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Reliability, Concurrent Validity, and Minimal Detectable Change of a Smartphone Application for Measuring Thoracic Kyphosis

Year 2023, , 511 - 516, 11.09.2023

Ertan Şahinoğlu , Gülbin Ergin , Serkan Bakırhan , Bayram Ünver

https://doi.org/10.33808/clinexphealthsci.1038122

Abstract

Objective: To assess the intra- and inter-rater reliability and concurrent validity, and to estimate minimal detectable change of a smartphone application for measuring thoracic kyphosis angle.
Methods: A total of 80 healthy university students were evaluated. Two raters measured the thoracic kyphosis angle using a digital inclinometer and the smartphone application. Intra- and inter-rater reliability were assessed using the intraclass correlation coefficient (ICC) with 95% confidence interval. The standard error of measurement (SEM) and the minimal detectable change at the 95% confidence level (MDC95) were also calculated. The concurrent validity between the digital inclinometer and the smartphone application was assessed by the linear regression analysis and Bland and Altman's 95% limits of agreement method.
Results: The intra- and inter-rater reliability were excellent for the digital inclinometer and the smartphone application (ICC > 0.75). The SEM values for the digital inclinometer and the smartphone application were close together. The MDC95 values for the smartphone application were 5.11 and 6.30 degrees, and 9.02 degrees for intra- and inter-rater, respectively. The digital inclinometer and the smartphone application showed a positive correlation (R2 = 0.85). The Bland-Altman plot showed a good agreement between the instruments.
Conclusion: The smartphone application used in this study is a cost-effective, practical, reliable, and valid instrument for measuring the thoracic kyphosis angle. More than 9 degrees in the value of the thoracic kyphosis angle measured by the smartphone application can be considered as a true change.

Keywords

Reliability validity kyphosis smartphone spine

References

  • Perriman DM, Scarvell JM, Hughes AR, Ashman B, Lueck CJ, Smith PN. Validation of the flexible electrogoniometer for measuring thoracic kyphosis. Spine (Phila Pa 1976) 2010;35(14):E633–640. DOI:10.1097/BRS.0b013e3181d13039
  • Barrett E, O’Keeffe M, O’Sullivan K, Lewis J, McCreesh K. Is thoracic spine posture associated with shoulder pain, range of motion and function? A systematic review. Man Ther 2016;26:38–46. DOI:10.1016/j.math.2016.07.008.
  • Sinaki M, Brey RH, Hughes CA, Larson DR, Kaufman KR. Balance disorder and increased risk of falls in osteoporosis and kyphosis: Significance of kyphotic posture and muscle strength. Osteoporos Int 2005;16(8):1004–1010. DOI: 10.1007/s00198- 004-1791-2
  • Kim DY, Moon ES, Park JO, Chong HS, Lee HM, Moon SH, Kim SH, Kim HS. The thoracic lordosis correction improves sacral slope and walking ability in neuromuscular scoliosis. Clin Spine Surg 2016;29(8):E413–E420. DOI:10.1097/BSD.0b013e318294368e
  • Ishikawa Y, Miyakoshi N, Hongo M, Kasukawa Y, Kudo D, Shimada Y. Relationships among spinal mobility and sagittal alignment of spine and lower extremity to quality of life and risk of falls. Gait Posture 2017;53:98–103. DOI:10.1016/j.gaitpost.2017.01.011
  • Kado DM, Lui L-Y, Ensrud KE, Fink HA, Karlamangla AS, Cummings SR. Hyperkyphosis predicts mortality independent of vertebral osteoporosis in older women. Ann Intern Med. 2009;150(10):681-687.DOI:10.7326/0003-4819-150-10- 200905190-00005
  • Barrett E, McCreesh K, Lewis J. Reliability and validity of non-radiographic methods of thoracic kyphosis measurement: A systematic review. Man Ther. 2014;19(1):10–17. DOI: 10.1016/j.math.2013.09.003.
  • Briggs AM, Wrigley TV, Tully EA, Adams PE, Greig AM, Bennell KL. Radiographic measures of thoracic kyphosis in osteoporosis: Cobb and vertebral centroid angles. Skeletal Radiol. 2007;36(8):761–767.DOI: 10.1007/s00256-007-0284-8.
  • Lundon KM, Li AM, Bibershtein S. Interrater and intrarater reliability in the measurement of kyphosis in postmenopausal women with osteoporosis. Spine (Phila Pa 1976) 1998;23(18):1978–1985. DOI:10.1097/00007632-199809150-00013.
  • Greendale GA, Nili NS, Huang MH, Seeger L, Karlamangla AS. The reliability and validity of three non-radiological measures of thoracic kyphosis and their relations to the standing radiological Cobb angle. Osteoporos Int. 2011;22(6):1897–1905. DOI: 10.1007/s00198-010-1422-z
  • Roghani T, Khalkhali Zavieh M, Rahimi A, Talebian S, Dehghan Manshadi F, Akbarzadeh Baghban A, King N,Katzman W. The Reliability of standing sagittal measurements of spinal curvature and range of motion in older women with and without hyperkyphosis using a skin-surface device. J Manipulative Physiol Ther 2017;40(9):685–691. DOI: 10.1016/j.jmpt.2017.07.008
  • Gravina A, Ferraro C, Poli P, Barazzuol M, del Felice A, Masiero S. Goniometric evaluation of the spinal sagittal curves in children and adolescents: A reliability study. J Back Musculoskelet Rehabil 2017;30(2):325–331. DOI: 10.3233/BMR-160541.
  • Suwannarat P, Amatachaya P, Sooknuan T, Tochaeng P, Kramkrathok K, Thaweewannakij T,Manimmanakom N, Amatachaya S. Hyperkyphotic measures using distance from the wall : Validity, reliability, and distance from the wall to indicate the risk for thoracic hyperkyphosis and vertebral fracture. Arch Osteoporos 2018;13(1):25. DOI: 10.1007/s11657-018-0433-9
  • Azadinia F, Kamyab M, Behtash H, Ganjavian MS, Javaheri MRM. The validity and reliability of noninvasive methods for measuring kyphosis. J Spinal Disord Tech 2014;27(6):E212–218. DOI:10.1097/BSD.0b013e31829a3574.
  • Otter SJ, Agalliu B, Baer N, Hales G, Harvey K, James K, Keating R, McConnell W, Nelson R, Qureshia S, Ryan S, St.John A, Waddington H, Warren K, Wong D. The Reliability of a smartphone goniometer application compared with a traditional goniometer for measuring first metatarsophalangeal joint dorsiflexion. J Foot Ankle Res. 2015;8:30. DOI 10.1186/s13047-015-0088-3
  • Milanese S, Gordon S, Buettner P, Flavell C, Ruston S, Coe D, O’Sullivan W, McCormak S. Reliability and concurrent validity of knee angle measurement: smart phone app versus universal goniometer used by experienced and novice clinicians. Man Ther 2014;19(6):569–574. DOI: 10.1016/j.math.2014.05.009
  • Werner BC, Holzgrefe RE, Griffin JW, Lyons ML, Cosgrove CT, Hart JM, Brockmeier SF . Validation of an innovative method of shoulder range-of-motion measurement using a smartphone clinometer application. J Shoulder Elb Surg 2014;23(11):e275–282. DOI:10.1016/j.jse.2014.02.030
  • Charlton PC, Mentiplay BF, Pua YH, Clark RA. Reliability and concurrent validity of a smartphone, bubble inclinometer and motion analysis system for measurement of hip joint range of motion. J Sci Med Sport 2015;18(3):262–267. DOI: 10.1016/j.jsams.2014.04.008
  • Waś J, Sitarski D, Ewertowska P, Bloda J, Czaprowski D. Using smartphones in the evaluation of spinal curvatures in a sagittal plane. Postep Rehabil 2016;30(4):29–38.
  • Shahri YFK, Hesar NGZ. Validity and reliability of smartphone-based Goniometer-Pro app for measuring the thoracic kyphosis. Musculoskelet Sci Pract 2020;49:102216. DOI:10.1016/j.msksp.2020.102216
  • de Vet HC, Terwee CB, Ostelo RW, Beckerman H, Knol DL, Bouter LM. Minimal changes in health status questionnaires: distinction between minimally detectable change and minimally important change. Health Qual Life Outcomes 2006;4:54. DOI:10.1186/1477-7525-4-54
  • Terwee CB, Bot SDM, de Boer MR, van der Windt DAWM, Knol DL, Dekker J, Bouter LM, de Vet HCW. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 2007;60(1):34–42. DOI: 10.1016/j.jclinepi.2006.03.012
  • Lewis JS, Valentine RE. Clinical measurement of the thoracic kyphosis. A study of the intra-rater reliability in subjects with and without shoulder pain. BMC Musculoskelet Disord 2010;11:39. DOI: 10.1186/1471-2474-11-39.
  • Walter SD, Eliasziw M, Donner A. Sample size and optimal designs for reliability studies. Stat Med 1998;17(1):101–110. DOI: 10.1002/(sici)1097- 0258(19980115)17:1<101::aid-sim727>3.0.co;2-e
  • Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull 1979;86(2):420–428. DOI: 10.1037//0033-2909.86.2.420
  • Cicchetti DV. Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychol Assess. 1994;6(4):284– 290.DOI:10.1037/1040-3590.6.4.284
  • Eliasziw M, Young SL, Woodbury MG, Fryday-Field K. Statistical methodology for the concurrent assessment of interrater and intrarater reliability: Using goniometric measurements as an example. Phys Ther. 1994;74(8):777–788. DOI: 10.1093/ptj/74.8.777.
  • Lexell JE, Downham DY. How to assess the reliability of measurements in rehabilitation. Am J Phys Med Rehabil 2005;84(9):719–723. DOI: 10.1097/01.phm.0000176452.17771.20.
  • Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986;1(8476):307–310. DOI:10.1016/S0140-6736(86)90837-8
  • Hey HWD, Teo AQA, Tan KA, Ng LWN, Lau LL, Liu KPG, Wong HK. How the spine differs in standing and in sitting-important considerations for correction of spinal deformity. Spine J 2017;17(6):799–806. DOI: 10.1016/j.spinee.2016.03.056.
  • Hinman MR. Comparison of thoracic kyphosis and postural stiffness in younger and older women. Spine J 2004;4(4):413–417. DOI: 10.1016/j.spinee.2004.01.002
  • McAlinden C, Khadka J, Pesudovs K. Statistical methods for conducting agreement (comparison of clinical tests) and precision (repeatability or reproducibility) studies in optometry and ophthalmology. Ophthalmic Physiol Opt. 2011;31(4):330–338. DOI: 10.1111/j.1475-1313.2011.00851.x.
  • Kolber MJ, Pizzini M, Robinson A, Yanez D, Hanney WJ. The reliability and concurrent validity of measurements used to quantify lumbar spine mobility: An analysis of an iphone® application and gravity based inclinometry. Int J Sports Phys Ther. 2013;8(2):129–137.

Year 2023, , 511 - 516, 11.09.2023

Ertan Şahinoğlu , Gülbin Ergin , Serkan Bakırhan , Bayram Ünver

https://doi.org/10.33808/clinexphealthsci.1038122

Abstract

References

  • Perriman DM, Scarvell JM, Hughes AR, Ashman B, Lueck CJ, Smith PN. Validation of the flexible electrogoniometer for measuring thoracic kyphosis. Spine (Phila Pa 1976) 2010;35(14):E633–640. DOI:10.1097/BRS.0b013e3181d13039
  • Barrett E, O’Keeffe M, O’Sullivan K, Lewis J, McCreesh K. Is thoracic spine posture associated with shoulder pain, range of motion and function? A systematic review. Man Ther 2016;26:38–46. DOI:10.1016/j.math.2016.07.008.
  • Sinaki M, Brey RH, Hughes CA, Larson DR, Kaufman KR. Balance disorder and increased risk of falls in osteoporosis and kyphosis: Significance of kyphotic posture and muscle strength. Osteoporos Int 2005;16(8):1004–1010. DOI: 10.1007/s00198- 004-1791-2
  • Kim DY, Moon ES, Park JO, Chong HS, Lee HM, Moon SH, Kim SH, Kim HS. The thoracic lordosis correction improves sacral slope and walking ability in neuromuscular scoliosis. Clin Spine Surg 2016;29(8):E413–E420. DOI:10.1097/BSD.0b013e318294368e
  • Ishikawa Y, Miyakoshi N, Hongo M, Kasukawa Y, Kudo D, Shimada Y. Relationships among spinal mobility and sagittal alignment of spine and lower extremity to quality of life and risk of falls. Gait Posture 2017;53:98–103. DOI:10.1016/j.gaitpost.2017.01.011
  • Kado DM, Lui L-Y, Ensrud KE, Fink HA, Karlamangla AS, Cummings SR. Hyperkyphosis predicts mortality independent of vertebral osteoporosis in older women. Ann Intern Med. 2009;150(10):681-687.DOI:10.7326/0003-4819-150-10- 200905190-00005
  • Barrett E, McCreesh K, Lewis J. Reliability and validity of non-radiographic methods of thoracic kyphosis measurement: A systematic review. Man Ther. 2014;19(1):10–17. DOI: 10.1016/j.math.2013.09.003.
  • Briggs AM, Wrigley TV, Tully EA, Adams PE, Greig AM, Bennell KL. Radiographic measures of thoracic kyphosis in osteoporosis: Cobb and vertebral centroid angles. Skeletal Radiol. 2007;36(8):761–767.DOI: 10.1007/s00256-007-0284-8.
  • Lundon KM, Li AM, Bibershtein S. Interrater and intrarater reliability in the measurement of kyphosis in postmenopausal women with osteoporosis. Spine (Phila Pa 1976) 1998;23(18):1978–1985. DOI:10.1097/00007632-199809150-00013.
  • Greendale GA, Nili NS, Huang MH, Seeger L, Karlamangla AS. The reliability and validity of three non-radiological measures of thoracic kyphosis and their relations to the standing radiological Cobb angle. Osteoporos Int. 2011;22(6):1897–1905. DOI: 10.1007/s00198-010-1422-z
  • Roghani T, Khalkhali Zavieh M, Rahimi A, Talebian S, Dehghan Manshadi F, Akbarzadeh Baghban A, King N,Katzman W. The Reliability of standing sagittal measurements of spinal curvature and range of motion in older women with and without hyperkyphosis using a skin-surface device. J Manipulative Physiol Ther 2017;40(9):685–691. DOI: 10.1016/j.jmpt.2017.07.008
  • Gravina A, Ferraro C, Poli P, Barazzuol M, del Felice A, Masiero S. Goniometric evaluation of the spinal sagittal curves in children and adolescents: A reliability study. J Back Musculoskelet Rehabil 2017;30(2):325–331. DOI: 10.3233/BMR-160541.
  • Suwannarat P, Amatachaya P, Sooknuan T, Tochaeng P, Kramkrathok K, Thaweewannakij T,Manimmanakom N, Amatachaya S. Hyperkyphotic measures using distance from the wall : Validity, reliability, and distance from the wall to indicate the risk for thoracic hyperkyphosis and vertebral fracture. Arch Osteoporos 2018;13(1):25. DOI: 10.1007/s11657-018-0433-9
  • Azadinia F, Kamyab M, Behtash H, Ganjavian MS, Javaheri MRM. The validity and reliability of noninvasive methods for measuring kyphosis. J Spinal Disord Tech 2014;27(6):E212–218. DOI:10.1097/BSD.0b013e31829a3574.
  • Otter SJ, Agalliu B, Baer N, Hales G, Harvey K, James K, Keating R, McConnell W, Nelson R, Qureshia S, Ryan S, St.John A, Waddington H, Warren K, Wong D. The Reliability of a smartphone goniometer application compared with a traditional goniometer for measuring first metatarsophalangeal joint dorsiflexion. J Foot Ankle Res. 2015;8:30. DOI 10.1186/s13047-015-0088-3
  • Milanese S, Gordon S, Buettner P, Flavell C, Ruston S, Coe D, O’Sullivan W, McCormak S. Reliability and concurrent validity of knee angle measurement: smart phone app versus universal goniometer used by experienced and novice clinicians. Man Ther 2014;19(6):569–574. DOI: 10.1016/j.math.2014.05.009
  • Werner BC, Holzgrefe RE, Griffin JW, Lyons ML, Cosgrove CT, Hart JM, Brockmeier SF . Validation of an innovative method of shoulder range-of-motion measurement using a smartphone clinometer application. J Shoulder Elb Surg 2014;23(11):e275–282. DOI:10.1016/j.jse.2014.02.030
  • Charlton PC, Mentiplay BF, Pua YH, Clark RA. Reliability and concurrent validity of a smartphone, bubble inclinometer and motion analysis system for measurement of hip joint range of motion. J Sci Med Sport 2015;18(3):262–267. DOI: 10.1016/j.jsams.2014.04.008
  • Waś J, Sitarski D, Ewertowska P, Bloda J, Czaprowski D. Using smartphones in the evaluation of spinal curvatures in a sagittal plane. Postep Rehabil 2016;30(4):29–38.
  • Shahri YFK, Hesar NGZ. Validity and reliability of smartphone-based Goniometer-Pro app for measuring the thoracic kyphosis. Musculoskelet Sci Pract 2020;49:102216. DOI:10.1016/j.msksp.2020.102216
  • de Vet HC, Terwee CB, Ostelo RW, Beckerman H, Knol DL, Bouter LM. Minimal changes in health status questionnaires: distinction between minimally detectable change and minimally important change. Health Qual Life Outcomes 2006;4:54. DOI:10.1186/1477-7525-4-54
  • Terwee CB, Bot SDM, de Boer MR, van der Windt DAWM, Knol DL, Dekker J, Bouter LM, de Vet HCW. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 2007;60(1):34–42. DOI: 10.1016/j.jclinepi.2006.03.012
  • Lewis JS, Valentine RE. Clinical measurement of the thoracic kyphosis. A study of the intra-rater reliability in subjects with and without shoulder pain. BMC Musculoskelet Disord 2010;11:39. DOI: 10.1186/1471-2474-11-39.
  • Walter SD, Eliasziw M, Donner A. Sample size and optimal designs for reliability studies. Stat Med 1998;17(1):101–110. DOI: 10.1002/(sici)1097- 0258(19980115)17:1<101::aid-sim727>3.0.co;2-e
  • Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull 1979;86(2):420–428. DOI: 10.1037//0033-2909.86.2.420
  • Cicchetti DV. Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychol Assess. 1994;6(4):284– 290.DOI:10.1037/1040-3590.6.4.284
  • Eliasziw M, Young SL, Woodbury MG, Fryday-Field K. Statistical methodology for the concurrent assessment of interrater and intrarater reliability: Using goniometric measurements as an example. Phys Ther. 1994;74(8):777–788. DOI: 10.1093/ptj/74.8.777.
  • Lexell JE, Downham DY. How to assess the reliability of measurements in rehabilitation. Am J Phys Med Rehabil 2005;84(9):719–723. DOI: 10.1097/01.phm.0000176452.17771.20.
  • Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986;1(8476):307–310. DOI:10.1016/S0140-6736(86)90837-8
  • Hey HWD, Teo AQA, Tan KA, Ng LWN, Lau LL, Liu KPG, Wong HK. How the spine differs in standing and in sitting-important considerations for correction of spinal deformity. Spine J 2017;17(6):799–806. DOI: 10.1016/j.spinee.2016.03.056.
  • Hinman MR. Comparison of thoracic kyphosis and postural stiffness in younger and older women. Spine J 2004;4(4):413–417. DOI: 10.1016/j.spinee.2004.01.002
  • McAlinden C, Khadka J, Pesudovs K. Statistical methods for conducting agreement (comparison of clinical tests) and precision (repeatability or reproducibility) studies in optometry and ophthalmology. Ophthalmic Physiol Opt. 2011;31(4):330–338. DOI: 10.1111/j.1475-1313.2011.00851.x.
  • Kolber MJ, Pizzini M, Robinson A, Yanez D, Hanney WJ. The reliability and concurrent validity of measurements used to quantify lumbar spine mobility: An analysis of an iphone® application and gravity based inclinometry. Int J Sports Phys Ther. 2013;8(2):129–137.
There are 33 citations in total.

Details

Primary Language English
Subjects Health Services and Systems (Other)
Journal Section Articles
Authors

Ertan Şahinoğlu 0000-0002-1755-9922

Gülbin Ergin 0000-0002-0469-6936

Serkan Bakırhan 0000-0003-0044-8203

Bayram Ünver 0000-0002-9829-5884

Publication Date September 11, 2023
Submission Date December 17, 2021
Published in Issue Year 2023

Cite

APA Şahinoğlu, E., Ergin, G., Bakırhan, S., Ünver, B. (2023). Reliability, Concurrent Validity, and Minimal Detectable Change of a Smartphone Application for Measuring Thoracic Kyphosis. Clinical and Experimental Health Sciences, 13(3), 511-516. https://doi.org/10.33808/clinexphealthsci.1038122
AMA Şahinoğlu E, Ergin G, Bakırhan S, Ünver B. Reliability, Concurrent Validity, and Minimal Detectable Change of a Smartphone Application for Measuring Thoracic Kyphosis. Clinical and Experimental Health Sciences. September 2023;13(3):511-516. doi:10.33808/clinexphealthsci.1038122
Chicago Şahinoğlu, Ertan, Gülbin Ergin, Serkan Bakırhan, and Bayram Ünver. “Reliability, Concurrent Validity, and Minimal Detectable Change of a Smartphone Application for Measuring Thoracic Kyphosis”. Clinical and Experimental Health Sciences 13, no. 3 (September 2023): 511-16. https://doi.org/10.33808/clinexphealthsci.1038122.
EndNote Şahinoğlu E, Ergin G, Bakırhan S, Ünver B (September 1, 2023) Reliability, Concurrent Validity, and Minimal Detectable Change of a Smartphone Application for Measuring Thoracic Kyphosis. Clinical and Experimental Health Sciences 13 3 511–516.
IEEE E. Şahinoğlu, G. Ergin, S. Bakırhan, and B. Ünver, “Reliability, Concurrent Validity, and Minimal Detectable Change of a Smartphone Application for Measuring Thoracic Kyphosis”, Clinical and Experimental Health Sciences, vol. 13, no. 3, pp. 511–516, 2023, doi: 10.33808/clinexphealthsci.1038122.
ISNAD Şahinoğlu, Ertan et al. “Reliability, Concurrent Validity, and Minimal Detectable Change of a Smartphone Application for Measuring Thoracic Kyphosis”. Clinical and Experimental Health Sciences 13/3 (September 2023), 511-516. https://doi.org/10.33808/clinexphealthsci.1038122.
JAMA Şahinoğlu E, Ergin G, Bakırhan S, Ünver B. Reliability, Concurrent Validity, and Minimal Detectable Change of a Smartphone Application for Measuring Thoracic Kyphosis. Clinical and Experimental Health Sciences. 2023;13:511–516.
MLA Şahinoğlu, Ertan et al. “Reliability, Concurrent Validity, and Minimal Detectable Change of a Smartphone Application for Measuring Thoracic Kyphosis”. Clinical and Experimental Health Sciences, vol. 13, no. 3, 2023, pp. 511-6, doi:10.33808/clinexphealthsci.1038122.
Vancouver Şahinoğlu E, Ergin G, Bakırhan S, Ünver B. Reliability, Concurrent Validity, and Minimal Detectable Change of a Smartphone Application for Measuring Thoracic Kyphosis. Clinical and Experimental Health Sciences. 2023;13(3):511-6.

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