Validity and reliability of a wearable-controlled serious game and goniometer for telemonitoring of wrist fracture rehabilitation

Abstract Purpose To determine the validity of wrist range of motion (ROM) measurements by the wearable-controlled ReValidate! wrist-rehabilitation game, which simultaneously acts as a digital goniometer. Furthermore, to establish the reliability of the game by contrasting ROM measurements to those found by medical experts using a universal goniometer. Methods As the universal goniometer is considered the reference standard, inter-rater reliability between surgeons was first determined. Internal validity of the game ROM measurements was determined in a test–retest setting with healthy volunteers. The reliability of the game was tested in 34 patients with a restricted range of motion, in whom the ROM was measured by experts as well as digitally. Intraclass-correlation coefficients (ICCs) were determined and outcomes were analyzed using Bland–Altman plots. Results Inter-rater reliability between experts using a universal goniometer was poor, with ICCs of 0.002, 0.160 and 0.520. Internal validity testing of the game found ICCs of − 0.693, 0.376 and 0.863, thus ranging from poor to good. Reliability testing of the game compared to medical expert measurements, found that mean differences were small for the flexion–extension arc and the radial deviation-ulnar deviation arc. Conclusion The ReValidate! game is a reliable home-monitoring device digitally measuring ROM in the wrist. Interestingly, the test–retest reliability of the serious game was found to be considerably higher than the inter-rater reliability of the reference standard, being healthcare professionals using a universal goniometer. Trial registration number (internal hospital registration only) MEC-AMC W17_003 #17.015.

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Validity and reliability of inertial sensors for elbow and wrist range of motion assessment

PeerJ ◽

10.7717/peerj.9687 ◽

2020 ◽

Vol 8 ◽

pp. e9687

Author(s):

Vanina Costa ◽

Óscar Ramírez ◽

Abraham Otero ◽

Daniel Muñoz-García ◽

Sandra Uribarri ◽

...

Keyword(s):

Range Of Motion ◽

Inertial Sensors ◽

High Reliability ◽

Intraclass Correlation ◽

Active Movement ◽

Neutral Position ◽

Maximum Difference ◽

Validity And Reliability ◽

Rater Reliability ◽

Flexion Extension

Background Elbow and wrist chronic conditions are very common among musculoskeletal problems. These painful conditions affect muscle function, which ultimately leads to a decrease in the joint’s Range Of Motion (ROM). Due to their portability and ease of use, goniometers are still the most widespread tool for measuring ROM. Inertial sensors are emerging as a digital, low-cost and accurate alternative. However, whereas inertial sensors are commonly used in research studies, due to the lack of information about their validity and reliability, they are not widely used in the clinical practice. The goal of this study is to assess the validity and intra-inter-rater reliability of inertial sensors for measuring active ROM of the elbow and wrist. Materials and Methods Measures were taken simultaneously with inertial sensors (Werium™ system) and a universal goniometer. The process involved two physiotherapists (“rater A” and “rater B”) and an engineer responsible for the technical issues. Twenty-nine asymptomatic subjects were assessed individually in two sessions separated by 48 h. The procedure was repeated by rater A followed by rater B with random order. Three repetitions of each active movement (elbow flexion, pronation, and supination; and wrist flexion, extension, radial deviation and ulnar deviation) were executed starting from the neutral position until the ROM end-feel; that is, until ROM reached its maximum due to be stopped by the anatomy. The coefficient of determination (r2) and the Intraclass Correlation Coefficient (ICC) were calculated to assess the intra-rater and inter-rater reliability. The Standard Error of the Measurement and the Minimum Detectable Change and a Bland–Altman plots were also calculated. Results Similar ROM values when measured with both instruments were obtained for the elbow (maximum difference of 3° for all the movements) and wrist (maximum difference of 1° for all the movements). These values were within the normal range when compared to literature studies. The concurrent validity analysis for all the movements yielded ICC values ≥0.78 for the elbow and ≥0.95 for the wrist. Concerning reliability, the ICC values denoted a high reliability of inertial sensors for all the different movements. In the case of the elbow, intra-rater and inter-rater reliability ICC values range from 0.83 to 0.96 and from 0.94 to 0.97, respectively. Intra-rater analysis of the wrist yielded ICC values between 0.81 and 0.93, while the ICC values for the inter-rater analysis range from 0.93 to 0.99. Conclusions Inertial sensors are a valid and reliable tool for measuring elbow and wrist active ROM. Particularly noteworthy is their high inter-rater reliability, often questioned in measurement tools. The lowest reliability is observed in elbow prono-supination, probably due to skin artifacts. Based on these results and their advantages, inertial sensors can be considered a valid assessment tool for wrist and elbow ROM.

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Feasibility of an iPhone-based application for knee joint goniometry during gait in a stroke patient (Preprint)

10.2196/preprints.12472 ◽

2018 ◽

Author(s):

Claudia Nava ◽

Patrizio Sale ◽

Vittorio Leggero ◽

Simona Ferrante ◽

Cira Fundaro' ◽

...

Keyword(s):

Range Of Motion ◽

Stroke Patient ◽

Reference Method ◽

Flexion Angle ◽

Good Reliability ◽

Rater Reliability ◽

Maximum Extension ◽

Angle Measurements ◽

Hemiparetic Gait ◽

Flexion Extension

BACKGROUND In recent years, different smartphone apps have been validated for joint goniometry, but none for goniometric assessment of gait after stroke. OBJECTIVE The aims of our work were to assess:1) to assess intra-rater reliability of an image-based goniometric app – DrGoniometer- in the measurement of the extension, flexion angles and range of motion of the knee during the hemiparetic gait of a stroke patient; (2) its validity comparing to the reference method (electrogoniometer) for flexion-extension excursion measurements; and the intra-rater agreement in the choice of the video frames. METHODS An left-hemiparetic inpatient following haemorrhagic stroke was filmed using the app while walking on a linear path. An electrogoniometer was fixed on the medial face of the affected knee in order to record the dynamic goniometry during gait. Twenty-one raters, blinded to measurements, were recruited to rate knee angle measurements from video acquired with DrGoniometer. Each rater repeated the same procedure twice, the second one at least one day after the first measure. RESULTS Results showed that flexion angle measurements are reliable (ICC95%=0.66, 0.34;0.85; SEM=4°), and adequately precise (CV=14%). Extension angles measurements demonstrated moderate reliability and higher degree of variation (ICC=0.51, 0.09;0.77; SEM 4°; CV=53%). ROM values were: ICC=0.23 (-0.21;0.60); CV=20%. Accuracy of DrGoniometer compared to the electrogoniometer was 7.3±4.7°. The selection of maximum extension frame revealed an accordance of 58% and 72% within a range of ±5 or ±10 frames, respectively; while the best flexion frame reported 86% of agreement for both range of 5 and 10 frames. CONCLUSIONS The results demonstrated moderate to good reliability concerning the maximum extension and flexion angles, while assessing ROM DrGoniometer showed poor intra-rater reliability. Flexion angle measurements seemed to be reliable according to ICC and SEM values and more precise with a limited dispersion of results DrGoniometer revealed a good accuracy in the measurement of range of motion. The agreement of the maximal extension frame was anyway adequate within 5 frames (59%) and noticeably increased within 10 frames (72%). In conclusion, DrGoniometer was found to be a valid and reliable method for assessing knee angles during hemiparetic gait. Further studies are necessary to investigate inter-rater reliability and confirm our results.

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A Thorax Marker Set Model to Analyse the Kinematics of Walking Without the Need to Place Markers on the Back

Journal of Biomechanical Engineering ◽

10.1115/1.4049160 ◽

2020 ◽

Author(s):

Eva Orantes-Gonzalez ◽

Jose Heredia-Jimenez ◽

Ambreen Chohan ◽

Jim D Richards

Keyword(s):

Angular Velocity ◽

Gait Analysis ◽

Research Question ◽

Intraclass Correlation ◽

Load Carriage ◽

Camera Motion ◽

Validity And Reliability ◽

Good Reliability ◽

Flexion Extension ◽

Angular Velocities

Abstract Background: Previous thorax models have been proposed for gait analysis, however these require markers to be placed on the back. This presents a limitation in the kinematic analysis of the thorax under load carriage conditions. Research question: This study evaluated the validity and reliability of a thorax marker set that does not require markers to be placed on the back (HubemaLab model) when compared to 3 previously published marker set models. Methods: 17 young adults were evaluated while walking at their self-selected speed. A 12 camera motion capture system was used to acquire the marker position data which was then processed using the respective models using Visual-3D. The level of agreement for the flexion/extension peak, right/left lateral peak and right/left rotation peak of the thorax angle and angular velocity; together with the range of motion and thorax angular velocities in the three planes was found between each thorax marker set, while the reliability was measured using the intraclass correlation coefficient. Results: The ICC results for the thorax angle ROM and the range of thorax angular velocity between the HubemaLab model and the other models showed excellent to good reliability in all three planes. While the ICCs for the peak flexion/extension, peak right/left lateral flexion and peak right/left rotation showed excellent to moderate reliability in all three planes. Conclusion: The new model could be potentially valuable for kinematic gait analysis under load carriage conditions which obscure markers placed on the back.

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Validity and reliability of the Self-Care Activities Screening Scale (SASS-14) during COVID-19 lockdown

Health and Quality of Life Outcomes ◽

10.1186/s12955-020-01607-6 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Martín Martínez ◽

Elkin O. Luis ◽

Edwin Yair Oliveros ◽

Pablo Fernández-Berrocal ◽

Ainize Sarrionandia ◽

...

Keyword(s):

General Population ◽

Perceived Stress ◽

Convergent Validity ◽

Self Care ◽

Internal Validity ◽

Well Being ◽

Validity And Reliability ◽

Good Reliability ◽

Confirmatory Factor Analyses ◽

Health Consciousness

Abstract Background In a context where there is no treatment for the current COVID-19 virus, the combination of self-care behaviours together with confinement, are strategies to decrease the risk of contagion and remain healthy. However, there are no self-care measures to screen self-care activities in general population and which, could be briefly in a lockdown situation. This research aims to build and validate a psychometric tool to screen self-care activities in general population. Methods Firstly, an exploratory factor analysis was performed in a sample of 226 participants to discover the underlying factorial structure and to reduce the number of items in the original tool into a significant pool of items related to self-care. Later a confirmatory factor analyses were performed in a new sample of 261 participants to test for the fit and goodness of factor solutions. Internal validity, reliability, and convergent validity between its score with perceived stress and psychological well-being measures were examined on this sample. Results The exploratory analyses suggested a four-factor solution, corresponding to health consciousness, nutrition and physical activity, sleep, and intra-personal and inter-personal coping skills (14 items). Then, the four-factor structure was confirmed as the best model fit for self-care activities. The tool demonstrated good reliability, predictive validity of individuals’ perception of coping with COVID-19 lockdown, and convergent validity with well-being and perceived stress. Conclusions This screening tool could be helpful to address future evaluations and interventions to promote healthy behaviours. Likewise, this tool can be targeted to specific population self-care’s needs during a scalable situation.

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Comparing Reliability Between 3D Imaging And 2D Photography For External Nasal Anthropometry

10.21203/rs.3.rs-669579/v1 ◽

2021 ◽

Author(s):

Yoon-Soo Seo ◽

Ki-Hun Jo ◽

Jun-Sang CHA ◽

Joo-Yeon Kim ◽

Jae-Hwan Kwon

Keyword(s):

3D Imaging ◽

Intraclass Correlation ◽

Digital Camera ◽

Angular Parameter ◽

Good Reliability ◽

Rater Reliability ◽

3D Images ◽

Imaging Result ◽

External Nose ◽

2D And 3D

Abstract Background: This study investigates and compare the reliability and reproducibility of two facial anthropometric methods about external nasal angles, 3D imaging and conventional 2D photography. Methods: 2D photograph images and 3D images about external nose of 30 volunteers were taken using digital camera and Morpheus 3D scanner. To evaluate intra-rater reliability, each images were taken over two different days for each subject by the same researcher. To evaluate inter-rater reliability, another researcher took each images for each subject on the first day. The reliability of each method for measuring 4 external nasal angle is obtained using intraclass correlation coefficient (ICC) and compared.Results: Inter-rater and intra-rater reliability of both 3D imaging and 2D photography had excellent agreement in all 4 nasal angles. In the nasofacial angular parameter, Inter-rater ICC, 2D photography was significantly higher than 3D imaging. Result of intra-rater ICC also showed both 3D imaging and 2D photography had good reliability in all 4 nasal angles. Similar to those of inter-rater ICC, nasofacial angular parameter showed statistically significant differences between 3D imaging and 2D photography.Conclusion: In terms of reliability, both 2D and 3D showed appropriate anthropometric results and considering its own advantage, each methods can be used complementarily.

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Smartphone Application with Virtual Reality Goggles for the Reliable and Valid Measurement of Active Craniocervical Range of Motion

Diagnostics ◽

10.3390/diagnostics9030071 ◽

2019 ◽

Vol 9 (3) ◽

pp. 71 ◽

Cited By ~ 4

Author(s):

Ke-Vin Chang ◽

Wei-Ting Wu ◽

Mei-Chu Chen ◽

Yi-Chi Chiu ◽

Der-Sheng Han ◽

...

Keyword(s):

Virtual Reality ◽

Range Of Motion ◽

Correlation Coefficient ◽

Pearson Correlation ◽

Random Effect Model ◽

Altman Plot ◽

Rater Reliability ◽

Hybrid Device ◽

Flexion Extension ◽

The Right

Objective: This study aimed to determine the intra-rater and inter-rater reliability and validity of a hybrid device, combining virtual reality goggles, a magnetometer and an inclinometer application for smartphones, to measure craniocervical range. Summary of Background Data: Accurate evaluation of craniocervical range of motion is important for early detection of certain diseased conditions and monitoring the progress of interventions. The universal goniometer is widely used for the measurement but it requires experienced practitioners. Whether a combination of virtual reality goggles and smartphone applications can provide the same or better performance compared with the goniometer is still unknown. Methods: Forty-one healthy adults from the department of physical medicine and rehabilitation were recruited for craniocervical range examination (flexion, extension, side-bending to the right or left and rotating to the right or left) by using the hybrid device and universal goniometer. Using the hybrid device, repeated measurements were performed twice by a primary rater and once by a second rater. The primary rater also conducted a measurement using the universal goniometer in the same cohort. The intra-rater and inter-rater reliability (intra-class correlation coefficient (ICC)) were calculated using the two-way random effect model, whereas the validity was examined by the Pearson correlation coefficient and Bland-and-Altman plot. The interval between the first and second sessions of the measurement for intra-rater reliability was set at 30 min. Results: Excellent intra-rater (ICC ≥ 0.925) and inter-rater (ICC ≥ 0.880) reliability was noted for the hybrid device. The minimal detectable changes from intra-observer and inter-observer comparisons ranged between 4.12° and 7.42° in all six directions. The Bland-and-Altman plot revealed small mean differences (≤1.68°) between the hybrid device and universal goniometer. Both instruments had highly correlated measurements of craniocervical motion (r values ≥ 0.918). Conclusion: For healthy participants, excellent intra-rater and inter-rater reliability was noted for the hybrid device, and the measurements were consistent with the universal goniometer measurements. Future studies are needed to examine whether the device can perform similarly for patients with neck disorders.

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Validity and reliability of assessing diaphragmatic mobility by area on X-rays of healthy subjects

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37562016000000131 ◽

2018 ◽

Vol 44 (3) ◽

pp. 220-226 ◽

Cited By ~ 1

Author(s):

Aline Pedrini ◽

Márcia Aparecida Gonçalves ◽

Bruna Estima Leal ◽

Michelle Gonçalves de Souza Tavares ◽

Wellington Pereira Yamaguti ◽

...

Keyword(s):

Correlation Coefficient ◽

Intraclass Correlation ◽

X Rays ◽

Altman Analysis ◽

Validity And Reliability ◽

Anthropometric Parameters ◽

Rater Reliability ◽

Bland Altman Analysis ◽

Left Hemidiaphragm ◽

The Right

ABSTRACT Objective: To investigate the concurrent validity, as well as the intra- and inter-rater reliability, of assessing diaphragmatic mobility by area (DMarea) on chest X-rays of healthy adults. Methods: We evaluated anthropometric parameters, pulmonary function, and diaphragmatic mobility in 43 participants. Two observers (rater A and rater B) determined diaphragmatic mobility at two time points. We used Pearson’s correlation coefficient to evaluate the correlation between DMarea and the assessment of diaphragmatic mobility by distance (DMdist). To evaluate intra- and inter-rater reliability, we used the intraclass correlation coefficient (ICC [2,1]), 95% CI, and Bland-Altman analysis. Results: A significant correlation was found between the DMarea and DMdist methods (r = 0.743; p < 0.0001). For DMarea, the intra-rater reliability was found to be quite high for the right hemidiaphragm (RHD)-ICC (2,1) = 0.92 (95% CI: 0.86-0.95) for rater A and ICC (2,1) = 0.90 (95% CI: 0.84-0.94) for rater B-and the left hemidiaphragm (LHD)-ICC (2,1) = 0.96 (95% CI: 0.93-0.97) for rater A and ICC (2,1) = 0.91 (95% CI: 0.81-0.95) for rater B-(p < 0.0001 for all). Also for DMarea, the inter-rater reliability was found to be quite high for the first and second evaluations of the RHD-ICC (2,1) = 0.99 (95% CI: 0.98-0.99) and ICC (2,1) = 0.95 (95% CI: 0.86-0.97), respectively-and the LHD-ICC (2,1) = 0.99 (95% CI: 0.98-0.99) and ICC (2,1) = 0.94 (95% CI: 0.87-0.97)-(p < 0.0001 for both). The Bland-Altman analysis showed good agreement between the mobility of the RHD and that of the LHD. Conclusions: The DMarea method proved to be a valid, reliable measure of diaphragmatic mobility.

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Reliability and concurrent validity of an alternative method of lateral lumbar range of motion in athletes

South African Journal of Sports Medicine ◽

10.17159/2078-516x/2016/v28i1a1414 ◽

2016 ◽

Vol 28 (1) ◽

pp. 23-26 ◽

Cited By ~ 1

Author(s):

M Hecimovich

Keyword(s):

Lumbar Spine ◽

Range Of Motion ◽

Concurrent Validity ◽

Pearson Correlation ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Index Test ◽

Low Back ◽

Detectable Change ◽

Rater Reliability

Background: Cricket bowling involves combined spinalmovements of side bending and rotation and, consequently, injuryto the low back is a common problem. Therefore the assessmentof lumbar spine kinematics has become a routine component inpreseason screening. This includes static measurement of lateralspinal flexion as asymmetrical range of motion may predispose anathlete to low back injury.Objectives: This study examined intra-rater reliability andconcurrent validity of the fingertip-to-floor distance test (FFD)when compared to a criterion range of motion measure.Methods: Thirty-four junior-level cricket players aged 13‑16years were recruited. Lumbar spine lateral flexion was measuredsimultaneously with the fingertip-to-floor distance test and digitalinclinometry methods. Relative and absolute intra-rater reliabilitywere investigated with intraclass correlation coefficients (ICC3,1)of agreement, standard error of measurement (SEM) estimates,Bland and Altman bias estimates and 95% limits of agreement,respectively. The concurrent validity of the fingertip-to-floordistance test, compared to digital inclinometry measures, wasexamined with Pearson correlation coefficients.Results: Intra-rater reliability demonstrated substantial agreementfor both measures (ICC3,1 > 0.84). The fingertip-to-floor distancetest SEM values ranged from 1.71‑2.01 cm with an estimatedminimum detectable change (MDC) threshold of 4.73‑5.55 cm.The inclinometry SEM values ranged from 1.00‑1.09° withminimal detectable change estimates of 2.77‑3.01°. There werestrong correlations between the index test and criterion measureoutcomes (r > 0.84, p < 0.001).Conclusions: This study’s results support the intra-rater reliabilityand concurrent validity of the finger-to-floor distance test,suggesting it to be a suitable surrogate measure for lumbar lateralflexion testing

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Smartphone App (2kmFIT-App) for Measuring Cardiorespiratory Fitness: Validity and Reliability Study (Preprint)

10.2196/preprints.14864 ◽

2019 ◽

Author(s):

Adria Muntaner-Mas ◽

Antonio Martinez-Nicolas ◽

Alberto Quesada ◽

Cristina Cadenas-Sanchez ◽

Francisco B Ortega

Keyword(s):

Operating System ◽

Cardiorespiratory Fitness ◽

Intraclass Correlation ◽

Field Testing ◽

Smartphone App ◽

Validity And Reliability ◽

Good Reliability ◽

Geographically Distributed ◽

Mean Differences ◽

Time Required

BACKGROUND There is strong evidence suggesting that higher levels of cardiorespiratory fitness (CRF) are associated with a healthier metabolic profile, and that CRF can serve as a powerful predictor of morbidity and mortality. In this context, a smartphone app based on the 2-km walk test (UKK test) would provide the possibility to assess CRF remotely in individuals geographically distributed around a country or continent, and even between continents, with minimal equipment and low costs. OBJECTIVE The overall aim of this study was to evaluate the validity and reliability of 2kmFIT-App developed for Android and iOS mobile operating systems to estimate maximum oxygen consumption (VO2max) as an indicator of CRF. The specific aims of the study were to determine the validity of 2kmFIT-App to track distance and calculate heart rate (HR). METHODS Twenty participants were included for field-testing validation and reliability analysis. The participants completed the UKK test twice using 2kmFIT-App. Distance and HR were measured with the app as well as with accurate methods, and VO2max was estimated using the UKK test equation. RESULTS The validity results showed the following mean differences (app minus criterion): distance (–70.40, SD 51.47 meters), time (–0.59, SD 0.45 minutes), HR (–16.75, SD 9.96 beats/minute), and VO2max (3.59, SD 2.01 ml/kg/min). There was moderate validity found for HR (intraclass correlation coefficient [ICC] 0.731, 95% CI –0.211 to 0.942) and good validity found for VO2max (ICC 0.878, 95% CI –0.125 to 0.972). The reliability results showed the following mean differences (retest minus test): app distance (25.99, SD 43.21 meters), app time (–0.15, SD 0.94 seconds), pace (–0.18, SD 0.33 min/km), app HR (–4.5, 13.44 beats/minute), and app VO2max (0.92, SD 3.04 ml/kg/min). There was good reliability for app HR (ICC 0.897, 95% CI 0.742-0.959) and excellent validity for app VO2max (ICC 0.932, 95% CI 0.830-0.973). All of these findings were observed when using the app with an Android operating system, whereas validity was poor when the app was used with iOS. CONCLUSIONS This study shows that 2kmFIT-App is a new, scientifically valid and reliable tool able to objectively and remotely estimate CRF, HR, and distance with an Android but not iOS mobile operating system. However, certain limitations such as the time required by 2kmFIT-App to calculate HR or the temperature environment should be considered when using the app.

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Validity and reliability of smartphone inclinometer applications for measurement of elbow range of motion in paediatric patients

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.14.200123 ◽

2020 ◽

Vol 14 (5) ◽

pp. 488-494

Author(s):

Denis P. Koong ◽

Jillian Lee ◽

Tegan L. Cheng ◽

David G. Little

Keyword(s):

Range Of Motion ◽

Gold Standard ◽

Assessment Tool ◽

Interobserver Reliability ◽

Intraclass Correlation ◽

Smartphone Application ◽

Absolute Difference ◽

Visual Estimation ◽

Paediatric Patients ◽

Flexion Extension

Purpose Precise measurement of elbow range of motion (ROM) post-injury or surgery forms an important part of determining prognosis and the need for further intervention. Clinicians are increasingly incorporating smartphone use in our medical practice; we sought to determine if a smartphone goniometer application is a valid and reliable tool for assessment of elbow ROM in the paediatric patient, compared to visual and goniometer assessment. Methods In total, 20 paediatric patients (40 elbows) between six and 15 years of age with an elbow or forearm injury were included in this prospective series. Elbow flexion, extension, pronation and supination were measured independently by two orthopaedic clinicians. Measurements were taken from injured as well as unaffected side using a standardized technique, first with visual estimation and then using a universal goniometer (UG) and smartphone goniometer application Angle Meter via Google Play store (Smart Tool Factory, Istanbul, Turkey). Results There was excellent interobserver reliability for all three modalities, with average intraclass correlation coefficient (ICC) values greater than 0.90. Visual estimation had the lowest average ICC of 0.92, compared to 0.97 for UG and smartphone. Overall, there was excellent intraobserver reliability between the smartphone application and the gold standard UG for all elbow movements with ICCs ranging between 0.98 to 0.99 and mean absolute difference ranging from 1.1 ± 1.0° to 2.6 ± 1.9°. The smartphone application showed superior agreement over visual estimation when compared to the gold standard UG with lower mean differences and 95% limits of agreement (LOA) falling within 10°. Conclusions Our study demonstrates that a smartphone application is a valid and reliable assessment tool for measurement of elbow ROM in paediatric patients, and better than visualization alone. Level of evidence III

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