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 ... -  《EXCLI Journal》

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 of the Moover® 3D Inertial Motion Sensor in Greek Patients With Chronic Neck Pain in a Primary Care Urban Setting.

Introduction Neck pain has a high lifetime prevalence and represents a significant health issue. Reduced active cervical range of motion (ACROM) has been found in neck pain patients. Inertial sensor technology can provide objective measurements to assess the impaired ACROM. Purpose Primarily, this study investigated the inter- and intra-rater reliability of the Moover® three-dimensional (3D) inertial motion sensor (Sensor Medica, Rome, Italy) in Greek patients with non-specific chronic neck pain. Secondly, the intra-rater reliability of the Neck Disability Index (NDI) was also assessed. Methods Fifty patients (18 males and 32 females) suffering from non-specific chronic neck pain participated in this study. Two physiotherapists measured separately each participant's ACROM in three planes, within a 48-hour period. The participants' position and the sequence and direction of the three cervical movements (cervical rotation, lateral flexion, and flexion-extension) were standardized. Results The inter-rater reliability intraclass correlation coefficient (ICC) values were good to excellent ranging from 0.77 to 0.95 for the first measurement and 0.85 to 0.95 for the second (p < 0.001). The intra-rater reliability ICC values were moderate to excellent ranging from 0.74 to 0.92 for the first rater and good to excellent ranging from 0.83 to 0.94 for the secondrater (p < 0.001). Intra-rater reliability of the overall NDI was indicated as good, and ICC was 0.80 (95%CI: 0.65-0.89; p < 0.001). ICC values for all sections were significant and ranged from 0.40 to 0.88. Conclusion This study showed the reliability of the Moover 3D inertial sensor for ACROM measurement in Greek patients with chronic neck pain. The NDI scale also showed good intra-rater reliability in the same sample. Both intra- and inter-rater reliability of the Moover 3D were proven to be acceptable over a 48-hour period. The specific sensor might have a potential application in a clinical setting.

Skordis C ，Mavrogenis A ，Georgoudis G 《-》

Intra-rater and inter-rater reliability of cervical active range of movement in young asymptomatic adults using inertial sensors.

Anoro-Hervera A ，Lafuente-Pérez A ，Navarro-Fernández G ，Muñoz-García D ，Lerma-Lara S ，Beltran-Alacreu H ... -  《-》

A novel virtual reality application for autonomous assessment of cervical range of motion: development and reliability study.

Neck pain, one of the most common musculoskeletal diseases, affects 222 million people worldwide. The cervical range of motion (CROM) is a tool used to assess the neck's state across three movement axes: flexo-extension, rotation, and lateral flexion. People with neck pain often have a reduced CROM, and they feel pain at the end-range and/or accompany neck movements with compensatory trunk movements. Virtual reality (VR) setups can track the movement of the head and other body parts in order to create the sensation of immersion in the virtual environment. Using this tracking position information, a CROM assessment can be performed using a VR setup that may be carried out autonomously from the user's home. The objectives of this study were to develop a VR experience that could be used to perform a CROM assessment, and to evaluate the intra-rater and inter-rater reliability of the CROM measures guided by this VR experience. To the best of our knowledge, a study of this type has not been carried out before. A total of 30 asymptomatic adults were assessed using a VR device (HTC Vive Pro Eye™). Two raters provided support with the VR setup, and the participants were guided by the VR experience as they performed the movements. Each rater tested each subject twice, in random order. In addition to a head-mounted display (HMD), a tracker located on the subject's back was used to measure trunk compensatory movements. The CROM was estimated using only the HMD position and this measurement was corrected using the tracker data. The mean and standard deviation were calculated to characterize the CROM. To evaluate the reliability, the interclass correlation coefficients (ICC) were calculated for intra-rater and inter-rater analysis. The standard error of measurement and minimum detectable change were also calculated. The usability of the VR system was measured using the Spanish version of the System Usability Scale. The mean CROM values in each axis of movement were compatible with those described in the literature. ICC values ranged between 0.86 and 0.96 in the intra-rater analysis and between 0.83 and 0.97 in the inter-rater analysis; these values were between good and excellent. When applying the correction of the trunk movements, both the intra-rater and inter-rater ICC values slightly worsened except in the case of the lateral flexion movement, where they slightly improved. The usability score of the CROM assessment/VR system was 86 points, which is an excellent usability score. The reliability of the measurements and the usability of the system indicate that a VR setup can be used to assess CROM. The reliability of the VR setup can be affected by slippage of the HMD or tracker. Both slippage errors are additive, i.e., only when the sum of these two errors is less than the compensatory movement do the measurements improve when considering the tracker data.

Santos-Paz JA ，Sánchez-Picot Á ，Rojo A ，Martín-Pintado-Zugasti A ，Otero A ，Garcia-Carmona R ... -  《-》