A randomised cross over study to evaluate the performance of a novel ankle dorsiflexion measurement device for novice users

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Abstract

Background

The ankle joint is a common site of musculoskeletal pathology. Measurement of its functional range of motion is a primary indicator for rehabilitation outcomes in therapy settings. The present study was designed to assess reliability and validity of a new standardised method using a D-Flex device to assess ankle range of motion.

Methods

A cohort of 20 healthy volunteers were recruited to measure the weight-bearing ankle range of motion using three assessment tools, namely, a goniometer, inclinometer and the D-Flex measurement devices. Repeated measures were performed both between and within observers for each device over a 48 h period. Performance evaluation of each device and their reliability was assessed using intra-class correlation coefficients and Bland and Altman plots.

Results

Although significant correlations ( p < 0.05) were observed between devices, there were large mean differences in ankle range of motion values ranging from 4.3°-15.7°. The D-flex produced the highest inter- and intra-rater reliability (ICCs 0.76–0.95), compared to values of 0.55–0.85 and 0.32–0.71 for the goniometer and inclinometer, respectively. The Bland and Altman plots revealed a low mean observer difference for the D-Flex (mean difference = 0.7°), with the vast majority of data coincident within the 95% confidence intervals. For both the goniometer and inclinometer mean differences were higher, with values of 3.1° and 5.7° respectively.

Conclusion

The results of the present study provide evidence to support the use of the D-Flex system as a valid, portable, and easy to use alternative to the weight-bearing lunge test when assessing ankle dorsiflexion ROM in healthy participants.

Related collections

Most cited references 26

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Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM.

Joseph P Weir (2005)

Reliability, the consistency of a test or measurement, is frequently quantified in the movement sciences literature. A common metric is the intraclass correlation coefficient (ICC). In addition, the SEM, which can be calculated from the ICC, is also frequently reported in reliability studies. However, there are several versions of the ICC, and confusion exists in the movement sciences regarding which ICC to use. Further, the utility of the SEM is not fully appreciated. In this review, the basics of classic reliability theory are addressed in the context of choosing and interpreting an ICC. The primary distinction between ICC equations is argued to be one concerning the inclusion (equations 2,1 and 2,k) or exclusion (equations 3,1 and 3,k) of systematic error in the denominator of the ICC equation. Inferential tests of mean differences, which are performed in the process of deriving the necessary variance components for the calculation of ICC values, are useful to determine if systematic error is present. If so, the measurement schedule should be modified (removing trials where learning and/or fatigue effects are present) to remove systematic error, and ICC equations that only consider random error may be safely used. The use of ICC values is discussed in the context of estimating the effects of measurement error on sample size, statistical power, and correlation attenuation. Finally, calculation and application of the SEM are discussed. It is shown how the SEM and its variants can be used to construct confidence intervals for individual scores and to determine the minimal difference needed to be exhibited for one to be confident that a true change in performance of an individual has occurred.

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A Anandacoomarasamy, L Barnsley (2005)

Ankle sprains are common sporting injuries generally believed to be benign and self limiting. However, some studies report a significant proportion of patients with ankle sprains having persistent symptoms for months or even years. To determine the proportion of patients presenting to an Australian sports medicine clinic who had long term symptoms after a sports related inversion ankle sprain. Consecutive patients referred to the NSW Institute of Sports Medicine from August 1999 to August 2002 with inversion ankle sprain were included. Exclusion criteria were fracture, ankle surgery, or concurrent lower limb problems. A control group, matched for age and sex, was recruited from patients attending the clinic for upper limb injuries in the same time period. Current ankle symptoms, ankle related disability, and current health status were ascertained through a structured telephone interview. Nineteen patients and matched controls were recruited and interviewed. The mean age in the ankle group was 20 (range 13-28). Twelve patients (63%) were male. Average follow up was 29 months. Only five (26%) ankle injured patients had recovered fully, with no pain, swelling, giving way, or weakness at follow up. None of the control group reported these symptoms (p<0.0001). Assessments of quality of life using short form-36 questionnaires (SF36) revealed a difference in the general health subscale between the two groups, favouring the control arm (p<0.05). There were no significant differences in the other SF36 subscales between the two groups. Most patients who sustained an inversion ankle injury at sport and who were subsequently referred to a sports medicine clinic had persistent symptoms for at least two years after their injury. This reinforces the importance of prevention and early effective treatment.

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Intra-rater and inter-rater reliability of a weight-bearing lunge measure of ankle dorsiflexion

Kim Louise Bennell, Richard Talbot, Henry Wajswelner … (1998)

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Author and article information

Contributors

Peter R. Worsley:

ORCID: http://orcid.org/0000-0003-0145-5042

p.r.worsley@soton.ac.uk

Journal

Journal ID (nlm-ta): J Foot Ankle Res

Journal ID (iso-abbrev): J Foot Ankle Res

Title: Journal of Foot and Ankle Research

Publisher: BioMed Central (London )

ISSN (Electronic): 1757-1146

Publication date (Electronic): 31 July 2018

Publication date PMC-release: 31 July 2018

Publication date Collection: 2018

Volume: 11

Electronic Location Identifier: 45

Affiliations

ISNI 0000 0004 1936 9297, GRID grid.5491.9, Clinical Academic Facility, Faculty of Health Sciences, , University of Southampton, ; Southampton, SO17 1BJ UK

Author information

Peter R. Worsley http://orcid.org/0000-0003-0145-5042

Article

Publisher ID: 286

DOI: 10.1186/s13047-018-0286-x

PMC ID: 6069889

PubMed ID: 30083236

SO-VID: faef1d64-c5c9-475b-8926-d0a5da468462

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 20 March 2018

Date accepted : 19 July 2018

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100000266, Engineering and Physical Sciences Research Council;

Award ID: EP/N02723X/1

Award Recipient : Dan L. Bader

Custom metadata

ScienceOpen disciplines: Orthopedics

Keywords: ankle dorsiflexion,reliability,goniometer,inclinometer,range of motion

Data availability: