Validity and Reliability of 2 Goniometric Mobile Apps: Device, Application, and Examiner Factors.

ABSTRACT

CONTEXT Smartphones are being used in a variety of practice settings to measure joint range of motion (ROM). A number of factors can affect the validity of the measurements generated. However, there are no studies examining smartphone-based goniometer applications focusing on measurement variability and error arising from the electromechanical properties of the device being used. OBJECTIVE: To examine the concurrent validity and interrater reliability of 2 goniometric mobile applications (Goniometer Records, Goniometer Pro), an inclinometer, and a universal goniometer (UG). DESIGN: Nonexperimental, descriptive validation study. SETTING: University laboratory. PARTICIPANTS: 3 physical therapists having an average of 25 y of experience. MAIN OUTCOME MEASURES: Three standardized angles (acute, right, obtuse) were constructed to replicate the movement of a hinge joint in the human body. Angular changes were measured and compared across 3 raters who used 3 different devices (UG, inclinometer, and 2 goniometric apps installed on 3 different smartphones Apple iPhone 5, LG Android, and Samsung SIII Android). Intraclass correlation coefficients (ICCs) and Bland-Altman plots were used to examine interrater reliability and concurrent validity. RESULTS: Interrater reliability for each of the smartphone apps, inclinometer and UG were excellent (ICC = .995-1.000). Concurrent validity was also good (ICC = .998-.999). Based on the Bland-Altman plots, the means of the differences between the devices were low (range = -0.4° to 1.2°). CONCLUSIONS: This study identifies the error inherent in measurement that is independent of patient factors and due to the smartphone, the installed apps, and examiner skill. Less than 2° of measurement variability was attributable to those factors alone. The data suggest that 3 smartphones with the 2 installed apps are a viable substitute for using a UG or an inclinometer when measuring angular changes that typically occur when examining ROM and demonstrate the capacity of multiple examiners to accurately use smartphone-based goniometers.