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Reliability and validity of clinically accessible smartphone applications to measure joint range of motion: A systematic review

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  • Justin W L Keogh
  • Alistair Cox
  • Sarah Anderson
  • Bernard Liew
  • Alicia Olsen
  • Ben Schram
  • James Furness

Abstract

Measuring joint range of motion is an important skill for many allied health professionals. While the Universal Goniometer is the most commonly utilised clinical tool for measuring joint range of motion, the evolution of smartphone technology and applications (apps) provides the clinician with more measurement options. However, the reliability and validity of these smartphones and apps is still somewhat uncertain. The aim of this study was to systematically review the literature regarding the intra- and inter-rater reliability and validity of smartphones and apps to measure joint range of motion. Eligible studies were published in English peer-reviewed journals with full text available, involving the assessment of reliability and/or validity of a non-videographic smartphone app to measure joint range of motion in participants >18 years old. An electronic search using PubMed, Medline via Ovid, EMBASE, CINAHL, and SPORTSDiscus was performed. The risk of bias was assessed using a standardised appraisal tool. Twenty-three of the eligible 25 studies exceeded the minimum 60% score to be classified as a low risk of bias, although 3 of the 13 criteria were not achieved in >50% of the studies. Most of the studies demonstrated adequate intra-rater or inter-rater reliability and/or validity for >50% of the range of motion tests across all joints assessed. However, this level of evidence appeared weaker for absolute (e.g. mean difference ± limit of agreement, minimal detectable change) than relative (e.g. intraclass correlation, correlation) measures; and for spinal rotation than spinal extension, flexion and lateral flexion. Our results provide clinicians with sufficient evidence to support the use of smartphones and apps in place of goniometers to measure joint motion. Future research should address some methodological limitations of the literature, especially including the inclusion of absolute and not just relative reliability and validity statistics.

Suggested Citation

  • Justin W L Keogh & Alistair Cox & Sarah Anderson & Bernard Liew & Alicia Olsen & Ben Schram & James Furness, 2019. "Reliability and validity of clinically accessible smartphone applications to measure joint range of motion: A systematic review," PLOS ONE, Public Library of Science, vol. 14(5), pages 1-24, May.
    • Handle: RePEc:plo:pone00:0215806
    DOI: 10.1371/journal.pone.0215806
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    1. Alessandro Liberati & Douglas G Altman & Jennifer Tetzlaff & Cynthia Mulrow & Peter C Gøtzsche & John P A Ioannidis & Mike Clarke & P J Devereaux & Jos Kleijnen & David Moher, 2009. "The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-28, July.
    2. M.A. Brodie & A. Walmsley & W. Page, 2008. "The static accuracy and calibration of inertial measurement units for 3D orientation," Computer Methods in Biomechanics and Biomedical Engineering, Taylor & Francis Journals, vol. 11(6), pages 641-648.
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