Document Type : Original Articles
Western Kentucky University
Total Fitness Connection
The Medical Center Home Care Program
Signature Healthcare of Bowling Green
Background: Range of motion is an essential component of the hip examination. Handling issues with the goniometer often create challenges when measuring hip passive range of motion (PROM). Recent generations of smartphones have emerged as an alternative instrument for the measurement of joint ROM. The purpose of this study was to investigate the intra-rater, inter-rater and inter-instrument reliability of smartphone and goniometric hip PROM. Methods:Two investigators measured hip PROM to a designated end position on 30 asymptomatic participants in a blinded within study design using two measurement methods, smartphone and goniometer. Relative reliability of smartphone and goniometric measurements of hip PROM was assessed using intraclass correlation coefficients (ICC). Absolute reliability of both measurement methods was assessed using paired t-tests, standard errors of measurement (SEM), and 95% limits of agreement (LOA).Results: Relative reliability ICCs ranged from 0.47-0.99 (intra-rater), 0.05-0.99 (inter-rater) and 0.25 -0.97 (inter-instrument). Inter-rater differences of smartphone hip measurements were non-significant, however, significant differences were found for all inter-rater goniometric hip measurements (p<0.02). The comparison of the smartphone to goniometric measurements showed bias was present in 7 out to 12 hip measurements (p < 0.04). SEM ranged from 1° to 3° (intra-rater, inter-rater, and inter-instrument). LOA ranged from -6.8° - 5.1° (inter-rater) and -8.9° - 13.8° (inter-instrument). Conclusion: These findings support intra-rater reliability of both instruments when measuring hip PROM. Inter-rater reliability, however, was supported only for the smartphone. Due to systematic bias of inter-instrument measurements performed by one rater, caution should be used if the instruments are to be used interchangeably in order to quantify within session hip PROM.
- Beneciuk JM, Bishop MD, George SZ. Clinical Prediction Rules for Physical Therapy Interventions: A Systematic Review. Phys Ther. 2009 Feb 1;89(2):114â24.
- Prather H, Harris-Hayes M, Hunt D, Steger-May K, Mathew V, Clohisy J. Hip range of motion and provocative physical examination tests reliability and agreement in asymptomatic volunteers. PM R. 2010 Oct;2(10):888â95.
- Reinhold Ganz TS. The lesser trochanter as a cause of hip impingement: Pathophysiology and treatment options. Hip Int J Clin Exp Res Hip Pathol Ther. 2013;
- Bierma-Zeinstra SM, Bohnen AM, Ramlal R, Ridderikhoff J, Verhaar JA, Prins A. Comparison between two devices for measuring hip joint motions. Clin Rehabil. 1998 Dec;12(6):497â505.
- Herrero P, Carrera P, Garcia E, Gomez-Trullen EM, Olivan-Blazquez B. Reliability of goniometric measurements in children with cerebral palsy: A comparative analysis of universal goniometer and electronic inclinometer. A pilot study. BMC Musculoskelet Disord. 2011 Jul 10;12:155.
- Poulsen E, Christensen HW, Penny JÃ, Overgaard S, Vach W, Hartvigsen J. Reproducibility of range of motion and muscle strength measurements in patients with hip osteoarthritis â an inter-rater study. BMC Musculoskelet Disord. 2012 Dec 6;13:242.
- Roach S, San Juan JG, Suprak DN, Lyda M. Concurrent validity of digital inclinometer and universal goniometer in assessing passive hip mobility in healthy subjects. Int J Sports Phys Ther. 2013 Oct;8(5):680â8.
- Anderson D Stephen, English E Alton, Varee K Bai, Diaz D, Lowe D. Reliability and validity of an iPhoneÂ® inclinometer as compared to a universal goniometer as a tool for measuring joint motion of the shoulder in apparently healthy subjects. Orthop Phys Ther Pract. 2013 Mar;25(1):34â8.
- Kolber MJ, Pizzini M, Robinson A, Yanez D, Hanney WJ. THE RELIABILITY AND CONCURRENT VALIDITY OF MEASUREMENTS USED TO QUANTIFY LUMBAR SPINE MOBILITY: AN ANALYSIS OF AN IPHONEÂ® APPLICATION AND GRAVITY BASED INCLINOMETRY. Int J Sports Phys Ther. 2013 Apr;8(2):129â37.
- Tousignant-Laflamme Y, Boutin N, Dion A, Vallee C-A. Reliability and criterion validity of two applications of the iPhoneTM to measure cervical range of motion in healthy participants. J Neuroeng Rehabil. 2013;10(1):69.
- Jenny J-Y. Measurement of the knee flexion angle with a Smartphone-application is precise and accurate. J Arthroplasty. 2013 May;28(5):784â7.
- Johnson LB, Sumner S, Duong T, Yan P, Bajcsy R, Abresch RT, de Bie E, Han JJ. Validity and reliability of smartphone magnetometer-based goniometer evaluation of shoulder abduction - A pilot study. Man Ther. 2015 Mar 17
- Vohralik SL, Bowen AR, Burns J, Hiller CE, Nightingale EJ. Reliability and validity of a smartphone app to measure joint range. Am J Phys Med Rehabil Assoc Acad Physiatr. 2015 Apr;94(4):325â30.
- Shin S Han, Ro D Hyun, Lee O-S, Oh J Han, Kim S Hoon. Within-day reliability of shoulder range of motion measurement with a smartphone. Man Ther. 2012 Aug;17(4):298â304.
- Charlton PC, Mentiplay BF, Pua Y-H, Clark RA. Reliability and concurrent validity of a Smartphone, bubble inclinometer and motion analysis system for measurement of hip joint range of motion. J Sci Med Sport. 2015 May 1;18(3):262â7.
- Nussbaumer S, Leunig M, Glatthorn JF, Stauffacher S, Gerber H, Maffiuletti NA. Validity and test-retest reliability of manual goniometers for measuring passive hip range of motion in femoroacetabular impingement patients. BMC Musculoskelet Disord. 2010;11:194.
- Bandy PhD PT SCS ATC WD, Reese PhD PT NB. Joint Range of Motion and Muscle Length Testing, 2e [Internet]. [cited 2015 May 19]. Available from: http://www.biblio.com/book/joint-range-motion-muscle-length-testing/d/817100305
- Portney LG, Watkins MP. Foundations of Clinical Research: Applications to Practice. Upper Saddle River, NJ: Pearson Prentice Hall; 2009.
- Bland JM, Altman DG. Measurement error. BMJ. 1996 Sep 21;313(7059):744.
- Boone DC, Azen SP, Lin CM, Spence C, Baron C, Lee L. Reliability of goniometric measurements. Phys Ther. 1978 Nov;58(11):1355â60.