Validation of an innovative method of shoulder range-of-motion measurement using a smartphone clinometer application.

An accurate and reliable measurement of shoulder range of motion (ROM) is important in the evaluation of the shoulder. A smartphone digital clinometer application is a potentially simpler method for measuring shoulder ROM. The goal of this study was to establish the reliability and validity of shoulder ROM measurements among varying health care providers using a smartphone clinometer application in healthy and symptomatic adults. An attending surgeon, fellow, resident, physician assistant, and student served as examiners. Bilateral shoulders of 24 healthy subjects were included. Fifteen postoperative patients served as the symptomatic cohort. Examiners measured ROM of each shoulder, first using visual estimation and then using a goniometer and smartphone clinometer in a randomized fashion. The interobserver reliability among examiners showed significant correlation, with average intraclass correlation coefficient [ICC(2,1)] values of 0.61 (estimation), 0.69 (goniometer), and 0.80 (smartphone). All 5 examiners had substantial agreement with the gold standard in healthy subjects, with average ICC(2,1) values ranging from 0.62 to 0.79. The interobserver reliability in symptomatic patients showed significant correlation, with average ICC(2,1) values of 0.72 (estimation), 0.79 (goniometer), and 0.89 (smartphone). Examiners had excellent agreement with the gold standard in symptomatic patients, with an average ICC(2,1) value of 0.98. The smartphone clinometer has excellent agreement with a goniometer-based gold standard for measurement of shoulder ROM in both healthy and symptomatic subjects. There is good correlation among different skill levels of providers for measurements obtained using the smartphone. A smartphone-based clinometer is a good resource for shoulder ROM measurement in both healthy subjects and symptomatic patients.

Werner BC ，Holzgrefe RE ，Griffin JW ，Lyons ML ，Cosgrove CT ，Hart JM ，Brockmeier SF ... -  《-》

Validation of an on-screen application-based measurement of shoulder range of motion over telehealth medium.

Shoulder range-of-motion (ROM) assessment is vital for the follow-up evaluation of operated patients and for the outcome-based research studies. The aim of this study was to investigate the accuracy and reliability of a remote on-screen application (app)-based method of shoulder ROM measurement through a telehealth medium. A consultant shoulder surgeon, a board-certified orthopedic resident, and a graduate medical doctor served as the examiners. The cohort consisted of 24 healthy volunteers and 16 symptomatic patients with expected shoulder ROM deficits. Shoulder ROM was first examined physically using a goniometer in the clinic and then over Zoom remote conferencing using the protractor extension app of the Chrome browser. Instrument validity was examined by comparing the goniometer method with the protractor app-based method of the expert shoulder consultant using Bland-Altman analysis. It showed only minor mean differences between the healthy volunteers and the patients in elevation (2.0° and 5.0°, respectively), abduction (2.0° and 3.0°, respectively), external rotation with the elbow adducted (1.9° and 0.2°, respectively), external rotation with the elbow abducted at 90° (0.4° and 4°, respectively), and internal rotation with elbow abducted at 90° (2.3° and 1.2°, respectively), with limits of agreement that were below the well-established minimal clinically important difference values. The intraclass correlation coefficient (ICC) values varied between 0.83 and 0.96 for the volunteers and between 0.90 and 0.98 for the patients, indicating excellent correlation between the 2 methods. The interobserver reliability between 2 examiners for the protractor app-based method as evaluated by ICC scores was excellent; it ranged between 0.86 and 0.98 for the volunteers and between 0.88 and 0.99 for the patients. Comparison of the protractor app-based method with the gold-standard goniometer method for the resident and the graduate doctor showed excellent ICC values. A protractor app-based method of measuring shoulder ROM over a telehealth medium is accurate and reliable compared with a clinical goniometer method. This validated method can be used during remote telehealth consultation with significant benefits of saving patients travel and time during the COVID-19 (coronavirus disease 2019) pandemic and even later.

Sahu D ，Shah D ，Joshi M ，Shaikh S ，Gaikwad P ，Shyam A ... -  《-》

Within-day reliability of shoulder range of motion measurement with a smartphone.

Measuring range of motion (ROM) is the first step of a physical examination and functional evaluation of the shoulder joint. Digital inclinometers are available on the market; however, they are expensive, and hence will not come into wide use. In this study, we present a new method for the shoulder ROM measurement using the inclinometer application on a smartphone. We hypothesized that the method would demonstrate acceptable reliability and reproducibility. Three observers performed goniometric and smartphone inclinometric measurements of various shoulder movements, including both active and passive ROM for forward flexion, abduction, external rotation while the arms are at the sides, external rotation at 90° abduction, and internal rotation at 90° abduction. Measurements were performed in the affected shoulders of 41 patients. All measurements were taken twice to assess the intra-observer reliability. Inter- and intra-observer reliabilities were evaluated using the intraclass correlation coefficient (ICC). Reliability between two measurements was also assessed in terms of the ICC. Both the goniometric and inclinometric measurements showed satisfactory inter-observer reliability except for internal rotation at 90° abduction for which the ICC value was <0.7 (range, 0.63-0.68). Intra-observer reliability was excellent with an ICC value>0.9, except for some movements. Within-day inclinometric measurements with a smartphone showed acceptable reliability compared to the classical goniometric measurements of movements and the correlation between the two measurements was fairly high. Considering convenience and cost-effectiveness, this new method could be widely used for measuring the shoulder ROM, although the between-day reliability needs to be established first.

Shin SH ，Ro du H ，Lee OS ，Oh JH ，Kim SH ... -  《-》

Reliability of the Knee Smartphone-Application Goniometer in the Acute Orthopedic Setting.

The standard goniometer (SG) is the most commonly used tool to assess range of motion (ROM) in patients with knee restrictions. Several medical applications have been designed to measure joint ROM. Little data are available on their reliability in the postoperative clinical setting. The purpose of this study was to assess whether a smartphone accelerometer-based knee goniometer application (App) is as reliable as the SG to measure knee ROM in clinical settings. A total of 60 subjects were included in this cross-sectional reliability trial. Overall, 20 healthy subjects (HS) and 20 acute postoperative patients (PO) underwent three active and three passive measurements in knee flexion and extension, using the SG and the smartphone knee goniometer App. To determine the fatigability of postoperative patients, a third group of 20 patients underwent a single active measurement in knee flexion and extension (PO1). Measurements were performed by three clinicians. For intraobserver reliability, mean intraclass correlation coefficient (ICC) values were higher for the App in all circumstances (overall mean SG 0.85, App 0.91), indicating an excellent correlation. For interobserver reliability, the highest ICC scores were in the PO1 group, with the App more consistent than the SG in all movements. Interobserver reliability was lower in the PO group versus PO1. Interobserver reliability was better for active ROM than for passive measurements. The overall concordance coefficient was very good to excellent with active measurements (range, 0.60-0.97). In conclusion, the App is a reliable tool for use in acute orthopedic care and offers better intra- and interobserver correlation scores for a single active measurement.

Pereira LC ，Rwakabayiza S ，Lécureux E ，Jolles BM ... -  《-》

Validity and reliability of a smartphone application for self-measurement of active shoulder range of motion in a standing position among healthy adults.

Shoulder range of motion (ROM) is one of the most important indicators of shoulder disease severity, function, and physical assessment. A universal goniometer (UG) was used as a gold standard for ROM measurement. Recently, smartphone applications for ROM measurement have attracted attention as alternatives to UG. This study aimed to investigate the validity and reliability of active ROM measurements using a smartphone application goniometer that can be used by patients in a standing position. The dominant shoulders of 19 healthy participants were included in the study. The 2 observers who were physical therapists used the UG, whereas the participants used a smartphone application goniometer to measure the shoulder ROM. A recorder, who is a physical therapist independent of the observer and participant, read and recorded the shoulder ROM measurements. The order of the measurement movements and devices used was randomized. Agreement between the smartphone application goniometer and UG (percentage of participants for whom the difference between the UG and application measurements was within ±20% of the mean of the goniometer and application measurements) ranged between 42% and 100%. The intraclass correlation coefficient values (3, 1) for the agreement between the smartphone application goniometer and UG was between 0.72 and 0.97, showing significant and approximately perfect correlations. High agreement with the UG showed excellent validity, indicating that the smartphone application goniometer used by the participants in the standing position is an excellent method and instrument. The results suggest a simpler, more reliable, practical, and inexpensive method for measuring ROM required for telerehabilitation.

Shimizu H ，Saito T ，Kouno C ，Shimoura K ，Kawabe R ，Shinohara Y ，Mukaiyama K ，Changyu C ，Kato M ，Nagai-Tanima M ，Aoyama T ... -  《-》