A Mobile App to Replace the Goniometer? A Pilot Study Focusing on the Measurement of Knee Range of Movement

Background: The universal goniometer is commonly used to measure knee range of movement in clinical practice. However, research has demonstrated that the universal goniometer lacks reliability failing to meet the standard of clinically acceptable error (5°). Objective: This study tested the concurrent validity and intra-rater reliability of a photographic based “app” developed for feedback in sport, the Hudl Ubersense App, as an alternative instrument for measuring knee range of movement. Methods: Measurements of knee range of movement were made concurrently with the electrogoniometer (the gold standard) and the Hudl Ubersense App across a pre-determined randomised set of 20 functional knee angles between 35° and 130°. This was then repeated. The pre-agreed standard of concurrent validity was that 95% of Hudl Ubersense App measurements would be within 5° of the electrogoniometer and differences were displayed in Bland-Altman plots. Results: Thirty nine (97%) of the forty app readings differed from the corresponding electrogoniometer readings by less than 5°. The mean differences between the electrogoniometer and Hudl Ubersense App measurements over each trial were 1.75° and 0.80° respectively, indicating a high level of concurrent validity. There was less than 1.0° mean difference between the first and second set of results indicating a high level of intra-rater reliability. Conclusions: The results suggest that the Hudl Ubersense App has high levels of concurrent validity (using the electrogoniometer as the gold standard) and intra-rater reliability, scoring better than previous research on the current clinical measuring device, the universal goniometer. The Hudl Ubersense App has clinical advantages over the electrogoniometer, so further research is recommended to determine its inter-rater reliability, acceptability, and appropriate clinical practice procedures.