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J Knee Surg 2017; 30(06): 577-584
DOI: 10.1055/s-0036-1593877
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Saurabh P. Mehta
1   School of Physical Therapy, Marshall University, Huntington, West Virginia
2   Department of Orthopedic Surgery, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia
,
Katherine Barker
1   School of Physical Therapy, Marshall University, Huntington, West Virginia
,
Brett Bowman
3   SOMC LIFE Center, Southern Ohio Medical Center, Portsmouth, Ohio
,
Heather Galloway
4   Department of Physical Therapy, Elk Valley Physical Therapy, Elkview, West Virginia
,
Nicole Oliashirazi
2   Department of Orthopedic Surgery, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia
,
Ali Oliashirazi
2   Department of Orthopedic Surgery, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia
› Author Affiliations
Further Information

Publication History

16 August 2016

18 September 2016

Publication Date:
28 November 2016 (online)

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Abstract

Much 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.

Keywords

goniometer - reliability - knee range of motion
 

  • References

  • 1 Tojima M, Ogata N, Yozu A, Sumitani M, Haga N. Novel 3-dimensional motion analysis method for measuring the lumbar spine range of motion: repeatability and reliability compared with an electrogoniometer. Spine 2013; 38 (21) E1327-E1333
    CrossrefPubMedSearch in Google Scholar
  • 2 Tsushima H, Morris ME, McGinley J. Test-retest reliability and inter-tester reliability of kinematic data from a three-dimensional gait analysis system. J Jpn Phys Ther Assoc 2003; 6 (01) 9-17
    CrossrefPubMedSearch in Google Scholar
  • 3 Horger MM. The reliability of goniometric measurements of active and passive wrist motions. Am J Occup Ther 1990; 44 (04) 342-348
    CrossrefPubMedSearch in Google Scholar
  • 4 Gogia PP, Braatz JH, Rose SJ, Norton BJ. Reliability and validity of goniometric measurements at the knee. Phys Ther 1987; 67 (02) 192-195
    CrossrefPubMedSearch in Google Scholar
  • 5 Brosseau L, Balmer S, Tousignant M. , et al. Intra- and intertester reliability and criterion validity of the parallelogram and universal goniometers for measuring maximum active knee flexion and extension of patients with knee restrictions. Arch Phys Med Rehabil 2001; 82 (03) 396-402
    CrossrefPubMedSearch in Google Scholar
  • 6 Jones A, Sealey R, Crowe M, Gordon S. Concurrent validity and reliability of the simple goniometer iPhone app compared with the universal goniometer. Physiother Theory Pract 2014; 30 (07) 512-516
    CrossrefPubMedSearch in Google Scholar
  • 7 Mitchell K, Gutierrez SB, Sutton S, Morton S, Morgenthaler A. Reliability and validity of goniometric iPhone applications for the assessment of active shoulder external rotation. Physiother Theory Pract 2014; 30 (07) 521-525
    CrossrefPubMedSearch in Google Scholar
  • 8 Milanese S, Gordon S, Buettner P. , et al. Reliability and concurrent validity of knee angle measurement: smart phone app versus universal goniometer used by experienced and novice clinicians. Man Ther 2014; 19 (06) 569-574
    CrossrefPubMedSearch in Google Scholar
  • 9 Ockendon M, Gilbert RE. Validation of a novel smartphone accelerometer-based knee goniometer. J Knee Surg 2012; 25 (04) 341-345
    Thieme ConnectPubMedSearch in Google Scholar
  • 10 Bennett D, Hanratty B, Thompson N, Beverland DE. The influence of pain on knee motion in patients with osteoarthritis undergoing total knee arthroplasty. Orthopedics 2009; 32 (04) pii
    PubMedSearch in Google Scholar
  • 11 Pereira LC, Rwakabayiza S, Lécureux E, Jolles BM. Reliability of the knee smartphone-application goniometer in the acute orthopedic setting. J Knee Surg 2016;
    CrossrefPubMedSearch in Google Scholar
  • 12 Jenny JY. Measurement of the knee flexion angle with a smartphone-application is precise and accurate. J Arthroplasty 2013; 28 (05) 784-787
    CrossrefPubMedSearch in Google Scholar
  • 13 Mayerson NH, Milano RA. Goniometric measurement reliability in physical medicine. Arch Phys Med Rehabil 1984; 65 (02) 92-94
    PubMedSearch in Google Scholar
  • 14 Clapper MP, Wolf SL. Comparison of the reliability of the Orthoranger and the standard goniometer for assessing active lower extremity range of motion. Phys Ther 1988; 68 (02) 214-218
    CrossrefPubMedSearch in Google Scholar
  • 15 Rothstein JM, Miller PJ, Roettger RF. Goniometric reliability in a clinical setting. Elbow and knee measurements. Phys Ther 1983; 63 (10) 1611-1615
    CrossrefPubMedSearch in Google Scholar
  • 16 Norkin CC, White DJ. The Knee. In: Norkin CC, White DJ. , eds. Measurement of Joint Motion: A Guide to Goniometry, 4th ed. Philadelphia, PA: F. A. Davis Company; 2009: 241-262
    Search in Google Scholar
  • 17 Arnold CM, Warkentin KD, Chilibeck PD, Magnus CR. The reliability and validity of handheld dynamometry for the measurement of lower-extremity muscle strength in older adults. J Strength Cond Res 2010; 24 (03) 815-824
    CrossrefPubMedSearch in Google Scholar
  • 18 Tiplady B, Jackson SH, Maskrey VM, Swift CG. Validity and sensitivity of visual analogue scales in young and older healthy subjects. Age Ageing 1998; 27 (01) 63-66
    PubMedSearch in Google Scholar
  • 19 Summers S. Evidence-based practice part 2: reliability and validity of selected acute pain instruments. J Perianesth Nurs 2001; 16 (01) 35-40
    CrossrefPubMedSearch in Google Scholar
  • 20 Von Korff M, Deyo RA, Cherkin D, Barlow W. Back pain in primary care. Outcomes at 1 year. Spine 1993; 18 (07) 855-862
    CrossrefPubMedSearch in Google Scholar
  • 21 Jensen MP, McFarland CA. Increasing the reliability and validity of pain intensity measurement in chronic pain patients. Pain 1993; 55 (02) 195-203
    CrossrefPubMedSearch in Google Scholar
  • 22 Jensen MP, Turner LR, Turner JA, Romano JM. The use of multiple-item scales for pain intensity measurement in chronic pain patients. Pain 1996; 67 (01) 35-40
    CrossrefPubMedSearch in Google Scholar
  • 23 Mehta SP, Fulton A, Quach C, Thistle M, Toledo C, Evans NA. Measurement properties of the lower extremity functional scale: a systematic review. J Orthop Sports Phys Ther 2016; 46 (03) 200-216
    CrossrefPubMedSearch in Google Scholar
  • 24 Jakobsen TL, Christensen M, Christensen SS, Olsen M, Bandholm T. Reliability of knee joint range of motion and circumference measurements after total knee arthroplasty: does tester experience matter?. Physiother Res Int 2010; 15 (03) 126-134
    CrossrefPubMedSearch in Google Scholar
  • 25 Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull 1979; 86 (02) 420-428
    CrossrefPubMedSearch in Google Scholar
  • 26 Bland JM, Altman DG. Agreement between methods of measurement with multiple observations per individual. J Biopharm Stat 2007; 17 (04) 571-582
    CrossrefPubMedSearch in Google Scholar
  • 27 Bland JM, Altman DG. Measuring agreement in method comparison studies. Stat Methods Med Res 1999; 8 (02) 135-160
    CrossrefPubMedSearch in Google Scholar
  • 28 Fitzpatrick R, Davey C, Buxton MJ, Jones DR. Evaluating patient-based outcome measures for use in clinical trials. Health Technol Assess 1998; 2 (14) : i–iv, 1-74
    PubMedSearch in Google Scholar
  • 29 Gajdosik RL, Bohannon RW. Clinical measurement of range of motion. Review of goniometry emphasizing reliability and validity. Phys Ther 1987; 67 (12) 1867-1872
    CrossrefPubMedSearch in Google Scholar
  • 30 Wellmon RH, Gulick DT, Paterson ML, Gulick CN. Validity and reliability of two goniometric mobile Apps: device, application and examiner factors. J Sport Rehabil 2015; 24: 1-25
    CrossrefPubMedSearch in Google Scholar
  • 31 Brosseau L, Tousignant M, Budd J. , et al. Intratester and intertester reliability and criterion validity of the parallelogram and universal goniometers for active knee flexion in healthy subjects. Physiother Res Int 1997; 2 (03) 150-166
    CrossrefPubMedSearch in Google Scholar
  • 32 Stratford PW, Kennedy DM, Robarts SF. Modelling knee range of motion post arthroplasty: clinical applications. Physiother Can 2010; 62 (04) 378-387
    CrossrefPubMedSearch in Google Scholar
  • 33 Santos CM, Ferreira G, Malacco PL, Sabino GS, Moraes GF, Felício DC. Intra and inter examiner reliability and measurement error of goniometer and digital inclinometer use. Revista Brasileira de Medicina do Esporte 2012; 18 (01) 38-41
    CrossrefPubMedSearch in Google Scholar