Validity and reliability of smartphone applications for measurement of hip rotation, compared with three-dimensional motion analysis

Performance of key physical tests for temporomandibular disorder via telehealth: Establishing validity and reliability

BACKGROUND

During the COVID-19 pandemic, many individuals sought healthcare virtually. Physiotherapy is integral in managing temporomandibular disorders (TMDs); therefore, establishing how key physical tests can be appropriately adapted to telehealth is paramount.

OBJECTIVES

To establish the validity and reliability of telehealth (specifically videoconferencing) assessments against in-person assessments on a battery of TMD physical tests.

METHOD

A repeated-measures study design was undertaken. Thirty-six adult participants (19 healthy and 17 TMD) underwent concurrent temporomandibular joint (TMJ) physiological movement measurements via videoconferencing and in-person as per standard clinical practice. Inclusion criteria included the presence of central incisors and no significant comorbidities precluding a safe telehealth examination. Participants with TMD completed seven additional pain provocation physical tests.

RESULTS

Agreement between telehealth and in-person physiological movement measures was excellent (ICC >0.90, 95% CI: 0.53 to >0.99). Inter- and intra-rater reliability for telehealth measures indicated excellent reliability (ICC >0.97, 95% CI: 0.91 to >0.99). Exact agreement between telehealth and in-person for provocation tests ranged between 58.8% and 94.1%. Fourteen of the twenty-six individual measures produced substantial to near perfect agreement (PABAK = 0.65-0.88), seven produced moderate agreement (PABAK = 0.53), while five produced poor to fair agreement (PABAK = 0.18-0.29).

CONCLUSION

There is high level of agreement between telehealth and in-person measurements of TMJ physiological movement and pain provocation tests.

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 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.

The Intra- and Inter-Rater Reliability of a Hip Rotation Range-of-Motion Measurement Using a Smartphone Application in Academy Football (Soccer) Players

The clinical assessment of hip rotation range-of-motion (ROM) is important for managing hip and groin injuries in footballers. Previously published reliability studies on hip ROM have employed protocols that are difficult to replicate under everyday clinical conditions. This single trial, intra- and inter-rater reliability study included 41 male academy football (soccer) players, aged 14–15 years, from one European football academy. Passive hip internal rotation (IR) and external rotation (ER) ROM were measured in supine with hip and knee flexed to 90°. The ROM was determined using a smartphone application, with the smartphone attached to the lower leg. The tests were performed on two separate occasions, one week apart, by two different physiotherapists and on both sides (left and right hips). Reliability was evaluated using Intra-Class Correlation Coefficients (ICCs) and Minimal Detectable Change (MDC). Hip IR and ER ROM displayed moderate to good intra-rater agreement (ICCs 0.54–0.75), with MDCs ranging from 10.9° to 16.4°. Inter-rater reliability displayed poor to moderate reliability (ICCs 0.33–0.75), with MDCs ranging from 11.7° to 16.5°. A hip rotation ROM test using a smartphone application and a protocol closely reflecting everyday clinical conditions displayed moderate to good intra-rater reliability and poor to moderate inter-rater reliability. Due to the high MDCs, the practical applicability of this test procedure is limited and further refinement is necessary.

The Telemedicine-Based Pediatric Examination of the Back and Lower Limbs: A Narrative Review

The COVID-19 pandemic has accelerated the transition to virtual healthcare while also prompting an abundance of new literature highlighting telemedicine's capabilities and limitations for various medical applications, notably musculoskeletal examinations. Telemedicine provides an opportunity to deliver timely patient- and family-centred care while maintaining physical distancing and improving access to remote communities. This review aims to narrate the current state of the literature on telemedicine applied in the context of a musculoskeletal examination for children aged 3 to 18 years. The PubMed and ScienceDirect databases were searched for relevant articles from January 2015 to August 2021 using a combination of keywords and nested searches. The general examination components relevant to the back and lumbosacral spine, hip, knee, ankle/foot, and gait are described. These components include inspection, palpation, range of motion, motor, and sensory examination as well as special testing. There is general feasibility, validity, and substantial reliability in performing most examination components, and primary diagnoses established virtually were found to be either the same or similar in the vast majority of cases. Despite the current literature focusing mainly on adult populations, we describe how each aspect of the exam can be reliably incorporated into a virtual appointment specific to the pediatric population. Currently available smartphone-based applications that measure joint range of motion were generally found to have high reliability and validity. Caregivers are needed for most of the consultation, especially in younger children, but select physical exam maneuvers can be self-performed by older children and adolescents alone. By providing an overview of the available smartphone tools as well as the reliability and validity of remote assessments, this review not only establishes a foundation for a structured pediatric musculoskeletal examination, but also aims to increase providers' confidence in incorporating telemedicine into their practice.