The Reliability of the iPhone Leveling Application in Measuring Forearm and Wrist Range of Motion: Implications for Use in Telehealth

The purpose of this study is to explore the reliability of the iPhone Leveling Application in measuring active range of motion of the wrist and forearm in order to enable a client to monitor progress at home. The measurement of range of motion (ROM) is an important component of physical examination following a wrist injury and is required in the performance of occupations. Traditionally, a goniometer is used to assess joint mobility. An individual receiving therapy is therefore reliant on the measurements obtained by the clinician to provide feedback on progress. The increased use of mobile devices by healthcare professions has transformed clinical practice. Mobile devices have become commonplace in health care settings leading to rapid growth and the development of medical software applications “apps” for these platforms (Ventola, 2014). Smartphones, such as the iPhone, are often equipped with an accelerometer and magnetometer, which, through software applications, can perform various inclinometric functions (Pourahmadi et al., 2016). Although these applications are intended for recreational use, they have been found to be reliable in measuring range of motion in the spine, knee, shoulder and wrist (Alford, Adkisson, Appl-Culp, Lies, Wilson & Zubradt, 2017; Matera, Boonyasirikool, Saggini, Pozzi & Pegoli, 2016; Armstrong, Macermid, Chinchalkar, Stevens, & King, 1998). There is also a growing focus on telehealth and ways occupational therapists can evaluate and perform interventions remotely using computers or smartphones.

METHODS: Thirty asymptomatic participants associated with Rockhurst University were recruited. Participants were at least 18 years old with no acute injuries, pain or pathology of the wrists or forearms. Individuals who experienced an onset of injury between test and retest or who were pregnant were also excluded from the study.

SETTING: Rockhurst University in Kansas City, Missouri

INSTRUMENTS: A demographic survey, a traditional 6-inch, 180 degree, plastic goniometer, an iPhone with the iPhone Leveling App, a written instruction sheet and a home computer or mobile device with access to Skype or Facetime.

PROCEDURES: Measurements of active forearm supination, pronation, wrist flexion, wrist extension, wrist radial and ulnar deviation were obtained using a 6-inch plastic goniometer followed by the iPhone Leveling App. Both right and left upper extremities were assessed. Two examiners measured each range, two times with each device. The measurements were blinded to the examiners and read by a designated recorder. Each participant was then provided a handout with pictures and written instructions. The participant used the same iPhone to repeat the measurement on themselves. A follow up remote session was scheduled a week later and measurements were repeated by the subject and verbally reported to the examiners. An Intraclass Correlation Coefficient (ICC) was performed using SPSS at a 95% confidence interval using a 2-way random analysis with absolute agreement. Good intra and inter-rater reliability was found.

CONCLUSION/IMPACT: Following a wrist injury, restoring range of motion to in order to provide the mobility required to participate in daily occupations is an important goal of treatment. Access to onsite occupational therapy services can be limited to some clients with wrist injuries such as those living in rural areas. With proper instruction, the iPhone Leveling Application can be used by individuals to reliably monitor their own ROM progress at home. This could also potentially result in increased motivation and compliance to home exercise programs.

References

Alford, S., Adkisson, A., Apple-Culp, M., Lies, S., Wilson, J.,& Zubradt, M. (2018). The use of the iPhone leveling application in measuring forearm and wrist range of motion. AOTA Annual Conference, Salt Lake City, UT.

Armstrong, A. D., Macdermid, J. C., Chinchalkar, S., Stevens, R. S., & King, G. J. (1998). Reliability of range-of-motion measurement in the elbow and forearm. Journal of Shoulder and Elbow Surgery,7(6), 573-580. doi:10.1016/s1058-2746(98)90003-9

Matera, G., Boonyasirikool, C., Saggini, R., Pozzi, A., & Pegoli, L. (2016). The new smartphone application for wrist rehabilitation. The Journal Of Hand Surgery Asian-Pacific Volume, 21(1), 2-7. doi:10.1142/S2424835516400014

Ventola, C. L. (2014). Mobile devices and apps for health care professionals: uses and benefits. Pharmacy and Therapeutics, 39(5), 356–364.