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ResearchKit’s Range of Motion task becomes an ideal choice to substitute the traditional Goniometer and inclinometer. The application guides the participant with the placement of the device and provides movement instructions to measure the extendibility of these two joints

The Qolty Mobile Assessments utilizes the Apple ResearchKit™ framework  to define a large number of predefined tasks in six broad categories: motor activities, fitness, cognition, voice, audio, and hand dexterity. We utilize these functions for your use in your study, making it easy to capture objectively reported data from your patients.

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Introduction

Flexibility is an important aspect of fitness that can greatly impact the quality of life of an individual. The Range of Motion measures the flexibility and capability of a joint to cover the maximum distance achievable. An individual’s diminished range of motion can result from injuries, swelling, pain and stiffness or diseases such as Arthritis. The Range of Motion assessments can be carried with or without support. Passive Range of Motion describes the movement of inactive joint by a therapist, while Active Range of Motion is movements that are performed solely by the individual. Assessments can also be Active-Assistive in nature, wherein the movements are performed with some manual assistance from the therapist or a strap or a band.

Goniometer and inclinometer are devices that are traditionally used in the measurement of range of motion, which is usually measured in degrees. However, with technology allowing easier and more precise measurements — ResearchKit’s Range of Motion task becomes an ideal choice.

Methods

The Range of Motion is commonly measured using a goniometer. The center of the goniometer is placed at the joint, with its arms extending on either end in alignment with the center of the bones. The administrator performs the assessment either as a Passive task, Active task or as an Active-Assistive task by having the joint flexed and extended. Another tool used is the inclinometer that assists with measures of spinal angle. Tape measures are also sometimes used in the assessment of the range of motion.

Active Task: Range of Motion

The range of motion measures the movement around a specific joint. This predefined Active task of the ResearchKit Framework measures the range of motion for shoulders and knees. The application guides the participant with the placement of the device and provides movement instructions to measure the extendibility of these two joints. This activity uses the accelerometer and gyroscope sensors of the iPhone to collect data via device motion.

Range of Motion task instructions

  1. Sit down on the edge of a chair for knee measure. Take a comfortable position for shoulder measure.
  2. Ensure that the sound is ‘ON’ on your device.
  3. Place the device on the knee/shoulder, screen facing out.
  4. Tap the screen to begin the task.
  5. Extend the knee/shoulder as far as possible.
  6. Tap the screen again when the task is complete.
  7. Repeat for the other knee/shoulder.
  8. Task completed.

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Applications

Thoracic Kyphosis

Kanlayanaphotporn (2014) evaluated the impact of slouched sitting on shoulder range of motions. Participants with no history of shoulder problems in the last six months before the test were evaluated in three different sitting positions (Erect, Comfortable Slouch and Maximum slouch). For each sitting posture, the subject was asked to move their right shoulder in 4 directions (flexion, abduction, external rotation, and internal rotation) in 90o of

shoulder abduction. At the slouched position, the mean reduction in shoulder external rotation was nearly 30% of that measured in the erect posture. Shoulder internal rotation was increased with increased thoracic kyphosis.

Swimming Fatigue

Matthews et al., 2017  evaluated competitive swimmers to investigate the effects of training-induced fatigue on shoulder range of motion. The range of motion assessment was performed at the glenohumeral joint with the arm abducted to 90°, and elbow flexed at 90° while lying on a mobile plinth. The internal and external range of motion assessment was performed before and after the participants 8 x 100 m training set. A significant reduction in the external range of motion in both arms of the swimmers was observed post-fatigue.

Knee Arthroplasty

Bade et al., 2014 studied the range of motion in the knees of patients with end-stage osteoarthritis pre- and post- knee arthroplasty. Active knee extension and active flexion range of motion were assessed by placing a raised block under the patient’s heel and then they were asked to extend/flex the knee maximally. Based on the results, preoperative knee flexion and preoperative knee extension were shown to be predictive of long-term knee flexion and long-term knee extension respectively.

Cam Deformity

Tak et al., 2016 studied the effect of cam deformity using the hip range of motion assessment in soccer players. Hip range of motion was assessed for hip internal rotation, external rotation and for bent knee fall out, before the training session and without warming up. Participants with cam deformity showed less internal rotation and total rotation values, and a higher bent knee fall-out value. Although, these values were not significant.

Sports

Malliaropoulos et al., 2015 assessed the active range of motion of posterior thigh flexibility in field and track athletes. The assessments were performed once every two months for six months. Although not significant, male runners and jumpers had comparatively higher mean active range of motion than throwers. On the other hand, female jumpers showed a higher active range of motion than runners and throwers.

Results and Data Analysis

The data collected from Range of Motion assessment is the degree to which a joint can flex and extend. Other observations that can be made during the assessment include pain and ease with which the task is performed.

The following sample graph shows the range of motion during shoulder abduction and flexion in three sitting postures.

The following sample graph shows the range of motion during shoulder abduction and flexion in three sitting postures.

Strengths and Limitations

Strengths

The Range of Motion is a simple method of analysis for assessing the flexibility of joints. ResearchKit’s Range of Motion task can cut the cost of equipment (goniometer and inclinator) that is generally employed for the test. Active Range of Motion measures muscular strain, while passive Range of Motion measures ligament sprains. The assessment assists in developing therapies and in understanding the progression of diseases such as Arthritis.

Limitations

The assessment is prone to human errors. This can be overcome by using ResearchKit’s Range of Motion task.

Summary

  • The Range of Motion measures the flexibility and capability of a joint to cover the maximum distance achievable.
  • Passive Range of Motion describes the movement of inactive joint by a therapist.
  • Active Range of Motion are movements that are performed solely by the individual.
  • Active-Assistive Range of Motion are movements that are performed with some manual assistance.
  • Goniometer and inclinometer are traditionally used tools in Range of Motion.
  • The range of assessment assists with developing physical therapies.

References

Bade MJ, Kittelson JM, Kohrt WM, Stevens-Lapsley JE (2014). Predicting functional performance and range of motion outcomes after total knee arthroplasty. Am J Phys Med Rehabil. 93(7):579-85. doi: 10.1097/PHM.0000000000000065.

Kanlayanaphotporn R (2014). Changes in sitting posture affect shoulder range of motion. J Bodyw Mov Ther. 18(2):239-43. doi: 10.1016/j.jbmt.2013.09.008.

Malliaropoulos N, Kakoura L, Tsitas K, Christodoulou D, Siozos A, Malliaras P, Maffulli N (2015). Active knee range of motion assessment in elite track and field athletes: normative values. Muscles Ligaments Tendons J. 5(3):203-7. doi: 10.11138/mltj/2015.5.3.203.

Matthews MJ, Green D, Matthews H, Swanwick E (2017). The effects of swimming fatigue on shoulder strength, range of motion, joint control, and performance in swimmers. Phys Ther Sport. 23:118-122. doi: 10.1016/j.ptsp.2016.08.011.

Ritter, S. (2014). Apples Research Kit Development Framework for iPhone Apps Enables Innovative Approaches to Medical Research Data Collection. Journal of Clinical Trials, 05(02). doi:10.4172/2167-0870.1000e120

Tak I, Glasgow P, Langhout R, Weir A, Kerkhoffs G, Agricola R (2016). Hip Range of Motion Is Lower in Professional Soccer Players With Hip and Groin Symptoms or Previous Injuries, Independent of Cam Deformities. Am J Sports Med. 2016 Mar;44(3):682-8. doi: 10.1177/0363546515617747.