Validity and Reliability of a Smartphone and Digital Inclinometer in Measuring the Lower Extremity Joints Range of Motion

In clinical settings, available valid and reliable tools are important components in evaluating the lower extremity range of motion. Although the digital inclinometer is highly reliable compared to the universal goniometer, its availability and high cost impede its extensive use. Nowadays, smartphone applications have become widely available to clinicians for assessing the joint range of motion. The present study aims to assess the validity and intra-rater reliability of the smart- phone application “Clinometer” for measuring hip, knee, and ankle sagittal ranges of motion, using the digital inclinom- eter as the reference standard. Active hip, knee flexion and ankle dorsiflexion and plantarflexion range-of-motion mea- surements were recorded in 102 young, healthy female participants on two separate occasions using Clinometer and a digital inclinometer. Pearson’s correlation coefficients (r) were used to evaluate the smartphone application’s validity against the digital inclinometer. To assess the reliability of the Clinometer app, the intra-class correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable difference (MDD) were used. Clinometer displayed excellent validity when compared to the digital inclinometer for hip and knee movements (r>0.90), while ankle ROM displayed moderate validity (r = 0.52-0.57). Additionally, Clinometer demonstrated excellent reliability (ICC > 0.90) for hip and knee sagittal plane motion and moderate reliability for the ankle sagittal plane motion (ICC = 0.53–0.67). Cli- nometer is a portable, low-cost, valid, and reliable tool for assessing active hip and knee range of motions and can be easily incorporated into clinical settings; however, it cannot be used interchangeably for ankle measures.

Reliability of scapular upward rotation and anterior-posterior tilt measurements using a modified digital inclinometer in patients with subacromial impingement syndrome

BACKGROUD: Reliable scapular upward rotation and anterior-posterior tilt data are required for patients with subacromial impingement syndrome (SIS). Only a few studies have explored the reliability of such measurements derived using a modified inclinometer. OBJECTIVES: To determine the relative and absolute reliability of scapular upward rotation and anterior-posterior tilt measurements derived using a modified digital inclinometer in patients with SIS. METHOD: Seventeen SIS patients were assessed twice within 1 week. We determined the relative and absolute measurement reliability by calculating the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal clinically important difference (MCID). Both intra- and interrater reliability were determined. RESULTS: The intra-rater reliability (both measurements) was high (0.72–0.88), and the interrater ICC was high to excellent (0.72–0.98). Clinically acceptable SEM and MCID values were obtained for scapular upward rotation (SEM: 4.28–9.33∘, MCID: 5.1–11.3∘) and anterior-posterior tilt (SEM: 3.72–7.55∘, MCID: 2.5–10.8∘). CONCLUSIONS: Measurements of scapular upward rotation and anterior-posterior tilt using a modified digital inclinometer reliably reveal scapular position and kinematics in patients with SIS.

Intra- and inter-rater reliability of joint range of motion tests using tape measure, digital inclinometer and inertial motion capturing

Background In clinical practice range of motion (RoM) is usually assessed with low-cost devices such as a tape measure (TM) or a digital inclinometer (DI). However, the intra- and inter-rater reliability of typical RoM tests differ, which impairs the evaluation of therapy progress. More objective and reliable kinematic data can be obtained with the inertial motion capture system (IMC) by Xsens. The aim of this study was to obtain the intra- and inter-rater reliability of the TM, DI and IMC methods in five RoM tests: modified Thomas test (DI), shoulder test modified after Janda (DI), retroflexion of the trunk modified after Janda (DI), lateral inclination (TM) and fingertip-to-floor test (TM). Methods Two raters executed the RoM tests (TM or DI) in a randomized order on 22 healthy individuals while, simultaneously, the IMC data (Xsens MVN) was collected. After 15 warm-up repetitions, each rater recorded five measurements. Findings Intra-rater reliabilities were (almost) perfect for tests in all three devices (ICCs 0.886–0.996). Inter-rater reliability was substantial to (almost) perfect in the DI (ICCs 0.71–0.87) and the IMC methods (ICCs 0.61–0.993) and (almost) perfect in the TM methods (ICCs 0.923–0.961). The measurement error (ME) for the tests measured in degree (°) was 0.9–3.3° for the DI methods and 0.5–1.2° for the IMC approaches. In the tests measured in centimeters the ME was 0.5–1.3cm for the TM methods and 0.6–2.7cm for the IMC methods. Pearson correlations between the results of the DI or the TM respectively with the IMC results were significant in all tests except for the shoulder test on the right body side (r = 0.41–0.81). Interpretation Measurement repetitions of either one or multiple trained raters can be considered reliable in all three devices.

The acute effect in performing common range of motion tests in healthy young adults: a prospective study

In the application of range of motion (ROM) tests there is little agreement on the number of repetitions to be measured and the number of preceding warm-up protocols. In stretch training a plateau in ROM gains can be seen after four to five repetitions. With increasing number of repetitions, the gain in ROM is reduced. This study examines the question of whether such an effect occurs in common ROM tests. Twenty-two healthy sport students (10 m/12 f.) with an average age of 25.3 ± 1.94 years (average height 174.1 ± 9.8 cm; weight 66.6 ± 11.3 kg and BMI 21.9 ± 2.0 kg/cm2) volunteered in this study. Each subject performed five ROM tests in a randomized order—measured either via a tape measure or a digital inclinometer: Tape measure was used to evaluate the Fingertip-to-Floor test (FtF) and the Lateral Inclination test (LI). Retroflexion of the trunk modified after Janda (RF), Thomas test (TT) and a Shoulder test modified after Janda (ST) were evaluated with a digital inclinometer. In order to show general acute effects within 20 repetitions we performed ANOVA/Friedman-test with multiple comparisons. A non-linear regression was then performed to identify a plateau formation. Significance level was set at 5%. In seven out of eight ROM tests (five tests in total with three tests measured both left and right sides) significant flexibility gains were observed (FtF: p < 0.001; LI-left/right: p < 0.001/0.001; RF: p = 0.009; ST-left/right: p < 0.001/p = 0.003; TT-left: p < 0.001). A non-linear regression with random effects was successfully applied on FtF, RF, LI-left/right, ST-left and TT-left and thus, indicate a gradual decline in the amount of gained ROM. An acute effect was observed in most ROM tests, which is characterized by a gradual decline of ROM gain. For those tests, we can state that the acute effect described in the stretching literature also applies to the performance of typical ROM tests. Since a non-linear behavior was shown, it is the decision of the practitioner to weigh up between measurement accuracy and expenditure. Researchers and practitioners should consider this when applying ROM assessments to healthy young adults.

The Reliability and Concurrent Validity of Digital Inclinometer, Smartphone Applications, and the Cervical Range of Motion Device for Measuring the Cervical Range of Motion

Objectives: Changes in the Range of Motion (ROM) are essential criteria in determining the severity of spinal disorders and could be effective in predicting pain progression. Instruments to measure the ROM are costly and unavailable in most therapy settings. While there is a tendency in therapists to use their smartphones instead, there is no report to measure the suitability of smartphones to be employed for this purpose. The current study aimed to compare the inter- and intra-rater reliability and concurrent validity of a Cervical Range of Motion (CROM) device (as a gold standard), a digital inclinometer, and smartphones in measuring the CROM in asymptomatic adults. Methods: Twenty-four healthy subjects (11 women, 13 men) aged 22 to 45 years were recruited for this study. Neck movements were assessed per study subject using CROM device, dual digital inclinometer, as well as IOS (for iPhone), and Android applications. Despite the popularity of using smartphone applications, there was no study comparing such applications. Results: The dual inclinometer and iPhone clinometer and compass applications presented acceptable absolute and relative reliability (ICC=0.662-0.913) and (ICC=0.753-0.887), respectively for neck movements in all planes. The reliability of the Android clinometer application in the sagittal and frontal planes was also acceptable (ICC=0.76-0.937); however, the Android compass application used in the horizontal plane indicated the least intraclass correlation coefficient (ICC: 0.202-0.433) in this area. Discussion: All the tested tools differed from the gold standard depending on the direction of movement, confirmed i.e. approved by the Bland-Altman. The dual digital inclinometer presented moderate to high agreement to the CROM device for all motions, except for rotation. The iPhone applications had high to a very high agreement, and the Android application revealed poor to a moderate agreement. These discrepancies should be considered in employing smartphones for diagnosing a cervical disorder and determining a therapeutic plan. However, as phone applications indicated desirable reproducibility, these tools could be used for the follow-up and monitoring of changes in the CROM.

A device-based stretch training for office workers resulted in increased range of motion especially at limited baseline flexibility

BACKGROUND: It is unclear whether and under which conditions stretch training programs lead to gains in flexibility when applied in work health promotion for office workers in order to reduce musculoskeletal disorders (MSD). OBJECTIVE: The aim of this study was to analyze whether the stretch training “five-Business” leads to gains in range of motion (ROM). Furthermore, the influence of baseline flexibility and socio-demographic factors (sex, age, weight, height and body mass index (BMI)) on trainability was assessed. METHODS: 161 office workers (n = 45 female; n = 116 male) without major MSD were recruited. Over three months, a standardized static stretch training (“five-Business”) was executed on a device, supervised twice per week for 10 min. ROM was assessed using a digital inclinometer (shoulder, hip and trunk extension) and a tape measure (fingertip-to-floor and lateral inclination). RESULTS: ROM gains (p≤0.001) were present in all tests, except for the hip extension. ROM changes correlated moderately (0.24–0.62) with the baseline flexibility (p≤0.001). Subjects with limited flexibility reached the largest gains (1.41–25.33%). Regarding the socio-demographic factors only one low correlation occurred (weight - retroflexion; –0.177). CONCLUSION: The “five-Business” stretch training effectively increases ROM in office workers, especially when baseline flexibility is limited.

Lumbar Lordosis, Pain Intensity and Type of Work in Women Participating in Fitness Activities

Introduction. The aim of this study was to examine women participating in fitness activities regarding their level of disability in daily activities and lumbar lordosis.Material and methods. Data were collected from 68 females between the ages of 25-70 participating in fitness exercises. The Oswestry Disability Index was applied to measure the level of disability due to the low back pain in everyday life. The angle of lumbar lordosis was measured using a Saunders’ digital inclinometer.Results. The results of the study confirmed the existence of problems related to low back pain in people performing sedentary work. There were no correlations between lumbar lordosis angle and the level of disability in daily activities of the groups. The low back pain increases especially among people performing sedentary work.Conclusions. The results of this study suggest that work in a sitting position is not associated with a decrease in the angle of lordosis in relation to another work than in a sitting position. Sitting work can be an indirect cause of back pain and slight disability in everyday life by weakening postural muscles.