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Abstract
BackgroundAnkle joint range of motion is a frequently assessed measure used by health care clinicians who manage lower limb pathologies to identify ankle equinus and/or other joint motion concerns that may negatively impact on function. The purpose of this study was to assess a new iPhone application (the level function of the ‘Measure application’), for measuring the weightbearing ankle lunge test in a healthy adult population (reliability) and measuring known angles (validity) when compared to a digital inclinometer.MethodsTo determine intra-rater reliability, inter-rater reliability and concurrent validity, 168 measures were conducted on 21 participants. Participants were preconditioned prior to assessment, and two experienced raters measured ankle dorsiflexion range of motion in the knee extended and knee flexed positions of the weight bearing lunge test, using an iPhone level function (of the Measure application) and a digital inclinometer in a randomised order, over two timepoints. Concurrent validity was also determined by comparison of measures of the two devices at known surface angles (0 and 15 degrees) in multiple planes. Reliability and validity were determined with intraclass correlation coefficients, concurrent validity was explored with the Bland Altman plot and an intraclass correlation coefficient. The Standard Error of the Mean and the minimal detectable change were also explored.ResultsThe intra-rater reliability using the iPhone and inter-rater reliability using the digital inclinometer, in the knee extended position, were ICC 0.85 respectively, indicating good reliability. All other intra-rater reliability and inter-rater reliability for both devices and both leg positions were over ICC 0.90, indicating excellent reliability. Concurrent validity between the two devices on a flat and known angle surface were ICC 1.0 (Limits of Agreement − 1.0 to 0.61), indicating excellent validity, with good validity demonstrated by a Bland Altman plot of all measures in all positions (ICC of 0.84 (Limits of agreement = − 4.51 to 6.49)).ConclusionThe use of the iPhone level measure, within the Measurement App has demonstrated to be an easy and reliable measurement tool to determine ankle joint dorsiflexion during the weightbearing lunge test in healthy adults.
Highlights
Ankle joint range of motion is a frequently assessed measure used by health care clinicians who manage lower limb pathologies to identify ankle equinus and/or other joint motion concerns that may negatively impact on function
The intra-rater reliability between timepoints for equipment was determined using the raw data with the intraclass correlation coefficient (ICC) (Model 3,1), 95% confidence interval, Standard Error of the Mean (SEM) and the minimal detectable change (MDC)
The intra-rater reliability of the digital inclinometer was excellent for both leg positions (ICC = 0.91 to 0.97)
Summary
Ankle joint range of motion is a frequently assessed measure used by health care clinicians who manage lower limb pathologies to identify ankle equinus and/or other joint motion concerns that may negatively impact on function. The purpose of this study was to assess a new iPhone application (the level function of the ‘Measure application’), for measuring the weightbearing ankle lunge test in a healthy adult population (reliability) and measuring known angles (validity) when compared to a digital inclinometer. The Tiltmeter App and the iHandy App (available on smart phones/tablets) have been shown as reliable measures of ankle joint dorsiflexion [13, 14] These have the additional benefits of being cheap, accessible and quick to administer [13]. With Apple’s recent software upgrade (operating systems IOS 7 and above) a new Measure App which includes a ‘level’ function has been introduced This level function, if reliable, would potentially be a suitable alternative to the discontinued Tiltmeter App with the additional bonus of being included in the Apple App suite (that is, it is standardly installed/upgraded with each software upgrade). To be confident in its use in the clinical setting, determination of the psychometric properties is required
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