Physical Therapy Korea
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Phys. Ther. Korea 2022; 29(3): 225-234
Published online August 20, 2022
https://doi.org/10.12674/ptk.2022.29.3.225
© Korean Research Society of Physical Therapy
The Reliability and Validity of the Digital Goniometer and Smart Phone to Determine Trunk Active Range of Motion in Stroke Patients
Hee-yong Park1 
, PT, MSc, Ui-jae Hwang2,3 , PT, PhD, Oh-yun Kwon2,3 , PT, PhD
1Department of Physical Therapy, The Graduate School, Yonsei University, 2Department of Physical Therapy, College of Health Science, Yonsei University, 3Kinetic Ergocise Based on Movement Analysis Laboratory, Wonju, Korea
Correspondence to: Oh-yun Kwon
E-mail: kwonoy@yonsei.ac.kr
https://orcid.org/0000-0002-9699-768X
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: Trunk movements are an important factor in activities of daily living; however, these movements can be impaired by stroke. It is difficult to quantify and measure the active range of motion (AROM) of the trunk in patients with stroke. Objects: To determine the reliability and validity of measurements using a digital goniometer (DG) and smart phone (SP) applications for trunk rotation and lateral flexion in stroke patients.
Methods: This is an observational study, in which twenty participants were clinically diagnosed with stroke. Trunk rotation and lateral flexion AROM were assessed using the DG and SP applications (Compass and Clinometer). Intrarater reliability was determined using intraclass correlation coefficients (ICCs) with 95% confidence intervals. Pearson correlation coefficient was used to determine the validity of the DG and SP in AROM measurement. The level of agreement between the two instruments was shown by Bland–Altman plot and 95% limit of agreement (LoA) was calculated.
Results: The intrarater reliability (rotation with DG: 0.96–0.98, SP: 0.98; lateral flexion with DG: 0.97–0.98, SP: 0.96) was excellent. A strong and significant correlation was found between DG and SP (rotation hemiplegic side: r = 0.95; non-hemiplegic side: r = 0.90; lateral flexion hemiplegic side: r = 0.88; non-hemiplegic side: r = 0.78). The level of agreement between the two instruments was rotation (hemiplegic side: 23.02° [LoA 17.41°, –5.61°]; non-hemiplegic side: 31.68° [LoA 23.87°, –7.81°]) and lateral flexion (hemiplegic side: 20.94° [LoA 17.48°, –3.46°]; non-hemiplegic side: 27.12° [LoA 18.44°, –8.68°]).
Conclusion: Both DG and SP applications can be used as reliable methods for measuring trunk rotation and lateral flexion in patients with stroke. Although, considering the level of clinical agreement, DG and SP could not be used interchangeably for measurements.
Keywords: Range of motion, Smartphone, Stroke
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Original Article
Phys. Ther. Korea 2022; 29(3): 225-234
Published online August 20, 2022 https://doi.org/10.12674/ptk.2022.29.3.225
Copyright © Korean Research Society of Physical Therapy.
The Reliability and Validity of the Digital Goniometer and Smart Phone to Determine Trunk Active Range of Motion in Stroke Patients
Hee-yong Park1 , PT, MSc, Ui-jae Hwang2,3 , PT, PhD, Oh-yun Kwon2,3 , PT, PhD
1Department of Physical Therapy, The Graduate School, Yonsei University, 2Department of Physical Therapy, College of Health Science, Yonsei University, 3Kinetic Ergocise Based on Movement Analysis Laboratory, Wonju, Korea
Correspondence to:Oh-yun Kwon
E-mail: kwonoy@yonsei.ac.kr
https://orcid.org/0000-0002-9699-768X
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Trunk movements are an important factor in activities of daily living; however, these movements can be impaired by stroke. It is difficult to quantify and measure the active range of motion (AROM) of the trunk in patients with stroke. Objects: To determine the reliability and validity of measurements using a digital goniometer (DG) and smart phone (SP) applications for trunk rotation and lateral flexion in stroke patients.
Methods: This is an observational study, in which twenty participants were clinically diagnosed with stroke. Trunk rotation and lateral flexion AROM were assessed using the DG and SP applications (Compass and Clinometer). Intrarater reliability was determined using intraclass correlation coefficients (ICCs) with 95% confidence intervals. Pearson correlation coefficient was used to determine the validity of the DG and SP in AROM measurement. The level of agreement between the two instruments was shown by Bland–Altman plot and 95% limit of agreement (LoA) was calculated.
Results: The intrarater reliability (rotation with DG: 0.96–0.98, SP: 0.98; lateral flexion with DG: 0.97–0.98, SP: 0.96) was excellent. A strong and significant correlation was found between DG and SP (rotation hemiplegic side: r = 0.95; non-hemiplegic side: r = 0.90; lateral flexion hemiplegic side: r = 0.88; non-hemiplegic side: r = 0.78). The level of agreement between the two instruments was rotation (hemiplegic side: 23.02° [LoA 17.41°, –5.61°]; non-hemiplegic side: 31.68° [LoA 23.87°, –7.81°]) and lateral flexion (hemiplegic side: 20.94° [LoA 17.48°, –3.46°]; non-hemiplegic side: 27.12° [LoA 18.44°, –8.68°]).
Conclusion: Both DG and SP applications can be used as reliable methods for measuring trunk rotation and lateral flexion in patients with stroke. Although, considering the level of clinical agreement, DG and SP could not be used interchangeably for measurements.
Keywords: Range of motion, Smartphone, Stroke
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Table 1 . General characteristics of the subjects (N = 20).
Characteristic Stroke Age (y) 69.5 ± 12.7 Height (cm) 158.1 ± 7.7 Weight (kg) 58.8 ± 8.2 Gender Male 7 Female 13 Pathogenesis Hemorrhage 7 Infarction 13 Time since stroke onset (mo) 2.4 ± 0.8 Paretic side Left 10 Right 10 Values are presented as mean ± standard deviation or number only..
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Table 2 . Active range of motion for trunk rotation and lateral flexion (N = 20).
Side Rotation (°) Lateral flexion (°) Hemiplegic Digital goniometer 18.05 ± 10.15 18.19 ± 18.19 Smart phone 24.00 ± 14.61 25.20 ± 11.10 Non-hemiplegic Digital goniometer 23.87 ± 9.91 16.87 ± 8.77 Smart phone 31.90 ± 15.67 21.75 ± 11.08
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Table 3 . Intrarater reliability of movement to trunk rotation using a digital goniometer and smart phone.
Hemiplegic Non-hemiplegic ICC (95% CI) SEM (°) MDC95 (°) ICC (95% CI) SEM (°) MDC95 (°) Digital goniometer 0.98 (0.96–0.99) 1.44 3.99 0.96 (0.90–0.98) 1.98 5.49 Smart phone 0.98 (0.95–0.99) 2.07 5.74 0.98 (0.95–0.99) 2.22 6.15
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Table 4 . Intrarater reliability of movement to trunk lateral flexion using a digital goniometer and smart phone.
Hemiplegic Non-hemiplegic ICC (95% CI) SEM (°) MDC95 (°) ICC (95% CI) SEM (°) MDC95 (°) Digital goniometer 0.98 (0.96–0.99) 2.57 7.12 0.97 (0.94–0.99) 1.52 4.21 Smart phone 0.96 (0.91–0.98) 2.22 6.15 0.96 (0.91–0.98) 2.22 6.15