Validity and reliability of inertial sensors for elbow and wrist range of motion assessment.

Elbow and wrist chronic conditions are very common among musculoskeletal problems. These painful conditions affect muscle function, which ultimately leads to a decrease in the joint's Range Of Motion (ROM). Due to their portability and ease of use, goniometers are still the most widespread tool for measuring ROM. Inertial sensors are emerging as a digital, low-cost and accurate alternative. However, whereas inertial sensors are commonly used in research studies, due to the lack of information about their validity and reliability, they are not widely used in the clinical practice. The goal of this study is to assess the validity and intra-inter-rater reliability of inertial sensors for measuring active ROM of the elbow and wrist. Measures were taken simultaneously with inertial sensors (Werium™ system) and a universal goniometer. The process involved two physiotherapists ("rater A" and "rater B") and an engineer responsible for the technical issues. Twenty-nine asymptomatic subjects were assessed individually in two sessions separated by 48 h. The procedure was repeated by rater A followed by rater B with random order. Three repetitions of each active movement (elbow flexion, pronation, and supination; and wrist flexion, extension, radial deviation and ulnar deviation) were executed starting from the neutral position until the ROM end-feel; that is, until ROM reached its maximum due to be stopped by the anatomy. The coefficient of determination (r 2) and the Intraclass Correlation Coefficient (ICC) were calculated to assess the intra-rater and inter-rater reliability. The Standard Error of the Measurement and the Minimum Detectable Change and a Bland-Altman plots were also calculated. Similar ROM values when measured with both instruments were obtained for the elbow (maximum difference of 3° for all the movements) and wrist (maximum difference of 1° for all the movements). These values were within the normal range when compared to literature studies. The concurrent validity analysis for all the movements yielded ICC values ≥0.78 for the elbow and ≥0.95 for the wrist. Concerning reliability, the ICC values denoted a high reliability of inertial sensors for all the different movements. In the case of the elbow, intra-rater and inter-rater reliability ICC values range from 0.83 to 0.96 and from 0.94 to 0.97, respectively. Intra-rater analysis of the wrist yielded ICC values between 0.81 and 0.93, while the ICC values for the inter-rater analysis range from 0.93 to 0.99. Inertial sensors are a valid and reliable tool for measuring elbow and wrist active ROM. Particularly noteworthy is their high inter-rater reliability, often questioned in measurement tools. The lowest reliability is observed in elbow prono-supination, probably due to skin artifacts. Based on these results and their advantages, inertial sensors can be considered a valid assessment tool for wrist and elbow ROM.

Costa V ，Ramírez Ó ，Otero A ，Muñoz-García D ，Uribarri S ，Raya R ... -  《PeerJ》

Reliability and concurrent validity of a new iPhone(®) goniometric application for measuring active wrist range of motion: a cross-sectional study in asymptomatic subjects.

Measurement of wrist range of motion (ROM) is often considered to be an essential component of wrist physical examination. The measurement can be carried out through various instruments such as goniometers and inclinometers. Recent smartphones have been equipped with accelerometers and magnetometers, which, through specific software applications (apps) can be used for goniometric functions. This study, for the first time, aimed to evaluate the reliability and concurrent validity of a new smartphone goniometric app (Goniometer Pro©) for measuring active wrist ROM. In all, 120 wrists of 70 asymptomatic adults (38 men and 32 women; aged 18-40 years) were assessed in a physiotherapy clinic located at the School of Rehabilitation Sciences, Iran University of Medical Science and Health Services, Tehran, Iran. Following the recruitment process, active wrist ROM was measured using a universal goniometer and iPhone® 5 app. Two blinded examiners each utilized the universal goniometer and iPhone® to measure active wrist ROM using a volar/dorsal alignment technique in the following sequences: flexion, extension, radial deviation, and ulnar deviation. The second (2 h later) and third (48 h later) sessions were carried out in the same manner as the first session. All the measurements were conducted three times and the mean value of three 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. Good to excellent intra-rater and inter-rater reliability was demonstrated for the goniometer with ICC values of ≥ 0.82 and ≥ 0.73 and the iPhone® app with ICC values of ≥ 0.83 and ≥ 0.79, respectively. Minimum detectable change at the 95% confidence level (MDC95 ) was computed as 1.96 × standard error of measurement × √2. The MDC95 ranged from 1.66° to 5.35° for the intra-rater analysis and from 1.97° to 6.15° for the inter-rater analysis. The concurrent validity between the two instruments was high, with r values of ≥ 0.80. From the results of this cross-sectional study, it can be concluded that the iPhone® app possesses good to excellent intra-rater and inter-rater reliability and concurrent validity. It seems that this app can be used for the measurement of wrist ROM. However, further research is needed to evaluate symptomatic subjects using this app.

Pourahmadi MR ，Ebrahimi Takamjani I ，Sarrafzadeh J ，Bahramian M ，Mohseni-Bandpei MA ，Rajabzadeh F ，Taghipour M ... -  《-》

Inter, intra-examiner reliability and validity of inertial sensors to measure the active cervical range of motion in patients with primary headache.

We analyzed the inter- and intra-examiner reliability of Werium inertial sensors and the cervical range of motion (CROM) instrument for the measurement of active CROM (AcROM) in patients with primary headache. Another objective is to analyze the validity of the inertial sensors (Werium). The literature has reported symptomatology features in patients diagnosed with primary headache similar to that of patients with cervicogenic headache. The International Classification of Headache (ICHD-III) established the presence of reduced AcROM as a diagnostic criterion for cervicogenic headache. Several instruments are used for this measurement, with limitations in their applicability in daily clinical practice. A prospective longitudinal repeated measures study was conducted to assess the intra- and inter-rater reliability and validity of Werium inertial sensors in 20 adults with chronic primary headache. For the inter-rater analysis, the intraclass correlation coefficient (ICC) values were above 0.75 for all movements, indicating a good level of reliability. For the intra-rater results, the ICC values obtained by the Werium inertial sensors for all cervical movements were good for rater A (ICC >0.80) and rater B (ICC >0.84). For the validity, the ICCs obtained by the Werium inertial sensors compared with the CROM instrument for all cervical movements were moderate for both raters (ICC > 0.70, respectively). Values obtained in the standard error of measurement, minimum detectable change at 90% and limits of agreement also indicated good agreement. Werium inertial sensors have shown good to excellent reliability results, both intra- and inter-examiner (ICC > 0.75). Likewise, when the sensors were compared with another validated instrument (CROM device) they obtained high reliability results (ICC > 0.70). These results plus its relatively low price and ease of use allow us to recommend it in daily clinical practice to measure AcROM in patients with chronic primary headache.

Elizagaray-García I ，Gil-Martínez A ，Navarro-Fernández G ，Navarro-Moreno AR ，Sánchez-de-Toro-Hernández J ，Díaz-de-Terán J ，Lerma-Lara S ... -  《-》

Validity and reliability of the GYKO inertial sensor system for the assessment of the elbow range of motion.

Santospagnuolo A ，Bruno AA ，Pagnoni A ，Martello F ，Santoboni F ，Perroni F ，Vulpiani MC ，Vetrano M ... -  《-》

Reliability and validity of an iPhone(®) application for the measurement of lumbar spine flexion and extension range of motion.

Pourahmadi MR ，Taghipour M ，Jannati E ，Mohseni-Bandpei MA ，Ebrahimi Takamjani I ，Rajabzadeh F ... -  《PeerJ》