Sports Medicine Research: In the Lab & In the Field: Your Inclinometer is Ringing (Sports Med Res)
Wednesday, June 18, 2014

Your Inclinometer is Ringing

Reliability and concurrent validity of a Smartphone, bubble inclinometer and motion analysis system form measurement of hip joint range of motion.

Charlton PC, Mentiply BF, Pua YH, and Clark RA. J Sci Med Sport. 2014; [Epub ahead of print].

Take Home Message: A Smartphone app for measuring passive hip range of motion in healthy, young men may be reliable and valid when compared to the measurement values of a motion analysis system and a bubble inclinometer.

Although smartphone applications can measure hip range of motion there is no literature to support their use when compared with a bubble inclinometer. Since the majority of clinicians own a smartphone there is a potential for clinicians to objectively measure hip range of motion efficiently and in a variety of settings. Therefore, Charlton and colleagues assessed the intra-tester reliability and validity of a smartphone application for the evaluation of hip flexion, rotation, and abduction. The authors recruited 20 healthy participants (average age 24 years) who were pain free at the time of testing. A single physiotherapist evaluated each participant twice (3 days apart). During each session, the physiotherapist measured passive hip range of motion on the right limbs using 3 tools: “Hip ROM tester” Smartphone app, bubble inclinometer, and a 9 camera marker-based motion capture system. Each movement was measured 3 times and the median value of each set was used for analysis. The physiotherapist measured hip flexion, abduction, adduction, supine internal rotation and external rotation, and sitting internal and external rotation. The smartphone application was reliable (consistent) between the two sessions for four of the seven motions, with abduction, adduction, and sitting external rotation being somewhat less reliable. In comparison, when the physiotherapist had the bubble inclinometer he/she was less reliable with abduction and sitting external rotation. Overall, the smartphone application had “good to excellent” relationships with the motion capture system in all measurements except supine external rotation, which had a “moderate to good association.” The bubble inclinometer displayed a “good to excellent” association in all 7 measurement thus the researchers concluded that the use of a Smartphone application was a valid and reliable measure of passive hip range of motion in young, active males.

The above conclusions pose some interesting implication for all clinicians who measure hip joint range of motion. The use of a smartphone application could potentially have a positive impact on clinical practice. Since many clinicians report having a smartphone, this will increase the portability and availability of the tool when compared to a bubble inclinometer. Furthermore, the use of a smartphone may also be more cost efficient for clinicians when compared to a bubble inclinometer although this difference may be nominal. While there are many positives to using a smartphone, all clinicians should be aware of some limitations of the current study. Firstly, the authors did not report data on multiple phones so they were unable to definitively conclude that 1 method was better. Further, only one physiotherapist tested the application and a co-author was an inventor of the application. It will be interesting to see if other groups can replicate these results using multiple clinicians and multiple devices. Until more analyses can be completed to more directly compare the devices themselves, it would be wise for clinicians who are interested in using a smartphone application to proceed with caution and test if they consistently get the same results when they use the application.

Questions for Discussion: Do you use a Smartphone in your daily practice? Do you use your smartphone to measure joint range of motion? If not, would you consider using a smartphone to measure joint range of motion if it proves to be reliable and accurate?

Written by: Kyle Harris
Reviewed by:  Jeffrey Driban

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6 comments:

Stacy Schurr said...

This was a very interesting study! I definitely think the time is coming where we will integrate smartphones and advanced technology into more aspects of clinical practice. We already use it for the ease of communicating, weather, etc., so it was interesting to see the effects of a joint range of motion app. I have never used my smartphone for this purpose, but I would certainly consider it. I agree that it is important to realize this study focused on only one clinician, one smartphone, and to go one step further, only one app was used. The validity and reliability should be investigated further because some people may be more "tech savvy," and some apps may be more reliable than others. But overall, I think it's a step in the right direction. Being able to pull out your phone for the purpose of measuring joint range of motion and other tests could open up a whole lot of other possibilities as well.

Kyle said...

Stacy, excellent comment! I am with you in that I would strongly consider using a ROM app but I too would want to know that it is a valid and reliable as possible. I did like that the study attempted to compare all smartphone result to a "gold-standard" but agree that the variables were somewhat limited. Again, I agree to your point that I too would want more apps and more clinicians using the app to see if and how much that swayed the results. I wonder though, with the pace of technology (especially the smartphone and app market) are we ever going to have enough time to evaluate these tools as much as we should? To make a parallel, we have seen in some literature that even surgical techniques are moving faster than research evaluating it's long-term efficacy. Perhaps there will be an issue here in that by the time we validate an app or a particular smartphone, there is a strong chance that the model of smartphone will be out-of-date. Do you think the "turnover" rate of smartphones and smarthphone technology will outpace clinical research? I'm interested to hear thoughts on this.

Thomas Gooding said...

What a great read. Several years ago I remember using a bubble inclinometer app on my iPhone to measure the ROM of an ACL-R patient I was working with. At the time I was unsure of how effective it would be and had wished I had a goniometer on hand, but this read helps me validate my moment of being "tech savvy." The hardest part in this I would say is deeming which specific app to use and to make sure you level it properly. I would love to see future evidence based literature of using these types of applications in our sports medicine realm. Going to your thought above about "turnover rate" posted above: I believe an advance in the technology would only serve to improve the accuracy of the accelerometer placed in the smartphones, which I believe to be the device that allows this measurement to be quantified. while the technology may change, the application used would simply be downloaded and most likely wouldn't show too much variation

Thomas Gooding said...

What a great read. Several years ago I remember using a bubble inclinometer app on my iPhone to measure the ROM of an ACL-R patient I was working with. At the time I was unsure of how effective it would be and had wished I had a goniometer on hand, but this read helps me validate my moment of being "tech savvy." The hardest part in this I would say is deeming which specific app to use and to make sure you level it properly. I would love to see future evidence based literature of using these types of applications in our sports medicine realm. Going to your thought above about "turnover rate" posted above: I believe an advance in the technology would only serve to improve the accuracy of the accelerometer placed in the smartphones, which I believe to be the device that allows this measurement to be quantified. while the technology may change, the application used would simply be downloaded and most likely wouldn't show too much variation.

Jeffrey Driban said...

Thanks Thomas! I think we should be careful because while technology changes it may not always be better for the components of the smart phone that are used in the inclinometer app. For example, a company may decide to spend money on a better screen and processor but then decide that the accelerometers don't need to be as good as their old phone (cost or energy savings). If we want to use our smart phones in clinical practice we may eventually want to look at the spec sheets to see if the accelerometers or other key components are sensitive enough for our clinical practice.

Kyle said...

Thomas and Jeff,

I agree that we need to be careful with changing technology. With that being said I also agree with your point Thomas that we should be looking for future research based on different goniometry apps but maybe we a professionals need to also be careful to have all the details possible surrounding the specific phone make and model to account for some of these issues. In the end I think we should try to advance our practice to make it as easy and seamless as possible for our athletes and ourselves, but also be vigilant not to sacrifice accuracy.

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