Abstract
The aim of this review was to determine whether smartphone applications are reliable and valid to measure range of motion (RoM) in lower extremity joints. A literature search was performed up to October 2020 in the databases PubMed and Cochrane Library. Studies that reported reliability or validity of smartphone applications for RoM measurements were included. The study quality was assessed with the QUADAS-2 tool and baseline information, validity and reliability were extracted. Twenty-five studies were included in the review. Eighteen studies examined knee RoM, whereof two apps were analysed as having good to excellent reliability and validity for knee flexion (“DrGoniometer”, “Angle”) and one app showed good results for knee extension (“DrGoniometer”). Eight studies analysed ankle RoM. One of these apps showed good intra-rater reliability and excellent validity for dorsiflexion RoM (“iHandy level”), another app showed excellent reliability and moderate validity for plantarflexion RoM (“Coach’s Eye”). All other apps concerning lower extremity RoM had either insufficient results, lacked study quality or were no longer available. Some apps are reliable and valid to measure RoM in the knee and ankle joint. No app can be recommended for hip RoM measurement without restrictions.
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Research funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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Author contributions: S.H., I.K, S.W and P.A. have made a substantial contribution in writing the manuscript. All authors have critically revised the manuscript and agreed to the publication of the final version.
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Competing interests: Authors state no conflict of interest.
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Informed consent: Not applicable.
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Ethical approval: Not applicable.
Appendix 1: Search terms
| AND | ||||
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| Smartphone [MeSH] | Range of motion, Articular [MeSH] | Hip joint [MeSH] | Reproducibility of results [MeSH] | |
| Mobile applications [MeSH] | Joint angle | Hip | Reliability | |
| Smartphone | Range of motion | Knee joint [MeSH] | Validity | |
| Smart phone | RoM | Knee | Objectivity | |
| Smart phones | Angular measurement | Ankle joint [MeSH] | Validation | |
| Smartphones | Joint range | Ankle | Reproducibility | |
| OR | Iphone | Arthrometry, Articular [MeSH] | Extremities, lower [MeSH] | Accuracy |
| Mobile phone | Angle | Hip [MeSH] | ||
| Cellular phone | Inclinometer | Knee [MeSH] | ||
| App | Ankle [MeSH] | |||
| Phone app | Lower extremity | |||
| Phone | Lower extremities | |||
| Cell phone | ||||
| Cell phone [MeSH] | ||||
Appendix 2: Signaling questions
| Patient Selection | Index Test | Reference Standard | Flow and Timing |
|---|---|---|---|
| Was a consecutive or random sample of patients enrolled? | Were the index test results interpreted without knowledge of the results of the reference standard? | Is the reference standard likely to correctly classify the target condition? | Was there an appropriate interval between index test and reference standard? |
| Did the study avoid inappropriate exclusions? | Was the scaling of the measuring instrument adequate? | Were the reference standard results interpreted without knowledge of the results of the index test? | Was there an adequate time window between the measurements within the index test? |
| Was the scaling of the measuring instrument adequate? | Did all patients receive a reference standard? | ||
| Did all patients receive the same reference standard? | |||
| Did an intervention take place between the tests? | |||
| Was the order of testing random or simultaneous? |
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The underlined text highlights the questions that have a greater impact on the evaluation of study quality.
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