Psychometric Properties of the iHandy Level Smartphone Application for Measuring Lumbar Spine Range of Motion and Lordosis: A Systematic Review of the Literature

Abstract

Context: Advent of smartphones has brought a wide range of clinical measurement applications (apps) within the reach of most clinicians. The vast majority of smartphones have numerous built-in sensors such as magnetometers, accelerometers, and gyroscopes that make the phone capable of measuring joint range of motion (ROM) and detecting joint positions. The iHandy Level app is a free app which has a visual display alike with the digital inclinometer in regard to numeric size. Objective: The purpose of this systematic review was to evaluate available evidence in the literature to assess the psychometric properties (ie, reliability and validity) of the iHandy Level app in measuring lumbar spine ROM and lordosis. Methods: PubMed/MEDLINE, Scopus, Ovid, Google Scholar, and ScienceDirect were searched from inception to September 2018 for single-group repeated-measures studies reporting outcomes of lumbar spine ROM or lordosis in adult individuals without symptoms of low back pain (LBP) or patients with LBP. The quality of each included study was assessed using the Quality Appraisal of Reliability Studies checklist. Results: A total of 4 studies with 273 participants were included. Two studies focused on measuring active lumbar spine ROM, and 2 studies evaluated lumbar spine lordosis. Three studies included asymptomatic subjects, and one study recruited patients with LBP. The results showed that the iHandy Level app has sufficient psychometric properties for measuring standing thoraco-lumbo-sacral flexion, extension, lateral flexion, isolated lumbar spine flexion ROM, and lumbar spine lordosis in asymptomatic subjects. One study reported poor concurrent validity with a bubble inclinometer (r = .19–.53), poor intrarater reliability (intraclass correlation coefficient = .19–.39), and poor to good interrater reliability (intraclass correlation coefficient = .24–.72) for the measurement of active lumbar spine ROM using the iHandy Level app in patients with LBP. Conclusions: This review provided a valuable summary of the research to date examining the psychometric properties of the iHandy Level app for measuring lumbar spine ROM and lordosis.

Smartphone applications are used for self-management, telerehabilitation, evaluation and data collection in low back pain healthcare: a scoping review

“…A total of 14 studies used smartphone apps as an evaluation tool including pain evaluation, [23][24][25][26] ROM measurement, 16,[27][28][29][30] 6-min walk test 31 and clinical or functional evaluation. 17,[32][33][34] Considering pain evaluation, PainMAP showed excellent intra-and inter-rater reliability and good validity for quantifying the number of pain sites…”

“…11 This idea has been developed in other healthcare intents such as diabetes, 13 chronic obstructive pulmonary disease, 14 and osteoarthritis. 15 However, smartphones equipped with multiple sensors, cameras, gyroscopes, accelerometers, and magnetometers could also be used as tools for range-of-motion (ROM) measurement 16 or could be simply used with the phone camera for clinical evaluation at a distance. 17 Another feature is that smartphone apps could be used for surveying large population samples, allowing to create a database for more sophisticated analyses including case-based reasoning systems.…”

“…28 Similar findings were further summarized in systematic review showing contradictory results of psychometric properties of the lumbar spine ROM and lordosis measurements with a smartphone app. 30 Other examples of smartphone use included clinical and functional evaluation. Peterson et al, suggested that a modified treatment-based classification system for subgrouping patients with LBP could direct treatment in telerehabilitation settings (smartphone app) because the overall rate of percentage agreement with face-to-face assessments was between 48.9% and 59.6%.…”

Developing a protocol for an online exercise programme for cerebral palsy clients using 'Physitrack'

“…Online applications can be useful throughout many different populations with the way that technology is growing globally (39). With most of the world having easy access to a source of technology it creates an easier avenue into receiving the information promptly and with great detail (39), which makes it easier for caregivers to deliver programs to their disabled clients; especially children with CP who have difficulties with neuromuscular activity (1). Virtual reality is much more popular with special populations than online applications as they are more engaging for the client (45).…”

“…The number of individuals using smartphones in 2020 is approximately 6.1 billion, 70% of the world's population (39). Numerous applications (apps) are central to our lives, and using smartphone technology for medicine and physical therapy is becoming more prevalent and widespread (39) especially following the COVID-19 global pandemic (40). Users have indicated apps in general are "useful" and "viable" with research suggesting apps cover a variety of health topics (41).…”