Knee Active Range of Motion in Multiple Participants

The range of motion (ROM) of joints in the human body is essential for movement and functional performance. Real-time monitoring of joint angles is crucial for confirming pathologic biomechanics, providing feedback during rehabilitation, and evaluating the treatment efficacy. This study aims to evaluate the concurrent validity of a wearable nanocomposite strain sensor with a two-dimensional electrical goniometer and its repeatability for measuring knee ROM during repetitive joint movements in 10 healthy female participants. The participants performed seated knee flexion and extension in three sessions, during which knee ROM was measured simultaneously using the two devices. A statistical analysis was conducted using the intraclass correlation coefficient (ICC) and Bland-Altman analysis. The strain sensor demonstrated excellent concurrent validity (ICC = 0.94) and good reliability (ICC = 0.87), with biases close to zero and the magnitude of disagreements lying within ±5-10° for validity and ±10-15° for reliability. The standard deviation of the mean (SEM) for absolute reliability was 2.18°, with the width of variability based on SEM at 9.88°. The results indicate that the strain sensor exhibits clinically acceptable accuracy and precision, comparable to the existing wearable sensors. However, careful interpretation is required for variations in repeated measurements exceeding 10°. Future research should focus on enhancing the sensor attachment and calibration methods, along with broadening the application scope to more dynamic activities, other joints, and patients with specific pathologies. The strain sensor presents significant potential for real-time and continuous monitoring of joint angles during real-world activities as well as rehabilitation programs.

Validity and Reliability of Gait Speed and Knee Flexion Estimated by a Novel Vision-Based Smartphone Application

Patients with knee osteoarthritis walk with reduced speed and knee flexion excursion in the early stance phase. A slow walking speed is also associated with falls in older adults. A novel vision-based smartphone application could potentially facilitate the early detection of knee osteoarthritis and fall prevention. This study aimed to test the validity and reliability of the app-captured gait speed and peak knee flexion during the initial stance phase of gait. Twenty adults (aged 23-68 years) walked at self-selected comfortable walking speeds while the gait speed and knee flexion were simultaneously measured using retroreflective sensors and Xsens motion trackers and the app in two separate sessions for validity and reliability tests. Pearson's r correlation and Bland-Altman plots were used to examine the correlations and agreements between the sensor- and app-measured outcomes. One-sample t-tests were performed to examine whether systematic bias existed. The intraclass correlation coefficient (ICC) was calculated to assess the test-retest reliability of the app. Very high correlations were found between the sensor and app measurements for gait speed (r = 0.98, p < 0.001) and knee flexion (r = 0.91-0.92, all p < 0.001). No significant bias was detected for the final app version. The app also showed a good to excellent test-retest reliability for measuring the gait speed and peak knee flexion (ICC = 0.86-0.94). This vision-based smartphone application is valid and reliable for capturing the walking speed and knee flexion during the initial stance of gait, potentially aiding in the early detection of knee osteoarthritis and fall prevention in community living locations.

Reliability of range of motion in straight leg raise and hip extension tests among healthy young adults using a smartphone application

INTRODUCTION

Measuring range of motion (ROM) is an important skill for clinicians because it can help in the accurate interpretation of a patient's condition. Recently, ROM tests using smartphone applications have been performed in clinical settings, with the tests demonstrating high reliability and validity. This study aimed to identify the usefulness of ROM tests conducted using smartphone applications by examining the reliability of straight leg raise (SLR) and hip extension (HE) tests.

METHODS

This cross-sectional observational study included 72 lower limbs of 36 participants (19 men and 17 women; mean age, 21.6 ± 0.8 years). Passive SLR-ROM and HE-ROM were measured in 1° increments using an iPhone goniometer (IG). Intra-rater and inter-rater reliabilities were calculated using intraclass correlation coefficients (ICCs). ROM test systematic error was confirmed using Bland-Altman analysis, and ROM measurement error was calculated.

RESULTS

The ICCs of the IG ROM tests were 0.820 or higher. According to Bland-Altman analyses, SLR-ROM and HE-ROM did not acknowledge fixed and proportional biases. Thus, ROM measurement error was calculated as the minimal detectable change (MDC). The intra-rater and inter-rater MDC 95% confidence interval (MDC95) values of SLR-ROM were 3.3° and 10.2°, respectively. The intra-rater and inter-rater MDC95 values for HE-ROM were 3.9° and 9.6°, respectively.

CONCLUSION

IG ROM tests were highly reliable, simple, and easy to perform. SLR-ROM and HE-ROM tests conducted using smartphone applications may be useful indices for clinical decision-making.

Inclinometers and Apps Are Better than Goniometers, Measuring Knee Extension Range of Motion in Anterior Cruciate Ligament Patients: Reliability and Minimal Detectable Change for the Three Devices

Knee extension range of motion (ROM) measurement is important in patients with anterior cruciate ligament (ACL) injury. The main objective is to evaluate the reliability and the minimal detectable change (MDC) of three methods of measuring knee extension ROM in ACL patients. The three common goniometric devices were a universal goniometer, an inclinometer, and a smartphone app. During a single-visit, knee extension ROM was measured in both knees of 92 ACL-injured or -reconstructed patients by two testers blinded to the other's measures. Intrarater, interrater, and test-retest intraclass correlation coefficients (ICC2,1) were calculated. Intrarater ICC2,1 was excellent for the three devices ranging from 0.92 to 0.94, with the inclinometer yielding the best results (ICC2,1 = 0.94 [95% confidence interval, CI: 0.91-0.96]). Interrater ICC2,1, however, varied from 0.36 to 0.80. The inclinometer and the smartphone app yielded similar results 0.80 (95% CI: 0.71-0.86) and 0.79 (95% CI: 0.70-0.86), respectively, whereas the universal goniometer was 0.36 (95% CI: 0.17-0.53). Test-retest ICC2,1 for the inclinometer was 0.89 (95% CI: 0.84-0.93), 0.86 (95% CI: 0.79-0.91) for the app, and 0.83 (95% CI:0.74-0.89) for the goniometer. The intrarater, interrater, and test-retest MDC95 values ranged from 2.0 to 3.5, 3.7 to 10.4, and 2.6 to 5.4 degrees, respectively. The goniometer was the least reliable. The inclinometer is the recommended device due to its highest ICC scores among the three devices and ease of use.

Comparison of computational pose estimation models for joint angles with 3D motion capture

Tools to calculate human movement patterns can benefit musculoskeletal clinicians and researchers for rehabilitation assessments. The research objective of this study was to compare two human pose estimation models (HRNet, MediaPipe) against the laboratory marker-based reference standard for joint angles and range of motion (ROM) for several movement parameters. Twenty-two healthy volunteers (Female n = 16, Male n = 6), participated to compare outputs for knee and elbow kinematics. Joint angles were calculated by selecting three marker points defining the joint and angle between them in Qualisys Track Manager software. Using predicted key points, pose estimation model calculations for the same musculoskeletal kinematic outputs were computed. Coefficient of Variation (CoV) was used as a variation statistic for joint angle during movements. All comparison results were under 10%, implying that both models compute reliable joint angle data during the five tested activities. When comparing ROM as a discrete parameter, CoV values remain low, though not all below 10%. Intra-class Correlation Coefficients were computed across the ROM data as a measure of statistical similarity. Each exercise displayed good-excellent and significant correlations for both models compared to Qualisys apart from left knee sit-to-stand. Exploration from this data sampling imply that flexion/extension exercises give stronger consistency results than full sit-to-stand movements when compared to 3D motion analysis, and there is little distinction between these two models. Finer tuning of models will give further reliability for in-depth analysis as these results are restricted, but valuable for a rehabilitative setting with limited objective analysis alternative.

Smartphone-Based Hand Function Assessment: Systematic Review

BACKGROUND

Hand function assessment heavily relies on specific task scenarios, making it challenging to ensure validity and reliability. In addition, the wide range of assessment tools, limited and expensive data recording, and analysis systems further aggravate the issue. However, smartphones provide a promising opportunity to address these challenges. Thus, the built-in, high-efficiency sensors in smartphones can be used as effective tools for hand function assessment.

OBJECTIVE

This review aims to evaluate existing studies on hand function evaluation using smartphones.

METHODS

An information specialist searched 8 databases on June 8, 2023. The search criteria included two major concepts: (1) smartphone or mobile phone or mHealth and (2) hand function or function assessment. Searches were limited to human studies in the English language and excluded conference proceedings and trial register records. Two reviewers independently screened all studies, with a third reviewer involved in resolving discrepancies. The included studies were rated according to the Mixed Methods Appraisal Tool. One reviewer extracted data on publication, demographics, hand function types, sensors used for hand function assessment, and statistical or machine learning (ML) methods. Accuracy was checked by another reviewer. The data were synthesized and tabulated based on each of the research questions.

RESULTS

In total, 46 studies were included. Overall, 11 types of hand dysfunction-related problems were identified, such as Parkinson disease, wrist injury, stroke, and hand injury, and 6 types of hand dysfunctions were found, namely an abnormal range of motion, tremors, bradykinesia, the decline of fine motor skills, hypokinesia, and nonspecific dysfunction related to hand arthritis. Among all built-in smartphone sensors, the accelerometer was the most used, followed by the smartphone camera. Most studies used statistical methods for data processing, whereas ML algorithms were applied for disease detection, disease severity evaluation, disease prediction, and feature aggregation.

CONCLUSIONS

This systematic review highlights the potential of smartphone-based hand function assessment. The review suggests that a smartphone is a promising tool for hand function evaluation. ML is a conducive method to classify levels of hand dysfunction. Future research could (1) explore a gold standard for smartphone-based hand function assessment and (2) take advantage of smartphones' multiple built-in sensors to assess hand function comprehensively, focus on developing ML methods for processing collected smartphone data, and focus on real-time assessment during rehabilitation training. The limitations of the research are 2-fold. First, the nascent nature of smartphone-based hand function assessment led to limited relevant literature, affecting the evidence's completeness and comprehensiveness. This can hinder supporting viewpoints and drawing conclusions. Second, literature quality varies due to the exploratory nature of the topic, with potential inconsistencies and a lack of high-quality reference studies and meta-analyses.

Emerging Innovations in Preoperative Planning and Motion Analysis in Orthopedic Surgery

In recent years, preoperative planning has undergone significant advancements, with a dual focus: improving the accuracy of implant placement and enhancing the prediction of functional outcomes. These breakthroughs have been made possible through the development of advanced processing methods for 3D preoperative images. These methods not only offer novel visualization techniques but can also be seamlessly integrated into computer-aided design models. Additionally, the refinement of motion capture systems has played a pivotal role in this progress. These "markerless" systems are more straightforward to implement and facilitate easier data analysis. Simultaneously, the emergence of machine learning algorithms, utilizing artificial intelligence, has enabled the amalgamation of anatomical and functional data, leading to highly personalized preoperative plans for patients. The shift in preoperative planning from 2D towards 3D, from static to dynamic, is closely linked to technological advances, which will be described in this instructional review. Finally, the concept of 4D planning, encompassing periarticular soft tissues, will be introduced as a forward-looking development in the field of orthopedic surgery.

Reliability of a Smartphone App to Objectively Monitor Performance Outcomes in Degenerative Cervical Myelopathy: Observational Study

BACKGROUND

Developing new clinical measures for degenerative cervical myelopathy (DCM) is an AO Spine RECODE-DCM Research, an international and multi-stakeholder partnership, priority. Difficulties in detecting DCM and its changes cause diagnostic and treatment delays in clinical settings and heightened costs in clinical trials due to elevated recruitment targets. Digital outcome measures can tackle these challenges due to their ability to measure disease remotely, repeatedly, and more economically.

OBJECTIVE

The aim of this study is to assess the reliability of the MoveMed battery of performance outcome measures.

METHODS

A prospective observational study in decentralized secondary care was performed in England, United Kingdom. The primary outcome was to determine the test-retest reliability of the MoveMed performance outcomes using the intraclass correlation (ICC) of agreement . The secondary outcome was to determine the measurement error of the MoveMed performance outcomes using both the SE of the mean (SEM) of agreement and the smallest detectable change (SDC) of agreement . Criteria from the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) manual were used to determine adequate reliability (ie, ICC of agreement ≥0.7) and risk of bias. Disease stability was controlled using 2 minimum clinically important difference (MCID) thresholds obtained from the literature on the patient-derived modified Japanese Orthopaedic Association (p-mJOA) score, namely, MCID ≤1 point and MCID ≤2 points.

RESULTS

In total, 7 adults aged 59.5 (SD 12.4) years who live with DCM and possess an approved smartphone participated in the study. All tests demonstrated moderate to excellent test-retest coefficients and low measurement errors. In the MCID ≤1 group, ICC of agreement values were 0.84-0.94 in the fast tap test, 0.89-0.95 in the hold test, 0.95 in the typing test, and 0.98 in the stand and walk test. SEM of agreement values were ±1 tap, ±1%-3% stability score points, ±0.06 keys per second, and ±10 steps per minute, respectively. SDC of agreement values were ±3 taps, ±4%-7% stability score points, ±0.2 keys per second, and ±27 steps per minute, respectively. In the MCID ≤2 group, ICC of agreement values were 0.61-0.91, 0.75-0.77, 0.98, and 0.62, respectively; SEM of agreement values were ±1 tap, ±2%-4% stability score points, ±0.06 keys per second, and ±10 steps per minute, respectively; and SDC of agreement values were ±3-7 taps, ±7%-10% stability score points, ±0.2 keys per second, and ±27 steps per minute, respectively. Furthermore, the fast tap, hold, and typing tests obtained sufficient ratings (ICC of agreement ≥0.7) in both MCID ≤1 and MCID ≤2 groups. No risk of bias factors from the COSMIN Risk of Bias checklist were recorded.

CONCLUSIONS

The criteria from COSMIN provide "very good" quality evidence of the reliability of the MoveMed tests in an adult population living with DCM.

Quantifying lumbar sagittal plane kinematics using a wrist-worn inertial measurement unit

Wearable sensors like inertial measurement units (IMUs), and those available as smartphone or smartwatch applications, are increasingly used to quantify lumbar mobility. Currently, wearable sensors have to be placed on the back to measure lumbar mobility, meaning it cannot be used in unsupervised environments. This study aims to compare lumbar sagittal plane angles quantified from a wrist-worn against that of a lumbar-worn sensor. Twenty healthy participants were recruited. An IMU was placed on the right wrist and the L3 spinal level. Participants had to position their right forearm on their abdomen, parallel to the floor. Three sets of three consecutive repetitions of flexion, and extension were formed. Linear mixed models were performed to quantify the effect of region (lumbar vs. wrist) on six outcomes [minimum, maximum, range of motion (ROM) of flexion and extension]. Only flexion ROM was significantly different between the wrist and lumbar sensors, with a mean of 4.54° (95% CI = 1.82°-7.27°). Across all outcomes, the maximal difference between a wrist-worn and lumbar-worn sensor was <8°. A wrist-worn IMU sensor could be used to measure gross lumbar sagittal plane mobility in place of a lumbar-worn IMU. This may be useful for remote monitoring during rehabilitation.

The Validity and Reliability of a Smartphone Application for Measuring Wrist and Metacarpophalangeal Joint Motion

Background Accurate measurement of the range of motion (ROM) is crucial for guiding upper extremity rehabilitation. Inaccurate measurements can mislead clinicians and harm patient compliance. This study aimed to evaluate the validity and reliability of a smartphone application (Angulus) for measuring wrist and metacarpophalangeal (MCP) joint ROM. Methodology This study included 64 volunteers with no prior wrist injuries. The wrist flexion/extension, radial/ulnar deviation, and MCP joint flexion/extension ROM were assessed by an experienced physiotherapist (Assessor 1) using the Angulus and a standard two-arm goniometer. The validity of Angulus was evaluated by correlating it with the goniometer measurements using the Pearson correlation coefficient. For the reliability analysis, an inexperienced biomedical engineer (Assessor 2) performed the same measurements using Angulus twice in different sessions, in addition to Assessor 1. The intra-rater and inter-rater reliability were tested using the intraclass correlation coefficient. Results The mean age of the participants was 29.5 ± 8.2 years, with 62% being female. The validity of the Angulus app measurements was indicated by the adequate to excellent correlation between the Angulus and goniometer measurements (ranging from 0.44 to 0.81). The intra-rater reliability of the Angulus app was excellent for Assessor 1 (ranging from 0.76 to 0.90) and adequate to excellent for Assessor 2 (ranging from 0.71 to 0.88). The inter-rater reliability of Angulus was excellent (ranging from 0.91 to 0.96). Conclusions Angulus is a valid and reliable method to measure the wrist and MCP joint ROM.

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.

Remote assessment of pelvic kinematics during single leg squat using smartphone sensors: Between-day reliability and identification of acute changes in motor performance

The biomechanical assessment of pelvic kinematics during a single leg squat (SLS) commonly relies on expensive equipment, which precludes its wider implementation in ecological settings. Smartphone sensors could represent an effective solution to objectively quantify pelvic kinematics remotely, but their measure properties need to be evaluated before advocating their use in practice. This study aimed to assess whether measures of pelvic kinematics collected remotely using smartphones during SLS are repeatable between days, and if changes in pelvic kinematics can be identified during an endurance task. Thirty-three healthy young adults were tested remotely on two different days using their own smartphones placed on the lumbosacral region. Pelvic orientation and acceleration were collected during three sets of seven SLS and an endurance task of twenty consecutive SLS. The intersession reliability was assessed using Intraclass Correlation Coefficient (ICC2,k), Standard Error of Measurement, and Minimal Detectable Change. T-tests were used to identify pelvic kinematics changes during the endurance task and to assess between-day bias. Measures of pelvic orientation and frequency features of the acceleration signals showed good to excellent reliability (multiple ICC2,k ≥ 0.79), and a shift of the power spectrum to lower frequencies on the second day (multiple p<0.05). The endurance task resulted in larger contralateral pelvic drop and rotation (multiple p<0.05) and increased spectral entropy (multiple p<0.05). Our findings demonstrate that reliable measures of pelvic kinematics can be obtained remotely using participants' smartphones during SLS. Smartphone sensors can also identify changes in motor control, such as contralateral pelvic drop during an endurance task.

Reliability and Concurrent Validity of Smartphone Clinometer Application for Measuring Scapular Rotations in Subjects With and Without Shoulder Pain

CONTEXT

  Clinical assessment of scapular motion is obscured by a lack of clinically accessible and feasible angular measurement tools. This study evaluates the reliability and validity of the smartphone "Clinometer" app in measuring scapular upward rotation (UR) and anteroposterior tilt.

DESIGN

Psychometric analysis.

METHODS

We recruited 57 participants-10 with and 47 without shoulder pain. Two physical therapists consecutively measured both scapular movements using the Clinometer app at the arm by the side (rest), 30°, 60°, 90°, and 120° of humeral elevation in the scapular plane; one therapist measured again after 2 days. For evaluating concurrent validity, we compared the Clinometer scores with those measured using an electromagnetic motion capture system in 10 healthy participants. Intraclass correlation coefficients (ICC) with standard error of measurement (SEM) and minimal detectable difference at 90% confidence intervals (MDD90) were calculated. Concurrent validity was evaluated using repeated-measures analysis of variance followed by post hoc testing with Tukey-Kramer test (P < .05).

RESULTS

We observed good intrarater reliability (ICC: UR = .76-.85, tilt = .69-.9; SEM: 2.2°-3.5°; MDD90: ∼5°-8°) and moderate to good interrater reliability (ICC: UR = .66-.78, tilt = .66-.76; SEM: 3.6°-8°; MDD90: ∼9°-18°) for both rotations. The Clinometer scores for UR were comparable to electromagnetic motion capture system at all angles except 90° (difference ∼8°); for scapular tilt, the scores were comparable only at rest and 30° elevation.

CONCLUSION

The Clinometer app is reliable and valid for measuring scapular UR throughout and for scapular tilt at lower humeral elevation angles. The MDD90 values for scapular rotations computed in this study can be helpful in rehabilitation planning and future research.

Validity and Reliability of Inertial Measurement Units in Active Range of Motion Assessment in the Hip Joint

Measuring joint range of motion has traditionally occurred with a universal goniometer, inclinometer, or expensive laboratory systems. The popularity of the inertial measurement unit (IMU) is growing, enabling the small and even single portable device to measure the range of motion. Until now, they were not used to assess hip joint range of motion. Our study aimed to check the validity of IMUs in assessing hip range of motion and compare them to other measurement devices-universal goniometer and inclinometer. Twenty participants completed three hip movements (flexion in standing and prone internal and external rotation) on both hips. Two testers independently assessed each movement with a goniometer, digital inclinometer, and IMU at different time points. To assess the agreement of active hip ROM between devices, Intraclass Correlation Coefficient (ICC) and Bland-Altman analysis were used. Furthermore, inter-rater and intra-rater reliability were also assessed by using ICC and Bland-Altman analysis. Limits of agreement (LOA) were calculated using Bland-Altman plots. The IMU demonstrated good to excellent validity (ICC: 0.87-0.99) compared to the goniometer and digital inclinometer, with LOAs < 9°, across all tested movements. Intra-rater reliability was excellent for all devices (ICC: 0.87-0.99) with LOAs < 7°. However, inter-rater reliability was moderate for flexion (ICC: 0.58-0.59, LOAs < 22.4) and poor for rotations (ICC: -0.33-0.04, LOAs < 7.8°). The present study shows that a single inertial measurement unit (RSQ Motion, RSQ Technologies, Poznan, Poland) could be successfully used to assess the active hip range of motion in healthy subjects, comparable to other methods accuracy.

Validity and reliability of hallux valgus angle measurement on smartphone digital photographs

BACKGROUND

This prospective study aimed to test the reliability and validity of hallux valgus angle (HVA) measurement on smartphone digital photographs compared with the standard radiographic evaluation.

METHODS

Twenty Seven female patients (45 feet) with forefoot deformity were evaluated with weight-bearing anteroposterior foot radiographs and smartphone photographs. Radiographic hallux valgus angle (rHVA) was measured on digital radiographs. Two different photographic HVA measurement methods were used. In the first, the longitudinal axes of the first metatarsal and proximal phalanx were determined, and the angle between these axes was measured (pHVA), similar to the radiographic method. In the other method, the angle of the margo medialis pedis was measured on the photograph (pMMP). Two independent observers performed all measurements twice on two different occasions. Reliability analysis was performed using the interclass correlation coefficient. Agreement between the measurements was tested using Bland-Altman analysis.

RESULTS

The repeated rHVA, pHVA and pMMP measurements showed excellent intra and inter-observer reliability, with ICC values above 0.900. The mean rHVA, pHVA, and pMMP were statistically similar (p:0.929, 27.03°±8.7°, 27.11°±8.8° and 26.5°±9.0° respectively). The mean difference between the rHVA and pHVA was - 0.07°±5.1° (range, --9.67 to 9.56°), and the mean difference between the rHVA and pMMP was 0.53°±4.4° (range, -9.76° to 8.22°). There was a strong positive correlation between both photographic methods and radiographic measurements (rho = 0.809, p = 0.001 and rho = 0.872, p = 0.001). In the Bland Altman plot, the upper and lower LOAs (95%CI) ranged from - 10.11° to 9.93° for rHVA and pHVA, and from - 8.26° to 9.33° for rHVA and pMMP. Linear regression analysis showed a proportional bias for pHVA but not for the pMMP (p:0.010 versus p:0.633, respectively). The range of the mean difference (prediction interval) between the pMMP and rHVA was 17.59° and 20° for pHVA and rHVA. Simple linear regression showed that the rHVA was predicted by the following equation: rHVA = 4.73 + 0.84 × pMMP (r2 = 0.761, p < 0.001).

CONCLUSIONS

Although measuring HVA through smartphone photographs is reliable, it is not a valid prediction method.

LEVEL OF EVIDENCE

Level II, diagnostic assessment.

Shoulder Range of Motion Measurement Using Inertial Measurement Unit-Concurrent Validity and Reliability

This study aimed to evaluate the reliability of the RSQ Motion sensor and its validity against the Propriometer and electronic goniometer in measuring the active range of motion (ROM) of the shoulder. The study included 15 volunteers (mean age 24.73 ± 3.31) without any clinical symptoms with no history of trauma, disease, or surgery to the upper limb. Four movements were tested: flexion, abduction, external and internal rotation. Validation was assessed in the full range of active shoulder motion. Reliability was revised in full active ROM, a fixed angle of 90 degrees for flexion and abduction, and 45 degrees for internal and external rotation. Each participant was assessed three times: on the first day by both testers and on the second day only by one of the testers. Goniometer and RSQ Motion sensors showed moderate to excellent correlation for all tested movements (ICC 0.61-0.97, LOA < 23 degrees). Analysis of inter-rater reliability showed good to excellent agreement between both testers (ICC 0.74-0.97, LOA 13-35 degrees). Analysis of intra-rater reliability showed moderate to a good agreement (ICC 0.7-0.88, LOA 22-37 degrees). The shoulder internal and external rotation measurement with RSQ Motion sensors is valid and reliable. There is a high level of inter-rater and intra-rater reliability for the RSQ Motion sensors and Propriometer.

Validity of an inertial measurement unit for the assessment of range and quality of movement during head and thoracic spine movements

BACKGROUND

Patients with spinal pain often exhibit movement limitations and altered motor control, which can be challenging to measure accurately in clinical practice. Inertial measurement sensors present a promising new opportunity to develop valid, low-cost, and easy-to-use methods for assessing and monitoring spinal motion in a clinical setting.

AIM

This study aimed to investigate the agreement of an inertial sensor and a 3D camera system for assessing the range of motion (ROM) and quality of movement (QOM) in head and trunk single-plane movements.

METHODS

Thirty-three healthy, pain-free volunteers were included. Each participant performed movements of the head (cervical flexion, extension, and lateral flexion) and trunk (trunk flexion, extension, rotation, and lateral flexion), which were simultaneously recorded by a 3D camera system and an inertial measurement unit (MOTI, Aalborg, Denmark). Agreement and consistency were analyzed for ROM and QOM by determining intraclass correlation coefficients (ICC), mean bias, and with Bland-Altman plots.

RESULTS

The agreement between systems was excellent for all movements (ICC between 0.91 and 1.00) for ROM and good to excellent for the QOM (ICC between 0.84 and 0.95). The mean bias for all movements (0.1-0.8°) was below the minimum acceptable difference between devices. The Bland-Altman plot indicated that MOTI systematically measured a slightly greater ROM and QOM than the 3D camera system for all neck and trunk movements.

CONCLUSION

This study showed that MOTI is a feasible and potentially applicable option to assess ROM and QOM for head and trunk movements in experimental and clinical settings.

Age-Related Decline in Cervical Proprioception and Its Correlation with Functional Mobility and Limits of Stability Assessed Using Computerized Posturography: A Cross-Sectional Study Comparing Older (65+ Years) and Younger Adults

Cervical proprioception and its implications on postural stability are crucial in older adults. Understanding their relationship is important in understanding and preventing falls in older adults. This research aims to evaluate the proprioceptive, functional mobility, and limits of stability (LOS) variables among two age groups: individuals aged 65 and above and those below 65. A secondary goal of the study is to analyze the relationship between cervical proprioception, functional mobility, and the LOS.

METHODS

In this cross-sectional study, 100 participants each were included in the older and younger groups. Researchers employed the target reposition technique to assess cervical proprioception and measured the joint position error (JPE) in degrees. Functional mobility was estimated using the Berg balance scale (BBS) and timed up-and-go test (TUG). In addition, dynamic posturography was utilized to evaluate variables related to the LOS, including reaction time, maximum excursion, and directional control.

RESULTS

The magnitudes of the mean cervical JPE are larger (p < 0.001), and functional mobility (p < 0.001) and the LOS (p < 0.001) are impaired in older individuals compared to the younger ones. The cervical proprioception is significantly associated with functional mobility (p < 0.001), and the LOS (p < 0.001).

CONCLUSION

In older adults aged above 65 years, cervical proprioception, functional mobility, and the LOS are impaired. Older adults with greater cervical JPE had more impaired functional mobility and LOS parameters. When evaluating or treating older adults with problems with their balance or falls, these factors should be considered.

Smartphone Apps for Domestic Violence Prevention: A Systematic Review

Smartphone applications or apps are increasingly being produced to help with protection against the risk of domestic violence. There is a need to formally evaluate their features.

OBJECTIVE

This study systematically reviewed app-based interventions for domestic violence prevention, which will be helpful for app developers.

METHODS

We overviewed all apps concerning domestic violence awareness and prevention without language restrictions, collating information about features and limitations. We conducted searches in Google, the Google Play Store, and the App Store (iOS) covering a 10-year time period (2012-2022). We collected data related to the apps from the developers' descriptions, peer reviewed research articles, critical reviews in blogs, news articles, and other online sources.

RESULTS

The search identified 621 potentially relevant apps of which 136 were selected for review. There were five app categories: emergency assistance (n = 61, 44.9%), avoidance (n = 29, 21.3%), informative (n = 29, 21.3%), legal information (n = 10, 7.4%), and self-assessment (n = 7, 5.1%). Over half the apps (n = 97, 71%) were released in 2020-22. Around a half were from north-east America (n = 63, 46.3%). Where emergency alerts existed, they required triggering by the potential victim. There was no automation. Content analysis showed 20 apps with unique features, including geo-fences, accelerometer-based alert, shake-based alert, functionality under low resources, alert auto-cancellation, anonymous communication, and data encryption. None of the apps deployed artificial intelligence to assist the potential victims.

CONCLUSIONS

Apps currently have many limitations. Future apps should focus on automation, making better use of artificial intelligence deploying multimedia (voice, video, image capture, text and sentiment analysis), speech recognition, and pitch detection to aid in live analysis of the situation and for accurately generating emergency alerts.

Video-based Goniometer Applications for Measuring Knee Joint Angles during Walking in Neurological Patients: A Validity, Reliability and Usability Study

Easy-to-use evaluation of Range Of Motion (ROM) during walking is necessary to make decisions during neurological rehabilitation programs and during follow-up visits in clinical and remote settings. This study discussed goniometer applications (DrGoniometer and Angles - Video Goniometer) that measure knee joint ROM during walking through smartphone cameras. The primary aim of the study is to test the inter-rater and intra-rater reliability of the collected measurements as well as their concurrent validity with an electro-goniometer. The secondary aim is to evaluate the usability of the two mobile applications. A total of 22 patients with Parkinson's disease (18 males, age 72 (8) years), 22 post-stroke patients (17 males, age 61 (13) years), and as many healthy volunteers (8 males, age 45 (5) years) underwent knee joint ROM evaluations during walking. Clinicians and inexperienced examiners used the two mobile applications to calculate the ROM, and then rated their perceived usability through the System Usability Scale (SUS). Intraclass correlation coefficients (ICC) and correlation coefficients (corr) were calculated. Both applications showed good reliability (ICC > 0.69) and validity (corr > 0.61), and acceptable usability (SUS > 68). Smartphone-based video goniometers could be used to assess the knee ROM during walking in neurological patients, because of their acceptable degree of reliability, validity and usability.

Test–retest reliability and validity of cervical range of motion measurement using a smartphone clinometer and compass application among individuals with and without neck pain

Background/Aims

Cervical disorders are major health problems in our society and an important source of disability. Assessing range of motion is a significant part of the physical therapist’s role when evaluating a patient presenting with cervical disorders. The purpose of this study was to evaluate the intrarater relibility as well as the criterion validity of two phone applications (clinometer and compass) when assessing the cervical range of motion among individuals with and without neck pain.

Methods

In total, 80 participants were included in this study and split into two groups. Group A comprised 40 participants (18 women and 22 men) without neck pain. Group B included 40 participants (26 women and 14 men) with neck pain (mean pain rating on visual analogue scale 3.76 ± 0.93). Cervical range of motion was measured with the clinometer application (flexion, extension, right and left lateral flexion) and compass application (right and left rotation). The readings were compared with a universal goniometer. Estimates of reliability and validity were then established using the intraclass correlation coefficient, standard error of measurement and minimum detectable change.

Results

The smartphone applications had good intrarater reliability when compared to a universal goniometer, showing good to excellent validity (intraclass correlation coefficient >0.65) for all six cervical ranges of motion in participants with and without neck pain.

Conclusions

The smartphone clinometer application was found to be valid and reliable in measuring frontal and sagittal cervical ranges of motion in participants with and without neck pain. The compass application was found to be valid and reliable when assessing the horizontal cervical range of motion in a seated position. The applications will benefit physiotherapists when assessing cervical range of motion.

Between-day reliability of trunk orientation measured with smartphone sensors during sit-to-stand in asymptomatic individuals

BACKGROUND

Trunk kinematics during sit-to-stand is often impaired in individuals with musculoskeletal disorders. Trunk kinematics is commonly assessed in laboratories using motion capture; however, this equipment is often not available outside research centers. Smartphones are widely available and may be a suitable alternative to assess trunk orientation during sit-to-stand remotely.

OBJECTIVES

We investigated whether trunk orientation in the sagittal plane during sit-to-stand can be measured reliably between days when collected remotely using smartphones.

DESIGN

Cross-sectional study.

METHOD

Forty-three asymptomatic participants performed 15 sit-to-stand movements in two separate sessions remotely over videoconferencing. Trunk orientation was measured using each participant's smartphone. Absolute peak trunk orientation in the sagittal plane was extracted during standing, sitting, stand up and sit down. Relative trunk orientation was calculated as the difference between sitting and stand up, or sitting and sit down. Reliability was assessed using Intraclass Correlation Coefficient (ICC_2,k), Standard Error of Measurement (SEM) and Minimal Detectable change (MDC). Between day bias and between-gender differences were assessed using T tests.

RESULTS

All measures showed good reliability (ICC_2,k > 0.80; SEM < 5.6°; MDC < 13.6°) and no between-day bias (p > 0.31). Relative measures were more consistent (ICC_2,k > 0.88; SEM < 3.6°; MDC < 9.9°). No between-gender differences were observed for relative orientation (p > 0.75).

CONCLUSIONS

Sagittal trunk orientation during sitting, standing, and sit-to-stand can be measured reliably when asymptomatic individuals use their own smartphones supervised over videoconferencing. These findings support the use of smartphone sensors for assessing how trunk orientation changes over time, which may assist physiotherapists assess movement patterns of individuals with musculoskeletal disorders remotely.

Comparison of the Effectiveness of Two Management Strategies in the Pandemic COVID-19 Period in Patient Visits (Face-to-Face Visits vs. a Smartphone) in follow-up the Range of Motion of the Knee in Patients with Anterior Cruciate Ligament Reconstruction

Background

As the prevalence of the coronavirus increases, there is now more emphasis on reducing "face-to-face" patient visits. Therefore, the use of smartphones and their special medical applications can play an important role in following up patients. The aim of this study was to evaluate the use of smartphone in evaluating clinical outcomes and range of motion (ROM) of patients after anterior cruciate ligament reconstruction (ACLR).

Materials and Methods

From January to December 2020, 112 patients between 20 and 50 years old were randomly selected at our orthopedic sports center. All patients were visited online through smartphone by a knee fellowship surgeon in the morning (case group) and again all of them were visited online through smartphone in the evening by another knee fellowship surgeon (control group). Both visits were done at regular intervals in the 2^nd, 6^th, and 12^th week after surgery. Patients were evaluated for function outcomes and joint ROM.

Results

The two groups were similar in terms of mean International Knee Documentation Committee score, Lysholm knee score, and Tegner Knee Score and did not show statistically significant difference (P < 0.05) There was no significant difference in knee ROM measurements between the two groups (face-to-face visits and online through smartphone visits) during the follow-ups (P > 0.05).

Conclusion

Smartphone apps are highly effective in assessing postoperative condition of knee ROM after ACLR, especially in the short time. However, this ability has been reduced in evaluating the long term. Hence, evaluation is still necessary through direct examination in the presence visit.

Reliability and Validity of Scoliosis Measurements Obtained with Surface Topography Techniques: A Systematic Review

BACKGROUND

Surface topography (ST) is one of the methods in scoliosis assessment. This study aimed to systematically review the reliability and validity of the ST measurements for assessing scoliosis.

METHODS

A literature search of four databases was performed and is reported following PRISMA guidelines. The methodological quality was evaluated using Brink and Louw appraisal tool and data extraction was performed. The results were analyzed and synthesized qualitatively using the level of evidence method.

RESULTS

Eighteen studies were included and analyzed. Four were evaluated for reliability, six for validity, and eight for reliability and validity. The methodological quality of fourteen studies was high. Good to excellent intra-investigator reliability was shown on asymmetry, sagittal, horizontal, and most frontal ST measurements (evidence level: strong). Asymmetry and most frontal, sagittal, horizontal ST measurements showed good to excellent inter-investigator reliability (evidence level: moderate). When comparing corresponding ST and radiological measurements, good to strong validity was shown on most frontal, sagittal, and asymmetry measurements (evidence level: strong). Formetric measurements had good intra-investigator reliability and validity (evidence level: strong).

CONCLUSIONS

Most asymmetry, sagittal, and frontal ST measurements showed satisfactory reliability and validity. Horizontal ST measurements showed good reliability and poor validity. The ST technique may have great potential in assessing scoliosis, especially in reducing radiation exposure and performing cosmetic assessments.

Validity and Reliability of a Novel Smartphone Tele-Assessment Solution for Quantifying Hip Range of Motion

BACKGROUND

Tele-health has become a major mode of delivery in patient care, with increasing interest in the use of tele-platforms for remote patient assessment. The use of smartphone technology to measure hip range of motion has been reported previously, with good to excellent validity and reliability. However, these smartphone applications did not provide real-time tele-assessment functionality. We developed a novel smartphone application, the TelePhysio app, which allows the clinician to remotely connect to the patient's device and measure their hip range of motion in real time. The aim of this study was to investigate the concurrent validity and between-sessions reliability of the TelePhysio app. In addition, the study investigated the concurrent validity, between-sessions, and inter-rater reliability of a second tele-assessment approach using video analysis.

METHODS

Fifteen participants (nfemales = 6) were assessed in our laboratory (session 1) and at their home (session 2). We assessed maximum voluntary active hip flexion in supine and hip internal and external rotation, in both prone and sitting positions. TelePhysio and video analysis were validated against the laboratory's 3-dimensional motion capture system in session 1, and evaluated for between-sessions reliability in session 2. Video analysis inter-rater reliability was assessed by comparing the analysis of two raters in session 2.

RESULTS

The TelePhysio app demonstrated high concurrent validity against the 3D motion capture system (ICCs 0.63-0.83) for all hip movements in all positions, with the exception of hip internal rotation in prone (ICC = 0.48, p = 0.99). The video analysis demonstrated almost perfect concurrent validity against the 3D motion capture system (ICCs 0.85-0.94) for all hip movements in all positions, with the exception of hip internal rotation in prone (ICC = 0.44, p = 0.01). The TelePhysio and video analysis demonstrated good between-sessions reliability for hip external rotation and hip flexion, ICC 0.64 and 0.62, respectively. The between-sessions reliability of hip internal and external rotation for both TelePhysio and video analysis was fair (ICCs 0.36-0.63). Inter-rater reliability ICCs for the video analysis were 0.59 for hip flexion and 0.87-0.95 for the hip rotation range.

CONCLUSIONS

Both tele-assessment approaches, using either a smartphone application or video analysis, demonstrate good to excellent concurrent validity, and moderate to substantial between-sessions reliability in measuring hip rotation and flexion range of motion, but less in internal hip rotation in the prone position. Thus, it is recommended that the seated position be used when assessing hip internal rotation. The use of a smartphone to remotely assess hip range of motion is an appropriate, effective, and low-cost alternative to the face-to-face assessments. This method provides a simple, cost effective, and accessible patient assessment tool with no additional cost. This study validates the use of smartphone technology as a tele-assessment tool for remote hip range of motion assessment.

Effectiveness of an expert assessment and individualised treatment compared with a minimal home-based exercise program in women with late-term shoulder impairments after primary breast cancer surgery: study protocol for a randomised controlled trial

Background

In breast cancer patients, late-term upper limb sequelae, such as shoulder pain and impaired shoulder function, remain common after primary breast cancer surgery. The aim of this trial is to evaluate whether an expert assessment of shoulder impairments, followed by an individualised treatment plan, is superior to a minimal physiotherapeutic rehabilitation program in reducing shoulder symptoms, among women with late-term shoulder impairments after primary breast cancer.

Methods/design

The study is designed as a stratified, parallel-group, assessor-blinded, randomised, controlled trial conducted in Denmark; 130 participants with late-term shoulder impairments 3–7 years after primary surgery for breast cancer will be recruited. Participants will be randomised (allocation 1:1) to either an expert assessment of shoulder impairments followed by an individualised treatment plan or to follow a minimal physiotherapeutic rehabilitation program delivered in a pamphlet. The primary outcome will be a change in shoulder pain and function from baseline to 12 weeks after initiating the treatment, as measured by the patient-reported outcome Shoulder Pain and Disability Index (SPADI) questionnaire.

Discussion

There has been an insufficient focus in research and clinical practice on late-term shoulder impairment in women following surgery for breast cancer. This trial will focus on interventions towards late-term shoulder impairments and is expected to provide evidence-based knowledge to physiotherapists and women about the management of shoulder pain and impaired shoulder function.

Trial registration

ClinicalTrials.gov NCT05277909. Registered on 11 March 2022.

Analysis of the Leap Motion Controller's Performance in Measuring Wrist Rehabilitation Tasks Using an Industrial Robot Arm Reference

The Leap Motion Controller (LMC) is a low-cost markerless optical sensor that performs measurements of various parameters of the hands that has been investigated for a wide range of different applications. Research attention still needs to focus on the evaluation of its precision and accuracy to fully understand its limitations and widen its range of applications. This paper presents the experimental validation of the LMC device to verify the feasibility of its use in assessing and tailoring wrist rehabilitation therapy for the treatment of physical disabilities through continuous exercises and integration with serious gaming environments. An experimental set up and analysis is proposed using an industrial robot as motion reference. The high repeatability of the selected robot is used for comparisons with the measurements obtained via a leap motion controller while performing the basic movements needed for rehabilitation exercises of the human wrist. Experimental tests are analyzed and discussed to demonstrate the feasibility of using the leap motion controller for wrist rehabilitation.

Wearable technology in orthopedic trauma surgery - An AO trauma survey and review of current and future applications

The use of wearable sensors to track activity is increasing. Therefore, a survey among AO Trauma members was conducted to provide an overview of their current utilization and determine future needs and directions. A cross sectional expert opinion survey was administered to members of AO Trauma. Respondents were surveyed concerning their experience, subspeciality, current use characteristics, as well as future needs concerning wearable technology. Three hundred and thirty-three survey sets were available for analysis (Response Rate 16.2%). 20.7% of respondents already use wearable technology as part of their clinical treatment. The most prevalent technology was accelerometry combined with smartphones (75.4%) to measure general patient activity. To facilitate the use of wearable technology in the future, the most pressing issues were cost, patient compliance and validity of results. Wearable activity monitors are currently being used in trauma surgery. Surgeons employing these technologies mostly measure simple activity or activity associated parameters. Cost was the greatest perceived barrier to implementation. Further research, especially concerning the interpretation of the outcome values obtained, is required to facilitate wearable activity monitoring as an objective patient outcome measurement tool.

Distal and/or Proximal Joint Stiffness Among Post-Fracture Patients Treated in University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia

Background

Methods

Results

Conclusion

Validity and reliability of balance Y-MED application in chronic mechanical low back pain patients

Background

Low back pain patients suffer from balance disturbance. Balance allows a person to interact with the surrounding environment and to do his daily activities. As recent technology has facilitated patient monitoring and enhanced our ability to monitor patients remotely, smartphone apps have been developed to achieve this goal. There are various balance assessment instruments used nowadays. It may be subjective or objective assessments. This study was applied to verify if the measurements of balance Y-MED smartphone applications are valid and reliable compared to the HUMAC balance board in order to offer easy, fast, cost-effective, and time-effective valid and reliable balance assessment that can be used in a clinical setting.

Methods

Fifty-four patients (12 males and 42 females) with chronic mechanical low back pain for more than 3 months was volunteered to participate in the current study with an age range of 25–60 years and BMI range of 18–34 kg/m2. Compared with the HUMAC balance board, the validity of the balance Y-MED smartphone application is evaluated, and the test-retest reliability of the balance Y-MED smartphone application is obtained by the same examiner 3 times.

Results

For concurrent validity, the correlations between balance measurements by Y-MED smartphone application and HUMAC balance board were not significant in both eyes open (r = − 0.12, p = 0.38) and eyes closed (r = 0.26, p = 0.054). The smartphone application showed poor test-retest reliability measurement of balance with eyes open; (ICC was 0.279, with 95% CI − 0.117–0.554) and with eyes closed (ICC was − 0.159, with 95% CI − 0.814–0.287).

Conclusions

According to the evaluation scheme selected in this study, the researchers were unable to confirm the validity of the balance Y-MED smartphone application in the balance assessment of patients with mechanical chronic low back pain. More than that, the balance Y-MED smartphone application has been shown poor score reliability. This makes it inaccurate for use in assessment balance.

Can a Patient use an App at Home to Measure Knee Range of Motion? Utilizing a Mobile App, Curovate, to Improve Access and Adherence to Knee Range of Motion Measurements

Introduction

Knee range of motion is a critical measure of progress after knee injury and knee surgery. However, many patients do not understand the importance of knee range of motion and most do not have a way to self-monitor their knee range of motion at home. The patient being able to measure their own range of motion can provide improved access to this critical health metric, and could improve adherence with their daily knee range of motion exercises. The purpose of this technical report is to determine if a mobile app, Curovate, can provide reliable measures of knee range of motion compared to standard goniometric measurements.

Procedures

There were four positions of knee flexion and four positions of knee extension each measured twice with a standard goniometer and four different mobile devices with the app Curovate. The reliability and validity of the Curovate app was tested across mobile devices and operating systems and compare to goniometric knee range of motion measurements. A total of 80 measurements were taken. All testing was completed on a healthy 23-year-old male with no knee pathology.

Results

A strong positive correlation, Pearson's r > = 0.9985, for all positions of knee flexion and extension across all four mobile devices as well as each mobile device compared to standard goniometric measurements.

Conclusions

This article presents a unique method for patients to measure their knee range of motion using the mobile app Curovate. Overall, the mobile app, Curovate, was found to have a strong positive correlation across four mobile devices with varying operating systems and compared to goniometric measurements.

Level of evidence

4.

Acute effects of varying densities of foam roller on hamstring flexibility and eccentric strength

Background/Aims

Foam rolling is a popular form of self-administered soft tissue therapy, commonly used in sporting environments. There are several variations in foam roller types including differences in density. No studies have examined the effects of different density type rollers on performance. This study compares the effects of varying foam roller density on hamstring flexibility and eccentric hamstring strength in active men.

Methods

A total of 28 healthy male participants (height 176.7 ± 5.9 cm; body mass 75.8 ± 9.6 kg; age 21.6 ± 4.0 years) were randomly allocated to receive a low density, medium density or high density foam roller or allocated to a control group. Outcome measures included hamstring flexibility through active knee extension (°) and eccentric hamstring strength pre and immediately-post foam roller application.

Results

Significant foam roller x time interactions were found for hamstring flexibility (P<0.05). Significant increases in active knee extension were reported post-foam roller application for all foam roller densities (P<0.05). No significant changes in strength parameters (break angle, peak and average force and torque) were found (P>0.05). No significant interactions between strength parameters, limb, type of roller or time were found (P>0.05).

Conclusions

Foam roller use elicits immediate positive increases in hamstring flexibility through active knee extension assessment, with the lower density foam roller displaying the largest increases in hamstring flexibility. No change in strength parameters were noted with the increases in flexibility; however, this does not denote that injury risk is reduced because of this. Findings provide practitioners with insight to inform decision making for the use of different densities of foam roller in practical settings.

Measurement properties of smartphone applications for the measurement of neck range of motion: a systematic review and meta analyses

Background

Smartphone applications offer an accessible and practical option to measure neck range of motion (ROM) and are becoming more commonly used in clinical practice. We assessed the validity, reliability, and responsiveness of smartphone applications (apps) to measure neck ROM in people with and without neck pain.

Methods

A comprehensive electronic search strategy of the main electronic databases was conducted from inception until June 2021. The identified studies investigated apps which measured neck ROM, and evaluated their validity, reliability, or responsiveness, in adult participants with neck pain or asymptomatic individuals. Two independent reviewers determined eligibility and risk of bias following COSMIN guidelines. The quality of evidence was assessed according to the GRADE approach.

Results

Eleven studies, with a total of 376 participants were included. Three types of apps were identified: clinometer apps, compass apps, and other apps of ‘adequate’ to ‘doubtful’ risk of bias. A meta-analysis revealed ‘good’ to ‘excellent’ intra-rater and inter-rater reliability across the three types of apps. The overall validity was rated from ‘moderate’ to ‘very high’ across all apps. The level of evidence was rated as ‘low’ to ‘very low’.

Conclusion

Smartphone applications showed sufficient intra-rater reliability, inter-rater reliability, and validity to measure neck ROM in people with and without neck pain. However, the quality of evidence and the confidence in the findings are low. High-quality research with large sample sizes is needed to further provide evidence to support the measurement properties of smartphone applications for the assessment of neck ROM.

Study registration

Following indications of Prisma-P guidelines, this protocol was registered in PROSPERO on 1/05/2021 with the number CRD42021239501.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05066-6.

Adjacent Joint Restriction Differentially Influences Intra- and Inter-rater Reliability and Agreement of Goniometric Measurements

BACKGROUND

Reliability and agreement of goniometric measurements can be altered by variations in measurement technique such as restricting adjacent joints to influence bi-articular muscles. It is unknown if the influence of adjacent joint restriction is consistent across different range of motion (ROM) tests, as this has yet to be assessed within a single study. Additionally, between-study comparisons are challenged by differences between methodology, participants and raters, obscuring the development of a conceptual understanding of the extent to which adjacent joint restriction can influence goniometric ROM measurements.

PURPOSE

To quantify intra- and inter-rater reliability and levels of agreement of goniometric measurements across five ROM tests, with and without adjacent joint restriction.

STUDY DESIGN

Descriptive reliability study.

METHODS

Three trained and experienced raters made two measurements of bilateral ankle dorsiflexion, first metatarsophalangeal dorsiflexion, hip extension, hip flexion, and shoulder flexion, with and without adjacent joint restriction. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), along with participant, measurement/rater and random error variance were estimated.

RESULTS

Eleven females (age 21.4 ±2.3 years) and 19 males (age 22.1 ±2.8 years) participated. Adjacent joint restriction did not influence the reliability and agreement in a consistent way across the five ROM tests. Changes in the inter-rater reliability and agreement were more pronounced compared to the intra-rater reliability and agreement. Assessing variance components (participant, measurement/rater and random error variance) that are used to calculate the ICC and SEM, improved interpretation of ICC and SEM scores.

CONCLUSION

The effects of adjacent joint restriction on reliability and agreement of goniometric measurements depend on the ROM test and should be considered when comparing measurements between multiple raters. Reporting variance components that are used to calculate the ICC and SEM can improve interpretation and may improve between-study comparisons, towards developing a conceptual framework to guide goniometric measurement technique.

LEVEL OF EVIDENCE

3b.

Reliability and validity of lower limb joint range of motion measurements using a smartphone

This study aimed to examine the reliability and validity of using a smartphone to measure the multi-joint range of motion of the lower limbs. We measured the straight leg raise angle, ankle dorsiflexion angle, and hip internal rotation angle in each of the 40 lower extremities of 20 healthy adults. Measurements were compared between a conventional method using a goniometer and a smartphone application method. The intraclass correlation coefficient (ICC) was used to evaluate the reliability of each smartphone measurement, and Bland-Altman analysis was used to examine measurement errors. The criterion-related validity of the two methods was also examined. Intra-rater reliability (ICC 0.668-0.939) was substantial to almost perfect, with no systematic errors found for all items, and the standard errors of measurement were acceptable. Inter-rater reliability (ICC 0.701-0.936) was also substantial to almost perfect, but the straight leg raise angle and hip internal rotation angle showed fixation errors. For these two measurements, with more than one examiner, the limit of agreement of error needs to be considered. No systematic errors were found in the ankle dorsiflexion angle, and the standard error of measurement was within the acceptable range. A moderate to strong correlation (r = 0.626-0.915) was found between the conventional and smartphone methods, demonstrating good criterion-related validity. However, in the ankle dorsiflexion angle measurements, the reliability and validity were shown to be lower than the other two items. This suggested the necessity of changing the measurement conditions in order to use the ankle dorsiflexion angle in clinical practice.

Порівняльний аналіз валідності гоніометричного, інклінометричного та рентгенологічного методів вимірювання розгинання у гомілковостопному суглобі

Актуальність. Пошук оптимального методу оцінки амплітуди розгинання в гомілковостопному суглобі (ГС) залишається актуальним предметом наукових дискусій. Мета роботи — провести порівняльний аналіз валідності гоніометричного та інклінометричного методів вимірювання обсягу розгинання у гомілково-стопному суглобі порівняно із рентгенологічними показниками. Матеріали та методи. У дослідження ввійшло 25 здорових, фізично активних осіб (50 гомілковостопних суглобів), серед яких чоловіків було 18, жінок— 7; середній вік обстежуваних становив 25,8 ± 5,2 року; середнє значення індексу маси тіла — 25,01 ± 5,01. Обсяг розгинання у ГС вимірювали при навантаженні за допомогою двоплощинного гоніометра та інклінометра і порівнювали їх з рентгенологічними показниками. Результати вимірювань оцінювали методами описової статистики. Результати. Cередні значення розгинання у ГС, виміряні за допомогою двоплощинного гоніометра, становили 37,62 ± 5,56°; інклінометра — 40,61 ± 5,15°; рентгенологічні показники — 23,69 ± 7,25°. Різниця між середніми була вірогідною (p < 0,001). Середнє значення коефіцієнта варіації для рентгенологічного методу становило 0,31 і значно переважало показники гоніометричного (0,15) та інклінометричного (0,13) методів вимірювання (p < 0,001). Рентгенографія ГС при навантаженні при максимальному розгинанні стопи призводить до збільшення показників тало-1-метатарзального кута. Висновки. Значення кутових параметрів розгинання у ГС при гоніометричному та інклінометричному методах вимірювання суттєво перевищують рентгенологічні показники. Більший коефіцієнт варіації для рентгенологічного дослідження вказує на кращу відтворюваність інклінометрії та гоніометрії при оцінці розгинання у ГС. Навантажувальна рентгенограма ГС в положенні максимального розгинання демонструє збільшення тало-1-метатарзального кута порівняно із нормативними значеннями, що потрібно враховувати при інтерпретації результатів рентгенологічної оцінки розгинання у ГС.

Validity and reliability of a smartphone goniometer application for measuring hip range of motions

BACKGROUND

Mobile applications which are designed to assess the range of motion (ROM) are widely used.

OBJECTIVE

The aim of this cross-sectional observational study was to determine the inter-observer and intra-observer reliability of a smartphone application "PT Goniometer" (PTG) and determine the correlation between PTG and universal goniometer (UG) regarding active ROMs of the hip in healthy participants.

METHODS

Thirty-four healthy young participants were included in the study. Two physiotherapists performed active hip flexion, abduction, internal rotation and external rotation ROM measurements of dominant legs of the participants by using PTG and UG. Intraclass correlation coefficients (ICC) were calculated to determine the intra-observer and inter-observer reliability. Level of correlations between PTG and UG were used to establish concurrent validity of PTG.

RESULTS

The PTG demonstrated excellent inter-observer and intra-observer reliability (ICC > 0.90) for all measured hip movements. The minimum detectable change (MDC95) was ranged from 3.29° to 5.1° for the intra-observer reliability, and from 2.55° to 3.21° for the inter-observer reliability. Additionally, the concurrent validity was found excellent (r = 0.91-0.93).

CONCLUSION

The results of the present study suggest that PTG is a valid and reliable mobile technology for measuring hip ROMs.

Reliability and validity varies among smartphone apps for range of motion measurements of the lower extremity: a systematic review

The aim of this review was to determine whether smartphone applications are reliable and valid to measure range of motion (RoM) in lower extremity joints. A literature search was performed up to October 2020 in the databases PubMed and Cochrane Library. Studies that reported reliability or validity of smartphone applications for RoM measurements were included. The study quality was assessed with the QUADAS-2 tool and baseline information, validity and reliability were extracted. Twenty-five studies were included in the review. Eighteen studies examined knee RoM, whereof two apps were analysed as having good to excellent reliability and validity for knee flexion ("DrGoniometer", "Angle") and one app showed good results for knee extension ("DrGoniometer"). Eight studies analysed ankle RoM. One of these apps showed good intra-rater reliability and excellent validity for dorsiflexion RoM ("iHandy level"), another app showed excellent reliability and moderate validity for plantarflexion RoM ("Coach's Eye"). All other apps concerning lower extremity RoM had either insufficient results, lacked study quality or were no longer available. Some apps are reliable and valid to measure RoM in the knee and ankle joint. No app can be recommended for hip RoM measurement without restrictions.

Remote self-measurement of wrist range of motion performed on normal wrists by a minimally trained individual using the iPhone level application only demonstrated good reliability in measuring wrist flexion and extension

STUDY DESIGN

This is a reliability study using the intraclass correlation coefficient.

PURPOSE

The purpose of this study was to determine whether an individual with minimal training could use the iPhone Level application to self-measure the range of motion of the forearm and wrist from a remote location.

METHODS

Forty healthy participants (80 wrists) were measured twice by two examiners using a universal goniometer and the iPhone Level application. After measurement, each participant received a training session in the self-measurement method. They were then asked to perform remote self-measurements two to three days later and report their findings to the examiners using Skype or FaceTime.

RESULTS

SPSS, version 26, was used to run intraclass correlation coefficients using a two-way random analysis at a 95% confidence interval with absolute agreement. Comparisons of single measurements were used to determine reliability. Good inter-rater reliability was found between wrist flexion and extension in all testing conditions. Measurement of active motion in supination, pronation, radial, and ulnar deviation demonstrated moderate reliability compared with the universal goniometer where the measurements were performed by the investigators. Self-measurement of the participant resulted in moderate reliability for supination and poor reliability in pronation, radial, and ulnar deviation.

DISCUSSION

Some participants found the procedures technologically and perceptually challenging. Anatomical variances, positional requirements, and substitution patterns complicated the process.

CONCLUSIONS

The iPhone Level application may be used to perform reliable self-measurements of wrist flexion and extension from a remote location. Further research exploring methods for remote selfmeasurement is indicated.