The validity and reliability of DrGoniometer, a smartphone application, for measuring forearm supination

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.

Novel Tools to Approach and Measure Outcomes in Patients with Fractures

Upper extremity fractures are prevalent and pose a great burden to patients and society. In the US alone, the annual incidence of upper extremity fractures is 67.6 fractures per 10,000 persons. While the majority of patients with upper extremity fractures demonstrate satisfactory outcomes when treated appropriately (the details of which are discussed in prior articles), the importance of follow-up and outcome measurement cannot be understated. Outcome measurement allows for accountability and improvement in clinical outcomes and research. The purpose of this article is to describe recent advances in methods and tools for assessing clinical and research outcomes in hand and upper extremity care. Three specific advances that are broadly changing the landscape of follow-up care of our patients include: 1) telemedicine, 2) patient-reported outcome measurement, and 3) wearables/remote patient monitoring.

A description of the barriers, facilitators, and experiences of hand therapists in providing remote (tele) rehabilitation: An interpretive description approach

BACKGROUND

Telerehabilitation is increasingly being used to meet the rehabilitation needs of situations where face-to-face therapy is not possible. Nevertheless, reports on barriers and facilitators of implementing this method from the perspective of therapists still need to be made available.

PURPOSE

To investigate the experiences of hand therapists when implementing telerehabilitation, examining the difficulties, barriers, and facilitators encountered during its implementation.

STUDY DESIGN

Qualitative study.

METHODS

This study used a purposive sampling method to recruit therapists with varying experiences in telerehabilitation and conducted semi-structured interviews. Data collection and analysis continued iteratively until thematic saturation was achieved. A total of 14 therapists were interviewed via Zoom. The interviews were recorded, transcribed, and qualitatively analyzed using thematic analysis. The process of interpretive description guided interviews and analysis of the interviews to identify key barriers and facilitators in providing telerehabilitation.

RESULTS/DISCUSSION

Six main themes and 10 corresponding sub-themes were constructed concerning facilitators and barriers to telerehabilitation: factors related to the patient, therapy, therapists, injury, technology, and policy. Therapists implemented different coping strategies in their interventions and measurements to facilitate treatment. However, some interventions, such as orthotic fabrication, could not be done online. Educating therapists, providing a standard method, and integrating with in-person rehabilitation can overcome the barriers to telerehabilitation in hand therapy.

CONCLUSIONS

Technology was the main facilitator and, on the other hand, a barrier to providing online hand therapy interventions. Therapists generally reported high satisfaction and usability of this method. Despite all barriers, telerehabilitation can be implemented as a part of hand therapy interventions alongside face-to-face therapy as a hybrid method. The barriers and facilitators experienced and raised by therapists can be added to what is already known regarding telerehabilitation in hand therapy. They might be applied to guide therapeutic procedures and upcoming studies.

Reliability and Concurrent Validity of a Markerless, Single Camera, Portable 3D Motion Capture System for Assessment of Glenohumeral Mobility

Introduction

Recent technological advancements have enabled medical, sport, and fitness professionals to utilize digital tools that assist with conducting movement examinations and screenings. One such advancement has been the implementation of a single camera, markerless, and portable 3D motion capture system designed to obtain ROM measurements for multiple body parts simultaneously. However, the reliability and validity of a markerless 3D motion capture system that uses a single camera has not been established.

Purpose

The purpose of this study was to investigate the reliability and concurrent validity of this 3D motion capture system compared to a goniometer in assessing ROM of the glenohumeral joint.

Study Design

Quasi-experimental reliability, convenience sampling.

Methods/materials

Forty healthy volunteers (mean ± SD, age 27.4 ± 12.4 years, height 173.4 ± 11.1 cm, weight 72.1 ± 16.2 kg) participated in this study. Intrarater reliability was analyzed by ICC(2,k) with a 95% CI using two repeated trials for each shoulder movement (flexion, abduction, external rotation, internal rotation) that were recorded simultaneously via two methods: a standard goniometer and a 3D motion capture system. Concurrent validity was analyzed using Pearson Correlation Coefficient (r).

Results

The intrarater reliability between the two instruments for glenohumeral motions yielded an overall ICC of 0.82 (95% CI: 0.74-0.88) indicating good reliability for both instruments.The 3D motion capture system demonstrated strong correlations with goniometry for shoulder flexion (r = 0.67), abduction (r = 0.63), and external rotation (r = 0.76), and very strong correlation for shoulder internal rotation (r = 0.84).

Conclusion

Results from this study indicated that a markerless, single camera, portable 3D motion capture system can be a reliable and valid tool to assess glenohumeral joint ROM in comparison to a standard goniometer.

Level of Evidence

3.

Smartphone goniometer application for reliable and convenient measurement of finger range of motion: a comparative study

ObjectiveGoniometer measurements are commonly used in hand clinics to follow progress or as an outcome measure for acute and chronic conditions. The use of an Apple iPhone goniometer application (smartphone app) may provide a practical alternative for clinicians. This study sought to assess accuracy in range-of-motion measurements obtained by a smartphone app compared to a traditional universal goniometer (UG) in healthy and diseased hands. MethodsPatients with various hand disease processes were recruited through a tertiary hospital hand clinic, as well as healthy volunteers. Middle and little fingers were assessed at the metacarpophalangeal (MCP), proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints for flexion and extension. Measurements were taken using a UG and a smartphone app by two independent evaluators using a standardised proforma. ResultsTwenty patients were recruited (50% male, 50% female; 13 healthy volunteers and seven with hand pathology). There were no significant differences in measurements using the smartphone app. The only significant difference found using the UG was for little finger PIP joint flexion; however, the difference was only 2.5°. Comparison of the average measurements using a UG and smartphone app found significant differences for six joints, with none of these > 5° (largest 4.6°). ConclusionThe smartphone app is as reliable as traditional UG and would be a practical tool for everyday use in hand clinics. Its uptake may provide broader utility for patient self-measurement and telemedicine.

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.

Use of Wearable Technology to Measure Activity in Orthopaedic Trauma Patients: A Systematic Review

BACKGROUND

Patient-Reported Outcome Measures (PROMs) are widely used for measurement of functional outcomes after orthopaedic trauma. However, PROMs rely on patient collaboration and suffer from various types of bias. Wearable Activity Monitors (WAMs) are increasingly used to objectify functional assessment. The objectives of this systematic review were to identify and characterise the WAMs technology and metrics currently used for orthopaedic trauma research.

METHODS

PubMed and Embase biomedical literature search engines were queried. Eligibility criteria included: Human clinical studies published in the English language between 2010 and 2019 involving fracture management and WAMs. Variables collected from each article included: Technology used, vendor/product, WAM body location, metrics measured, measurement time period, year of publication, study geographic location, phase of treatment studied, fractures studied, number of patients studied, sex and age of the study subjects, and study level of evidence. Six investigators reviewed the resulting papers. Descriptive statistics of variables of interest were used to analyse the data.

RESULTS

One hundred and thirty-six papers were available for analysis, showing an increasing trend of publications per year. Accelerometry followed by plantar pressure insoles were the most commonly employed technologies. The most common location for WAM placement was insoles, followed by the waist. The most commonly studied fracture type was hip fractures followed by fragility fractures in general, ankle, "lower extremity", and tibial fractures. The rehabilitation phase following surgery was the most commonly studied period. Sleep duration, activity time or step counts were the most commonly reported WAM metrics. A preferred, clinically validated WAM metric was not identified.

CONCLUSIONS

WAMs have an increasing presence in the orthopaedic trauma literature. The optimal implementation of this technology and its use to understand patients' pre-injury and post-injury functions is currently insufficiently explored and represents an area that will benefit from future study.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO ID:210344.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s43465-022-00629-0.

Reliability and Concurrent Validity of Mobile Health Technology for Patient Self-Monitoring in Physical Rehabilitation

Background

Forearm pronation and supination are important for everyday functional tasks and some recreational activities. Healthcare providers use reliable and valid tools during the physical rehabilitation process to measure joint range of motion (ROM), assess functional mobility, guide decisions for skilled interventions, and progress a plan of care. Since the onset of the COVID-19 pandemic, both healthcare providers and patients benefited from mobile health technologies that have emerged, which can be used by patients in the home to monitor ROM and assist the healthcare provider in guiding the rehabilitation process when utilizing telehealth.

Purpose

The goal of this study was to investigate the reliability and concurrent validity of a smartphone application for obtaining goniometric measurements of forearm pronation and supination.

Methods

This study consisted of 83 participants that were recruited on a voluntary basis from an academic institution. An iPhone with the application Clinometer and a standard goniometer (SG) were utilized to obtain goniometric measurements of forearm pronation and supination. The intraclass correlation coefficient (ICC) was used to analyze intrarater reliability, and the Pearson correlation coefficient was used to analyze concurrent validity. Scatterplots with regression lines were created to visually display the results.

Results

The smartphone demonstrated strong correlations for both pronation and supination (r = 0.71, P < .001; r = 0.73, P < .001). This study demonstrated overall good-excellent intrarater reliability and good concurrent validity for the smartphone application with a higher test-retest reliability in the measurement of forearm pronation compared to supination.

Conclusions

This study concludes that the reliability and concurrent validity of the smartphone was consistent with the SG for assessing forearm pronation and supination. It may be of value to further investigate interrater reliability between patient and healthcare practitioner, and report on the ease of use to assess ROM with a smartphone.

The Telemedicine-Based Pediatric Examination of the Neck and Upper Limbs: A Narrative Review

With the COVID-19 pandemic hastening the adoption of telemedicine into clinical practice, it has also prompted an abundance of new literature highlighting its capabilities and limitations. The purpose of this review is to summarize the current state of the literature on telemedicine applied in the context of a musculoskeletal examination of the neck and upper limbs for children 3 to 18 years old. The PubMed and ScienceDirect databases were searched for relevant articles from January 2015 to August 2021 using a combination of keywords and nested searches. General examination components including inspection, guided self-palpation, range of motion, sensory and motor examination, as well as special testing are described. Although the literature is focused mainly on adult populations, we describe how each component of the exam can be reliably incorporated into a virtual appointment specific to pediatric patients. Caregivers are generally needed for most consultations, but certain maneuvers can be self-performed by older children and adolescents alone. There is general feasibility, validity, and substantial reliability in performing most examination components of the upper limbs remotely, except for the shoulder exam. Compared to those made in person, clinical diagnoses established virtually were found to be either the same or similar in most cases, and management decisions also had high agreement. Despite this, there is evidence that some pediatric providers may not be able to collect all the information needed from a telemedicine visit to make a complete clinical assessment. Lastly, currently available smartphone applications measuring joint range of motion were found to have high reliability and validity. This narrative review not only establishes a foundation for a structured pediatric musculoskeletal examination, but also aims to increase physicians' confidence in incorporating telemedicine into their standard of care.

Reliability and validity of smartphone applications to measure the spinal range of motion: A systematic review

Introduction: The objective of this study is to conduct a systematic review on the reliability and validity of various smartphone applications for spinal range of motion (ROM) measurements.Methods: Eleven studies were selected following an electronic search of PubMed, CINAHAL, Medline, Embase and SPORTDiscus. Quality appraisals of selected studies were conducted using a standardized appraisal tool.Results: Most studies demonstrated a good intra- and inter-rater reliability, as well as validity in more than 50% of joint movements. At the same time, relative reliability/validity outcomes (e.g. interclass correlation co-efficient) were stronger than absolute reliability/validity outcomes (e.g. mean differences, limits of agreement). Spinal rotation movement showed less reliability and validity when compared to other spinal movements.ConclusionsːResult of the study supports the use of smartphone applications for ROM measurements of spinal joints. However, we cannot advocate the most appropriate application for spinal ROM measurement or suggest which application is superior to all others. As clinicians have multiple options in selecting applications, it is recommended they use applications that have proven reliable and valid for that particular joint. Data from this study provides clinicians with evidence-based research on smartphone devices for measuring spinal joint ROM in clinical settings.

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.

Adding mobilisation with movement to exercise and advice hastens the improvement in range, pain and function after non-operative cast immobilisation for distal radius fracture: a multicentre, randomised trial

QUESTION

Does adding mobilisation with movement (MWM) to usual care (ie, exercises plus advice) improve outcomes after immobilisation for a distal radius fracture?

DESIGN

A prospective, multicentre, randomised, clinical trial with concealed allocation, blinding and intention-to-treat analysis.

PARTICIPANTS

Sixty-seven adults (76% female, mean age 60 years) treated with casting after distal radius fracture.

INTERVENTION

The control group received exercises and advice. The experimental group received the same exercises and advice, plus supination and wrist extension MWM.

OUTCOME MEASURES

The primary outcome was forearm supination at 4 weeks (immediately post-intervention). Secondary outcomes included wrist extension, flexion, pronation, grip strength, QuickDASH (Disabilities of Arm, Shoulder and Hand), Patient-Rated Wrist Evaluation (PRWE) and global rating of change. Follow-up time points were 4 and 12 weeks, with patient-rated measures at 26 and 52 weeks.

RESULTS

Compared with the control group, supination was greater in the experimental group by 12 deg (95% CI 5 to 20) at 4 weeks and 8 deg (95% CI 1 to 15) at 12 weeks. Various secondary outcomes were better in the experimental group at 4 weeks: extension (14 deg, 95% CI 7 to 20), flexion (9 deg, 95% CI 4 to 15), QuickDASH (-11, 95% CI -18 to -3) and PRWE (-13, 95% CI -23 to -4). Benefits were still evident at 12 weeks for supination, extension, flexion and QuickDASH. The experimental group were more likely to rate their global change as 'improved' (risk difference 22%, 95% CI 5 to 39). There were no clear benefits in any of the participant-rated measures at 26 and 52 weeks, and no adverse effects.

CONCLUSION

Adding MWM to exercise and advice gives a faster and greater improvement in motion impairments for non-operative management of distal radius fracture.

REGISTRATION

ACTRN12615001330538.