Abstract

Purpose: Smartphones have become a staple in our society. They are essential not only for our day-to-day lives but also as a healthcare tool in the face of the emergence of a myriad of health-based applications. Analyze the reliability and concurrent validity of an iPhone app as compared with traditional goniometry. Methods: 21 subjects of our work centre, in 2016 had 4 measurements of their degree of knee flexion for a randomly chosen knee position: 2 by universal goniometry (UG) and 2 by the Goniometer-Pro (G-Pro) application. A different evaluator made each measurement. The radiographs were used as a gold standard to measure the actual knee flexion angle. Results: The difference between mean intra-group values was 3,148º (±2,669º) and 2,476º (±2,638º) for G-Pro. The difference between the mean intra-group values was 5.45º. Inter-observer consistency for UG was 0,990 and 0,993 for G-Pro; As regards validity, the values obtained were 0,976 for UG and 0,992 for G-Pro. Conclusions: The Goniometer-Pro app seems to be a reliable and accurate tool for determining the values of knee flexion. The values obtained are slightly more accurate than those of traditional goniometry. Implication: This study intend to promote the use of apps of systemic form in the health system, as a component integrated into the management of the health. This work not only compares the reliability of two methods of measurement, compare the reliability or validity with a gold standard, as it is the radiological measurement.

References

• United States government agency responsible for regulating food, drugs, cosmetics, medical devices, biologic products and blood derivatives (FDA), United States of America, 2016.
• European Directory of Health apps 2012-13. A review by patients groups and empowered consumers, 2015.
• Institute for Healthcare Informatics (IMS), 2015.
• Research 2 Guidance. Mobile Health Market Report, 2013-2017, 2016.
• Gajdosik, R., Bohannon, R. Clinical measurement of range of motion: Review of goniomtery emphasizing reliabilty and validity. Physical Therapy. 1987;67(12):1867-72.
• Lea, R.D., Gerhardt, J.J. Current concepts review: Range of motion measurements. J Bone Joint Surg Am. 1995;77(1):784-98.
• Croxford, P., Jones, K., Barker, K. Inter-tester comparison between visual estimation and goniometric measurement of ankle dorsiflexion. Physiother Theory Pract. 2009;14(6):107-13.
• Bruton, A., Ellis, B., Goddard, J. Comparison of visual estimation and goniometry for assessment of metacarpophalangeal joint angle. Physiother. 1999;85:201-8.
• Nawoczenski, D.A., Baumhauer, J.F., Umberger, B.R. Relationship between clinical measurements and motion of the first metatarsophalangeal joint during gait. J Bone Joint Surg Am. 1999;81(3):370-6.
• Biedert, R.M., Warnke, K. Correlation between the Q angle and the patella position: a clinical and axial computed tomography evaluation. Arch Orthop Trauma Surg. 2001; 121(6):346-9.
• Kailas, A., Chong, C.C., WatanabeM F. From mobile phones to personal wellness dashboards. IEEE Pulse. 2010;1(1):57-63.
• Terry, M. Medical applications for smartphones. Telemed J and e-health. 2010;16:17-22.
• Free, C., Phillips, G., Galli, L., Watson, L., Felix, L., Edwards, P., Patel, V., Haines, A. The effectiveness of mobile-health technology-based health behaviour change or disease management interventions for health care consumers: a systematic review. PLoS Med. 2013;10(1):e1001362.
• Koehler, N., Vujovic, O., McMenamin, C. Are individuals more accepting of the internet than mobile phone applications being used in clinical practice?. J Mob Technol Med. 2013;2(1):14-21.
• 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(11):1038-43.
• Kim, T.S., Park, D.D., Lee, Y.B., Han, D.G., Shim, J.S., Lee, Y.J., Kim, P.C. A study on the measurement of wrist motion range using the iPhone 4 gyroscope application. Ann Plast Surg 2014;73(2):215-8.
• Norkin, C.C., White, D.J. 2005. Goniometria: evaluación de la movilidad articular. Madrid: Marban Libros.
• The app Intelligence. Report on the 50 top Spanish-language health-based apps, 2014.
• Milanese, S., Gordon, S., Buettner, P., Flavell, C., Ruston, S., Coe, D., O'Sullivan, W., McCormack, S. Reliability and concurrent validity of knee angle measurement: smartphone app versus universal goniometer used by experienced and novice clinicians. Man Ther. 2014;19(6):569-74.
• Jones, A., Sealey, R., Crowe, M., Gordon, S. Concurrent validity and reliability of the simple goniometer iPhone app compared with Universal Goniometer. Physiother Theory Pract. 2014;30(7):512-6.
• Ockendon, M., Gilbert, R.E. Validation of a novel smartphone accelerometer-based knee goniometer. J Knee Surg. 2012;25(4):341-5.
• Ferretti, A., Valeo, L., Mazza, D., Muliere, L., Iorio, P., Giovannetti, G., Conteduca, F., Iorio, R. Smartphone versus knee ligament arthrometer when size does not matter. Int Orthop. 2014;38(10):2197-9.
• Kuegler, P., Wurzer, P., Tuca, A., Sendlhofer, G., Lumenta, D.B., Giretzlehner, M., Kamolz, L.P. Goniometer-apps in hand surgery and their applicability in daily clinical practice. Safety in Health, 2015;1:11.
• Werner, B.C., Holzgrefe, R.E., Griffin, J.W., Lyons, M.L., Cosgrove, C.T., Hart, J.M., Brockmeier, S.F. Validation of an innovative method of shoulder range-of-motion measurement using a smartphone clinometer application. J Shoulder Elbow Surg. 2014 Nov;23(11):e275-82.
• Johnson, L.B., Sumner, S., Duong, T., Yan, P., Bajcsy, R., Abresch, R.T., de Bie, E., Han, J.J. Validity and reliability of smartphone magnetometer-based goniometer evaluation of shoulder abduction: A pilot study. Man Ther. 2015;20(6):777-82.
• Yoon, J.O., Kang, M.H., Kim, J.S., Oh, J.S. The effects of gait use of smartphone on repositioning error and curvature of the lumbar spine. J Phys Ther Sci. 2015;27(8):2507-8.
• Lee, W.W., Yen, S.C., Tay, A., Zhao, Z., Xu, T.M., Ling, K.K., Ng, Y.S., Chew, E., Cheong, A.L., Huat, G.K.. A smartphone-centric system for the range of motion assessment in stroke patients IEEE J Biomed Health Inform. 2014;18(6):1839-47.
• Kinsey Global Institute, 2011.
• Touching lives through mobile health. Assessment of the global market opportunity, 2012.
• Report on the Society of Information in Spain by Fundación Telefónica, 2016.