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Reliability of iPhone app for measuring the lunge test

Discussion in 'General Issues and Discussion Forum' started by NewsBot, Mar 15, 2013.

  1. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1

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    The TiltMeter app is a novel and accurate measurement tool for the weight bearing lunge test
    Cylie M. Williams, Antoni J. Caserta, Terry P. Haines
    Journal of Science and Medicine in Sport (in press)
     
  2. David Smith

    David Smith Well-Known Member

    One has to ask, What's the Point?

    Dave
     
  3. Bruce Williams

    Bruce Williams Well-Known Member

    Dave,
    While I don't disagree with you, the lunge test is "accepted" by most practitioners as a reliable measurement of AJ ROM.
    I think it is probably more useful with assessing athletes, than the general walking population.
    Cheers,
    Bruce
     
  4. David Smith

    David Smith Well-Known Member

    Yeah what I meant by that Bruce was what was the point in doing the research to validate a measurement from the iPhone inclinometer app that can be done just as easily or easier using a goniometer (no app required). What degree of precision do we need to judge that the ankle dorsiflexes enough in the lunge test? Even if we can measure with precision how do we then judge with precision what is the actual RoM we are measuring, i.e. is it purley dorsiflexion or is the percieved dorsiflexion really some function of pronation (eversion, dorsiflexion and abduction)?

    Just because you have a reliable measuring device doesn't automatically mean you can measure reliably

    Dave
     
    Last edited: Mar 15, 2013
  5. Bug

    Bug Well-Known Member

    We are using the lunge test more and more in research to better understand how certain conditions affect the foot and ankle. The lunge test is one of the suite of tests that is shown to be a reliable measure of ankle range change.

    Goni's arent accurate enough, they move too much and the are a PITA when you want a number so the digital inclinometer is often purchased at a cost to both the service or the funding body. A lot of people have iphones. This project was to see if we could use those instead and save some $$. It wasn't funded (apart from wages) so no "real" research lost funding to have waste our time on it.

    Is this applicable to general practice? Well I guess it is how you practice and your demographic. I see a lot of toe walkers and want to know if my treatment is working over time. If I have measured and get a 10-15 degree difference with a tool I am confident is using, I am confident in my treatment.

    Sure there are a lot of flaws in that argument and process but it is better than nothing.
     
  6. David Smith

    David Smith Well-Known Member

    Ok Cylie

    It's good to have a handle on your pseudonym (any relation to Bruce?)

    I understand why you want to defend the research and there's nothing wrong with it in itself. However your research question was 'Is the iPhone tiltmeter a reliable tool to use to measure ankle dorsiflexion in the lunge test'

    First off note that I don't have access to the full paper so some of these next things may be explained there:

    So, it was already established that the lunge test is useful and reliable in terms of determining a change in useful ankle dorsiflexion RoM regardless of whether or not the actual RoM measured was purely dorsiflexion or was a component of pronation.

    So really all that was required was to calibrate the iPhone tiltmeter against a standard certified tool. Then publish the precision and accuracy in terms of resolution, full scale error, linearity and hysteresis. The reader would then know it is a reliable tool to measure any angular displacement in terms of the references of the ground and gravity i.e a tilt.

    Using the iPhone tiltmeter didn't increase or decrease inter or intra tester/rater reliability because it was not able to do this, it only could reflect the same data as the digital inclinometer, which I assume was your standard tool for calibration of the iPhone. (Was it?) So, I think and perhaps I'm wrong but I don't think so, therefore that any comparative statistical analysis of this was invalid.

    So just to be more clear, the inclinometers measure tilt in one single plane of interest. How that displacement is achieved is not discernible from the data provided. The data characterises ankle dorsiflexion in a convenient way and removes or filters other confounding data like how much inversion and abduction was included in the actual action.

    Therefore the rater or tester reliability comes mostly from their ability to judge between what is actual dorsiflexion and not some illusion of dorsiflexion once the measuring tool error has been eliminated, which it has by using the inclinometer as opposed to a goniometer. So if you use two types of inclinometer there can be no inter or intra operator error outside the error of the instrument itself.

    I don't know what the precision, and error is of the goniometer when calibrated against the digital inclinometer when measuring pure angular displacement. I would have thought the precision would be reliant on the marked increments and the size of the gauge and error would be due to some play in the mechanism. If a precision goniometer was used I would expect there to be a precision of 0.5 degrees and and error less than that. Full scale error, because of the type of instrument, would not vary much either I wouldn't think. So error when using a goniometer would most likely come from estimating what exactly is the dorsiflexion component content of the visible ankle RoM deflection..

    Would an error in measurment of 1 degree, that might be an error when using a goniometer, be enough to dissuade you that your treatment was a success? Wouldn't you use other outcome criteria?


    Regards Dave
     
  7. David Smith

    David Smith Well-Known Member

    OooH! PITA, Pain in the ---- DoH! I was trying to work out a technical acronym. :confused:

    Dave
     
  8. Bug

    Bug Well-Known Member

    Sorry Dave, nothing technical about PITA, you got it. I was talking about the little gravity ones that you purchase for $30. Want me to send you the full paper? You've posted a whole heap of questions, most of which are in the paper. Not at all here to defend, doesn't worry me either way. Just thought you had some questions that I might be able to expand upon. To lunge or not, doesn't worry me.

    I think people either use or don't use the lunge test for various reasons. For me, pronation is part of dorsiflexion so while you position the foot to minimise the effect, you will still have some. There is still no fool proof method however this one is a big improvement on the "push and see how much you will get" approach. We just wanted to see if we could use an app and have comparable results to the digital inclinometer, or the tool that is generally quoted within research as the tool of measurement choice. This gives young researchers with minimal budgets then an alternative and cheap option, and one that still gives the same outputs that are required for measurement. Simple publications are coming out about spinal measurement and knee measurement so for sports/researchers or measurement happy clinicians, this may be useful.

    As far as measurement as outcome, it is only one of the tools in the box and never one that is solely relied on.

    As for Bruce? Now my turn....I'm a little blond at times, might need to spell it out for me. :D
     
  9. David Smith

    David Smith Well-Known Member

    Bruce Williams - Cylie Williams

    Paper to david@foothouse.co.uk please

    Dave
     
  10. Bruce Williams

    Bruce Williams Well-Known Member

    Clie is No relation and not my alter ego, sorry Dave.
    Cheers
    The "real" Bruce Williams
     
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    NewsBot The Admin that posts the news.

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