Smartphone applications for the evaluation of pathologic shoulder range of motion and shoulder scores-a comparative study

Kevyn Mejia-Hernandez, Angela Chang, Nathan Eardley-Harris, Ruurd Jaarsma, Tiffany K Gill, James M McLean, Kevyn Mejia-Hernandez, Angela Chang, Nathan Eardley-Harris, Ruurd Jaarsma, Tiffany K Gill, James M McLean

Abstract

Hypothesis and background: Accurate measurement of range of motion (ROM) is important in evaluating a pathologic shoulder and calculating shoulder scores. The aim of this study was to establish the reliability and validity of different smartphone applications (apps) in assessing pathologic shoulder ROM and to determine whether differences in recorded ROM measurements affect calculated shoulder scores. The authors hypothesized that there is no difference between shoulder ROM assessment methods and calculated shoulder scores.

Methods: In this nonrandomized controlled clinical trial, ROM of 75 participants with a history of shoulder disease (21 women, 54 men) was assessed using a smartphone inclinometer and virtual goniometer, a standard goniometer, and clinicians' visual estimation. Shoulder strength was assessed, and Constant-Murley (CM) and University of California-Los Angeles (UCLA) shoulder scores were calculated.

Results: Independent of diagnosis or operation, all cases (except for passive glenohumeral abduction of unstable shoulders) showed excellent intraclass correlation coefficients (>0.84). Interobserver reliability was excellent for all ROM measures (intraclass correlation coefficient > 0.97). All modalities had excellent agreement to values attained with the universal goniometer. There were no differences for the calculated CM or UCLA scores between the modalities employed to measure ROM.

Conclusions: A smartphone inclinometer or virtual goniometer is comparable to other clinical methods of measuring pathologic shoulder ROM. Clinicians can employ smartphone applications with confidence to measure shoulder ROM and to calculate UCLA and CM scores. The apps are also available to patients and may be a useful adjunct to physiotherapy, especially in cases of limited access to health care services.

Keywords: Constant-Murley score; Goniometer; Inclinometer; Shoulder range of motion; Smartphone application; UCLA score.

Figures

Figure 1
Figure 1
The iPhone applications. (A) GetMyROM. (B) DrGoniometer.
Figure 2
Figure 2
Measurements of (A) forward flexion, (B) glenohumeral abduction, (C) external rotation, and (D) internal rotation.

References

    1. Albrecht U.V., von Jan U., Sedlacek L., Groos S., Suerbaum S., Vonberg R.P. Standardized, App-based disinfection of iPads in a clinical and nonclinical setting: comparative analysis. J Med Internet Res. 2013;15:e176. doi: 10.2196/jmir.2643.
    1. Awan R., Smith J., Boon A.J. Measuring shoulder internal rotation range of motion: a comparison of 3 techniques. Arch Phys Med Rehabil. 2002;83:1229–1234. doi: 10.1053/apmr.2002.34815.
    1. Blonna D., Zarkadas P.C., Fitzsimmons J.S., O'Driscoll S.W. Validation of a photography-based goniometry method for measuring joint range of motion. J Shoulder Elbow Surg. 2012;21:29–35. doi: 10.1016/j.jse.2011.06.018.
    1. Cicchetti D.V. Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychol Assess. 1994;6:284–290.
    1. Constant C.R., Gerber C., Emery R.J., Sojbjerg J.O., Gohlke F., Boileau P. A review of the Constant score: modifications and guidelines for its use. J Shoulder Elbow Surg. 2008;17:355–361. doi: 10.1016/j.jse.2007.06.022.
    1. Coons S.J., Gwaltney C.J., Hays R.D., Lundy J.J., Sloan J.A., Revicki D.A. Recommendations on evidence needed to support measurement equivalence between electronic and paper-based patient-reported outcome (PRO) measures: ISPOR ePRO Good Research Practices Task Force report. Value Health. 2009;12:419–429. doi: 10.1111/j.1524-4733.2008.00470.x.
    1. Cuesta-Vargas A.I., Roldan-Jimenez C. Validity and reliability of arm abduction angle measured on smartphone: a cross-sectional study. BMC Musculoskelet Disord. 2016;17:93. doi: 10.1186/s12891-016-0957-3.
    1. Dawson J., Fitzpatrick R., Carr A. Questionnaire on the perceptions of patients about shoulder surgery. J Bone Joint Surg Br. 1996;78:593–600.
    1. De Winter A.F., Heemskerk M.A., Terwee C.B., Jans M.P., Deville W., Schaardenburg D.J. Inter-observer reproducibility of measurements of range of motion in patients with shoulder pain using a digital inclinometer. BMC Musculoskelet Disord. 2004;5:18. doi: 10.1186/1471-2474-5-18.
    1. El-Zayat B.F., Efe T., Heidrich A., Wolf U., Timmesfeld N., Heyse T.J. Objective assessment of shoulder mobility with a new 3D gyroscope—a validation study. BMC Musculoskelet Disord. 2011;12:168. doi: 10.1186/1471-2474-12-168.
    1. Ellman H., Hanker G., Bayer M. Repair of the rotator cuff. End-result study of factors influencing reconstruction. J Bone Joint Surg Am. 1986;68:1136–1144.
    1. Ferriero G., Vercelli S., Sartorio F., Munoz Lasa S., Ilieva E., Brigatti E. Reliability of a smartphone-based goniometer for knee joint goniometry. Int J Rehabil Res. 2013;36:146–151. doi: 10.1097/MRR.0b013e32835b8269.
    1. Hayes K., Walton J.R., Szomor Z.R., Murrell G.A. Reliability of five methods for assessing shoulder range of motion. Aust J Physiother. 2001;47:289–294.
    1. Jenny J.Y. Measurement of the knee flexion angle with a Smartphone-application is precise and accurate. J Arthroplasty. 2013;28:784–787. doi: 10.1016/j.arth.2012.11.013.
    1. Johnson L.B., Sumner S., Duong T., Yan P., Bajcsy R., Abresch R.T. Validity and reliability of smartphone magnetometer-based goniometer evaluation of shoulder abduction—a pilot study. Man Ther. 2015;20:777–782. doi: 10.1016/j.math.2015.03.004.
    1. Jordan K., Dziedzic K., Jones P.W., Ong B.N., Dawes P.T. The reliability of the three-dimensional FASTRAK measurement system in measuring cervical spine and shoulder range of motion in healthy subjects. Rheumatology (Oxford) 2000;39:382–388.
    1. Kolber M.J., Pizzini M., Robinson A., Yanez D., Hanney W.J. The reliability and concurrent validity of measurements used to quantify lumbar spine mobility: an analysis of an iphone application and gravity based inclinometry. Int J Sports Phys Ther. 2013;8:129–137.
    1. Lim J.Y., Kim T.H., Lee J.S. Reliability of measuring the passive range of shoulder horizontal adduction using a smartphone in the supine versus the side-lying position. J Phys Ther Sci. 2015;27:3119–3122. doi: 10.1589/jpts.27.3119.
    1. Milanese S., Gordon S., Buettner P., Flavell C., Ruston S., Coe D. Reliability and concurrent validity of knee angle measurement: smart phone app versus universal goniometer used by experienced and novice clinicians. Man Ther. 2014;19:569–574. doi: 10.1016/j.math.2014.05.009.
    1. Milani P., Coccetta C.A., Rabini A., Sciarra T., Massazza G., Ferriero G. Mobile smartphone applications for body position measurement in rehabilitation: a review of goniometric tools. PM R. 2014;6:1038–1043. doi: 10.1016/j.pmrj.2014.05.003.
    1. Mitchell K., Gutierrez S.B., Sutton S., Morton S., Morgenthaler A. Reliability and validity of goniometric iPhone applications for the assessment of active shoulder external rotation. Physiother Theory Pract. 2014;30:521–525. doi: 10.3109/09593985.2014.900593.
    1. Mourcou Q., Fleury A., Diot B., Franco C., Vuillerme N. Mobile phone-based joint angle measurement for functional assessment and rehabilitation of proprioception. Biomed Res Int. 2015;2015:328142. doi: 10.1155/2015/328142.
    1. Pichonnaz C., Duc C., Gleeson N., Ancey C., Jaccard H., Lécureux E. Measurement properties of the smartphone-based B-B Score in current shoulder pathologies. Sensors (Basel) 2015;15:26801–26817. doi: 10.3390/s151026801.
    1. Pohl M., Mehrholz J. A new shoulder range of motion screening measurement: its reliability and application in the assessment of the prevalence of shoulder contractures in patients with impaired consciousness caused by severe brain damage. Arch Phys Med Rehabil. 2005;86:98–104. doi: 10.1016/j.apmr.2004.01.038.
    1. Russell T.G., Jull G.A., Wootton R. Can the Internet be used as a medium to evaluate knee angle? Man Ther. 2003;8:242–246. doi: 10.1016/S1356-689X(03)00016-X.
    1. Shin S.H., Ro du H., Lee O.S., Oh J.H., Kim S.H. Within-day reliability of shoulder range of motion measurement with a smartphone. Man Ther. 2012;17:298–304. doi: 10.1016/j.math.2012.02.010.
    1. Tekerekoǧlu M.S., Duman Y., Serindağ A., Cuǧlan S.S., Kaysadu H., Tunc E. Do mobile phones of patients, companions and visitors carry multidrug-resistant hospital pathogens? Am J Infect Control. 2011;39:379–381. doi: 10.1016/j.ajic.2010.10.026.
    1. Terwee C.B., de Winter A.F., Scholten R.J., Jans M.P., Deville W., van Schaardenburg D. Interobserver reproducibility of the visual estimation of range of motion of the shoulder. Arch Phys Med Rehabil. 2005;86:1356–1361. doi: 10.1016/j.apmr.2004.12.031.
    1. Werner B.C., Holzgrefe R.E., Griffin J.W., Lyons M.L., Cosgrove C.T., Hart J.M. Validation of an innovative method of shoulder range-of-motion measurement using a smartphone clinometer application. J Shoulder Elbow Surg. 2014;23:e275–e282. doi: 10.1016/j.jse.2014.02.030.
    1. Williams C.M., Caserta A.J., Haines T.P. The TiltMeter app is a novel and accurate measurement tool for the weight bearing lunge test. J Sci Med Sport. 2013;16:392–395. doi: 10.1016/j.jsams.2013.02.001.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe