Peer Review #2 of "Reliability and validity of an iPhone® application for the measurement of lumbar spine flexion and extension range of motion (v0.3)"

BackgroundMeasurement of lumbar spine range of motion (ROM) is often considered to be an essential component of lumbar spine physiotherapy and orthopedic assessment. The measurement can be carried out through various instruments such as inclinometers, goniometers, and etc. Recent smartphones have been equipped with accelerometers and magnetometers, which, through specific software applications (apps) can be used for inclinometric functions.PurposeThe main purpose was to investigate the reliability and validity of an iPhone®app (TiltMeter©-advanced level and inclinometer) for measuring standing lumbar spine flexion–extension ROM in asymptomatic subjects.DesignA cross-sectional study was carried out.SettingThis study was conducted in a physiotherapy clinic located at School of Rehabilitation Sciences, Iran University of Medical Science and Health Services, Tehran, Iran.SubjectsA convenience sample of 30 asymptomatic adults (15 males; 15 females; age range = 18–55 years) was recruited between August 2015 and December 2015.MethodsFollowing a 2–minute warm-up, the subjects were asked to stand in a relaxed position and their skin was marked at the T12–L1and S1–S2spinal levels. From this position, they were asked to perform maximum lumbar flexion followed by maximum lumbar extension with their knees straight. Two blinded raters each used an inclinometer and the iPhone®app to measure lumbar spine flexion–extension ROM. A third rater read the measured angles. To calculate total lumbar spine flexion–extension ROM, the measurement from S1–S2was subtracted from T12–L1. The second (2 hours later) and third (48 hours later) sessions were carried out in the same manner as the first session. All of the measurements were conducted 3 times and the mean value of 3 repetitions for each measurement was used for analysis. Intraclass correlation coefficient (ICC) models (3, k) and (2, k) were used to determine the intra-rater and inter-rater reliability, respectively. The Pearson correlation coefficients were used to establish concurrent validity of the iPhone®app. Furthermore, minimum detectable change at the 95% confidence level (MDC95) was computed as 1.96 × standard error of measurement × $\sqrt{2}$.ResultsGood to excellent intra-rater and inter-rater reliability were demonstrated for both the gravity-based inclinometer with ICC values of ≥0.84 and ≥0.77 and the iPhone®app with ICC values of ≥0.85 and ≥0.85, respectively. The MDC95ranged from 5.82°to 8.18°for the intra-rater analysis and from 7.38°to 8.66° for the inter-rater analysis. The concurrent validity for flexion and extension between the 2 instruments was 0.85 and 0.91, respectively.ConclusionsThe iPhone®app possesses good to excellent intra-rater and inter-rater reliability and concurrent validity. It seems that the iPhone®app can be used for the measurement of lumbar spine flexion–extension ROM.Level of evidenceIIb.

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The reliability and concurrent validity of a new iPhone® application for measuring active lumbar spine flexion and extension range of motion in patients with low back pain

Physiotherapy Theory and Practice ◽

10.1080/09593985.2019.1616017 ◽

2019 ◽

pp. 1-14

Author(s):

Mohammadreza Pourahmadi ◽

Elnaz Momeni ◽

Negar Mohseni ◽

Hamid Hesarikia ◽

Ali Ghanjal ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Lumbar Spine ◽

Range Of Motion ◽

Concurrent Validity ◽

Low Back ◽

Flexion And Extension

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Impairment Tutorial: Recurrent Radioculpathy: Recurrent Radioculpathy and Apportionment

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2002.julaug03 ◽

2002 ◽

Vol 7 (4) ◽

pp. 8-10

Author(s):

Christopher R. Brigham ◽

Leon H. Ensalada

Keyword(s):

Lumbar Spine ◽

Range Of Motion ◽

Disk Herniation ◽

Fourth Edition ◽

Recurrent Injury ◽

Injury Model ◽

Whole Person ◽

Spinal Region

Abstract Recurrent radiculopathy is evaluated by a different approach in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, compared to that in the Fourth Edition. The AMA Guides, Fifth Edition, specifies several occasions on which the range-of-motion (ROM), not the Diagnosis-related estimates (DRE) method, is used to rate spinal impairments. For example, the AMA Guides, Fifth Edition, clarifies that ROM is used only for radiculopathy caused by a recurrent injury, including when there is new (recurrent) disk herniation or a recurrent injury in the same spinal region. In the AMA Guides, Fourth Edition, radiculopathy was rated using the Injury Model, which is termed the DRE method in the Fifth Edition. Also, in the Fourth Edition, for the lumbar spine all radiculopathies resulted in the same impairment (10% whole person permanent impairment), based on that edition's philosophy that radiculopathy is not quantifiable and, once present, is permanent. A rating of recurrent radiculopathy suggests the presence of a previous impairment rating and may require apportionment, which is the process of allocating causation among two or more factors that caused or significantly contributed to an injury and resulting impairment. A case example shows the divergent results following evaluation using the Injury Model (Fourth Edition) and the ROM Method (Fifth Edition) and concludes that revisions to the latter for rating permanent impairments of the spine often will lead to different results compared to using the Fourth Edition.

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A Scoring System for Anterior Longitudinal Ligament Ossification of the Lumbar Spine in Diffuse Idiopathic Skeletal Hyperostosis: Relationship Between the Extent of Ligament Ossification and the Range of Motion

Global Spine Journal ◽

10.1177/2192568221996681 ◽

2021 ◽

pp. 219256822199668

Author(s):

Yusuke Murakami ◽

Tadao Morino ◽

Masayuki Hino ◽

Hiroshi Misaki ◽

Hiroshi Imai ◽

...

Keyword(s):

Lumbar Spine ◽

Intervertebral Disc ◽

Range Of Motion ◽

Scoring System ◽

Diffuse Idiopathic Skeletal Hyperostosis ◽

Disc Height ◽

Rater Reliability ◽

Canal Stenosis ◽

Intervertebral Disc Height ◽

The Relationship

Study Design: Retrospective observational study. Objective: To investigate the relationship between the extent of ligament ossification and the range of motion (ROM) of the lumbar spine and develop a new scoring system. Methods: Forty-three patients (30 men and 13 women) with lumbar spinal canal stenosis who underwent decompression from January to December 2018. Ligament ossification at L1/2 to L5/S was assessed on plain X-ray (Xp) and computed tomography (CT) using a modified Mata scoring system (0 point: no ossification, 1 point: ossification of less than half of the intervertebral disc height, 2 points: ossification of half or more of the intervertebral disc height, 3 points: complete bridging), and the intra-rater and inter-rater reliability of the scoring was assessed. The relationship of the scores with postoperative lumbar ROM was investigated. Result: Intra-rater reliability was high (Cronbach’s α was 0.74 for L5/S on Xp but 0.8 or above for other sections), as was inter-rater reliability (Cronbach’s α was 0.8 or above for all the segments). ROM significantly decreased as the score increased (scores 1 to 2, and 2 to 3). A significant moderate negative correlation was found between the sum of the scores at L1/2-L5/S and the ROM at L1-S (ρ = − 0.4493, P = 0.025). Conclusion: Our scoring system reflects lumbar mobility and is reproducible. It is effective for assessing DISH in fractures and spinal conditions, and monitoring effects on treatment outcomes and changes over time.

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