Reliability, Concurrent Validity, and Minimal Detectable Change for iPhone Goniometer App in Assessing Knee Range of Motion

AbstractMuch of the published works assessing the reliability of smartphone goniometer apps (SG) have poor generalizability since the reliability was assessed in healthy subjects. No research has established the values for standard error of measurement (SEM) or minimal detectable change (MDC) which have greater clinical utility to contextualize the range of motion (ROM) assessed using the SG. This research examined the test–retest reproducibility, concurrent validity, SEM, and MDC values for the iPhone goniometer app (i-Goni; June Software Inc., v.1.1, San Francisco, CA) in assessing knee ROM in patients with knee osteoarthritis or those after total knee replacement. A total of 60 participants underwent data collection which included the assessment of active knee ROM using the i-Goni and the universal goniometer (UG; EZ Read Jamar Goniometer, Patterson Medical, Warrenville, IL), knee muscle strength, and assessment of pain and lower extremity disability using quadruple numeric pain rating scale (Q-NPRS) and lower extremity functional scale (LEFS), respectively. Intraclass correlation coefficients (ICCs) were calculated to assess the reproducibility of the knee ROM assessed using the i-Goni and UG. Bland and Altman technique examined the agreement between these knee ROM. The SEM and MDC values were calculated for i-Goni assessed knee ROM to characterize the error in a single score and the index of true change, respectively. Pearson correlation coefficient examined concurrent relationships between the i-Goni and other measures. The ICC values for the knee flexion/extension ROM were superior for i-Goni (0.97/0.94) compared with the UG (0.95/0.87). The SEM values were smaller for i-Goni assessed knee flexion/extension (2.72/1.18 degrees) compared with UG assessed knee flexion/extension (3.41/1.62 degrees). Similarly, the MDC values were smaller for both these ROM for the i-Goni (6.3 and 2.72 degrees) suggesting smaller change required to infer true change in knee ROM. The i-Goni assessed knee ROM showed expected concurrent relationships with UG, knee muscle strength, Q-NPRS, and the LEFS. In conclusion, the i-Goni demonstrated superior reproducibility with smaller measurement error compared with UG in assessing knee ROM in the recruited cohort. Future research can expand the inquiry for assessing the reliability of the i-Goni to other joints.

Download Full-text

HAMSTRING MORPHOLOGY AND STRENGTH REMAIN ALTERED 2 YEARS FOLLOWING A HAMSTRING GRAFT IN ACL RECONSTRUCTION

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117s00181 ◽

2017 ◽

Vol 5 (5_suppl5) ◽

pp. 2325967117S0018 ◽

Cited By ~ 1

Author(s):

Christopher J. Vertullo ◽

Jason M. Konrath ◽

Benjamin Kennedy ◽

Hamish Bush ◽

Rodney S. Barrett ◽

...

Keyword(s):

Muscle Strength ◽

Acl Reconstruction ◽

Knee Flexion ◽

Biceps Femoris ◽

Muscle Size ◽

Tibial Rotation ◽

Hamstring Graft ◽

Knee Muscle ◽

Donor Muscle ◽

Knee Muscle Strength

Background: The hamstring graft used in anterior cruciate ligament (ACL) reconstruction has been shown to lead to changes to the semitendinosus and gracilis musculature. This study further evaluated the effect of the surgery on hamstring muscle morphology and knee muscle strength at 2 years post-surgery. Hypotheses: (1) Loss of donor muscle size would significantly correlate with knee muscle strength deficits (2) Loss of donor muscle size would be greater for muscles that do not experience tendon regeneration, and (3) Morphological adaptations would also be evident in non-donor knee muscles. Study Design: Cross sectional evaluation. Methods: 20 participants (14 male, 6 female, 29 ± 7 years, 82 ± 15 kg) that had undergone a hamstring graft in ACL reconstruction at least two years previously, underwent bilateral MRI and subsequent strength testing. Muscle and tendon volumes, peak CSA’s and lengths were determined for 12 muscles and 6 functional muscle groups of the surgical and contralateral limbs. Peak isokinetic concentric strength was measured in knee flexion/extension and internal/external tibial rotation. Results: Only 50% of the patients regenerated both the semitendinosus and gracilis tendons. The regenerated tendons were longer with larger volume and CSA compared to the contralateral side. Deficits in semitendinosus and gracilis muscle size were greater for tendons that did not regenerate. In addition, combined hamstrings (semitendinosus, semimembranosus, biceps femoris) and combined medial knee muscles (semitendinosus, semimembranosus, gracilis, vastus medialis, medial gastrocnemius, sartorius) on the surgical side were reduced in volume by 12% and 10% respectively. A 7% larger volume was observed in the surgical leg for the biceps femoris and corresponded with a lower internal/external tibial rotation strength ratio. The difference in volume, peak CSA and length of the semitendinosus and gracilis correlated significantly with the deficit in knee flexion strength with Pearson correlations of 0.51, 0.57 and 0.61 respectively. Conclusion: The muscle-tendon properties of the semitendinosus and gracilis are substantially altered following harvesting, and these alterations may contribute to knee flexor weakness in the surgical limb. These deficits are more pronounced in tendons that do not regenerate and are only partially offset by compensatory hypertrophy of other hamstring muscles. Clinical Relevance: Surgeons should consider muscle retraction of the hamstring following tendon harvest in their choice of graft option for ACL reconstruction.

Download Full-text

Association of Knee Muscle Strength with Lower Extremity Dysfunction in Patients with Osteoarthritis: a Comparison with Rheumatoid Arthritis Patients and Healthy Controls

Turkish Journal of Rheumatology ◽

10.5606/tjr.2013.2744 ◽

2013 ◽

Vol 28 (2) ◽

pp. 78-86

Author(s):

Yasemin Ulus

Keyword(s):

Rheumatoid Arthritis ◽

Muscle Strength ◽

Lower Extremity ◽

Healthy Controls ◽

Knee Muscle ◽

Lower Extremity Dysfunction ◽

Knee Muscle Strength

Download Full-text

Intra- and Inter-Rater Reliability of a Well-Used and a Less-Used IsoMed 2000 Dynamometer for Knee Flexion and Extension Peak Torque Measurements in a Concentric Test in Athletes

Applied Sciences ◽

10.3390/app11114951 ◽

2021 ◽

Vol 11 (11) ◽

pp. 4951

Author(s):

Tuğba Kocahan ◽

Bihter Akınoğlu ◽

Ayfer Ezgi Yilmaz ◽

Thomas Rosemann ◽

Beat Knechtle

Keyword(s):

Muscle Strength ◽

Knee Flexion ◽

Peak Torque ◽

Weight Lifting ◽

Strength Parameters ◽

Limits Of Agreement ◽

Rater Reliability ◽

Knee Muscle ◽

Knee Muscle Strength ◽

Flexion And Extension

This study aimed to evaluate the intra- and inter-rater reliability of a well-used and a less-used IsoMed-2000 dynamometer for knee flexion and extension peak torque (PT) measurements in a concentric test in athletes. Two IsoMed-2000 isokinetic dynamometers were used, an old one that was well-used and a new one that was less-used. Thirty-seven weight-lifting athletes (12 female, 25 male) were included in this study. Both legs of each athlete were tested twice on each isokinetic dynamometer at 60°/s and 180°/s. The Intraclass Correlation Coefficients (ICC), Standard Error Measurement (SEM), Smallest Detectable Change (SDC), SDC% and 95% limits of agreement were calculated to evaluate the intra- and inter-rater reliability of a well-used and a less-used IsoMed 2000 dynamometer for knee flexion and extension peak torque in athletes. Intra-rater reliability was moderate to excellent (ICCs: 0.516–0.928) for knee muscle strength parameters, and the highest SDC and SEM values were 0.76 N/kg and 0.28 N/kg, respectively. Inter-rater reliability was moderate to excellent (ICCs: 0.519–915) for knee muscle strength parameters, and the highest SDC and SEM values were 0.81 N/kg and 0.29 N/kg, respectively. At least 89.2% of the obtained values of parameters fell within the 95% limits of agreement. Our findings demonstrate the intra and inter-rater reliability of a Well-Used and a Less-Used IsoMed 2000 Dynamometer for Knee Flexion and Extension Peak Torque in Athletes.

Download Full-text

Is the relationship between increased knee muscle strength and improved physical function following exercise dependent on baseline physical function status?

Arthritis Research & Therapy ◽

10.1186/s13075-017-1477-8 ◽

2017 ◽

Vol 19 (1) ◽

Cited By ~ 9

Author(s):

Michelle Hall ◽

Rana S. Hinman ◽

Martin van der Esch ◽

Marike van der Leeden ◽

Jessica Kasza ◽

...

Keyword(s):

Muscle Strength ◽

Physical Function ◽

Knee Muscle ◽

The Relationship ◽

Knee Muscle Strength

Download Full-text

Isokinetic Strength After ACL Reconstruction: Influence of Concomitant Anterolateral Ligament Reconstruction

Sports Health A Multidisciplinary Approach ◽

10.1177/19417381211005405 ◽

2021 ◽

pp. 194173812110054

Author(s):

Benoit Gillet ◽

Yoann Blache ◽

Isabelle Rogowski ◽

Grégory Vigne ◽

Bertrand Sonnery-Cottet ◽

...

Keyword(s):

Muscle Strength ◽

Ligament Reconstruction ◽

Knee Extensor ◽

Anterolateral Ligament ◽

Flexor Muscle ◽

Knee Flexor ◽

Strength Recovery ◽

Flexor Muscles ◽

Knee Muscle ◽

Knee Muscle Strength

Background: To reduce the rate of anterior cruciate ligament (ACL) graft rupture, recent surgeries have involved anterolateral ligament reconstruction (ALLR). This reconstruction procedure harvests more knee flexor muscle tendons than isolated ACL reconstruction (ACLR), but its influence on knee muscle strength recovery remains unknown. This study aimed to assess the influence of ALLR with a gracilis graft on the strength of the knee extensor and flexor muscles at 6 months postoperatively. Hypothesis: The additional amount of knee flexor harvest for ALLR would result in impairment in knee flexor muscle strength at 6 months postoperatively. Study Design: Retrospective cohort study. Level of Evidence: Level 2. Methods: A total of 186 patients were assigned to 2 groups according to the type of surgery: ACL + ALLR (graft: semitendinosus + gracilis, n = 119) or isolated ACLR (graft: semitendinosus, n = 67). The strength of the knee extensor and flexor muscles was assessed using an isokinetic dynamometer at 90, 180, and 240 deg/s for concentric and 30 deg/s for eccentric contractions and compared between groups using analysis of variance statistical parametric mapping. Results: Regardless of the surgery and the muscle, the injured leg produced significantly less strength than the uninjured leg throughout knee flexion and extension from 30° to 90° for each angular velocity (30, 90, 180, and 240 deg/s). However, the knee muscle strength was similar between the ACL + ALLR and ACLR groups. Conclusion: The addition of ALLR using the gracilis tendon during ACLR does not alter the muscle recovery observed at 6 months postoperatively. Clinical Relevance: Although more knee flexor muscle tendons were harvested in ACL + ALLR, the postoperative strength recovery was similar to that of isolated ACLR.

Download Full-text