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

Abstract

BackgroundMeasurement of lumbar spine range of motion (ROM) is often considered to be an essential component of lumbar spine physiotherapy and orthopedic assessment. The measurement can be carried out through various instruments such as inclinometers, goniometers, and etc. Recent smartphones have been equipped with accelerometers and magnetometers, which, through specific software applications (apps) can be used for inclinometric functions.PurposeThe main purpose was to investigate the reliability and validity of an iPhone® app (TiltMeter© -advanced level and inclinometer) for measuring standing lumbar spine flexion–extension ROM in asymptomatic subjects.DesignA cross-sectional study was carried out.SettingThis study was conducted in a physiotherapy clinic located at School of Rehabilitation Sciences, Iran University of Medical Science and Health Services, Tehran, Iran.SubjectsA convenience sample of 30 asymptomatic adults (15 males; 15 females; age range = 18–55 years) was recruited between August 2015 and December 2015.MethodsFollowing a 2–minute warm-up, the subjects were asked to stand in a relaxed position and their skin was marked at the T12–L1 and S1–S2 spinal levels. From this position, they were asked to perform maximum lumbar flexion followed by maximum lumbar extension with their knees straight. Two blinded raters each used an inclinometer and the iPhone ® app to measure lumbar spine flexion–extension ROM. A third rater read the measured angles. To calculate total lumbar spine flexion–extension ROM, the measurement from S1–S2 was subtracted from T12–L1. The second (2 hours later) and third (48 hours later) sessions were carried out in the same manner as the first session. All of the measurements were conducted 3 times and the mean value of 3 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. Furthermore, minimum detectable change at the 95% confidence level (MDC95) was computed as 1.96 × standard error of measurement × .ResultsGood to excellent intra-rater and inter-rater reliability were demonstrated for both the gravity-based inclinometer with ICC values of ≥0.84 and ≥0.77 and the iPhone® app with ICC values of ≥0.85 and ≥0.85, respectively. The MDC95 ranged from 5.82°to 8.18°for the intra-rater analysis and from 7.38°to 8.66° for the inter-rater analysis. The concurrent validity for flexion and extension between the 2 instruments was 0.85 and 0.91, respectively.ConclusionsThe iPhone®app possesses good to excellent intra-rater and inter-rater reliability and concurrent validity. It seems that the iPhone® app can be used for the measurement of lumbar spine flexion–extension ROM.Level of evidenceIIb.

Reliability and Validity of I Handy Android Application on Measurement of Lumbar Spine Movement in Patients with Low Back Pain

“…There are few published studies measuring the reliability and validity of I Handy apps and they were done it with normal individual [7,8]. This is the first study attempted with patients and the result of this study shows that few movements TTLPE, ILF has good intra-rater reliability and TTLPE, LT TLF has good inter-reliability.…”

“…Moreover, this app is also available for free for Apple store. As the number of smartphone users Research Ayyappan Jayavel has been increasing since the last decade, utilizing a valid and reliable app instead of traditional instruments can provide an easy, simple and cost-effective measurement of joint ROM [8].…”

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

“…Clinicians may be reluctant to use their personal smartphone for assessment because there would be a direct contact between the smartphone and the patient's skin (Kolber et al 2013;Salamh & Kolber, 2014). In addition, smartphones sometimes freeze or stop unexpectedly and would therefore obstruct or interfere with the measurement (Pourahmadi et al 2016b). The smartphone battery charge level is another important factor that should be considered during the assessment.…”

“…The use of smartphone apps for clinical assessment is gaining popularity and many studies have evaluated the reliability and validity of smartphone apps for the measurements of the ROM of many joints (Shin et al 2012;Kolber et al 2013;Milanese et al 2014;Quek et al 2014;Salamh & Kolber, 2014;Werner et al 2014;Charlton et al 2015;Otter et al 2015;Vohralik et al 2015;Behnoush et al 2016;Cuesta-Vargas & Rold an-Jim enez, 2016;Guidetti et al 2016;Pourahmadi et al 2016b). Generally, good to excellent intra-rater and inter-rater reliability have been reported in the previous studies.…”

“…Nowadays, smartphones are equipped with a set of cheap but powerful embedded sensors, such as accelerometers, magnetometers, and gyroscopes that make the phone capable of detecting joint position and measuring joint ROM (Otter et al 2015). A wide range of clinical measurement apps can be downloaded freely or for little cost from the internet (Shin et al 2012;Kolber et al 2013;Milanese et al 2014;Salamh & Kolber, 2014;Pourahmadi et al 2016b). The purpose of these apps is to provide easy, quick and simple ROM measurement.…”