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The paper can be potentially accepted. A reviewer still has some comments. Please revise and give a one-to-one response.
The updated manuscript is clearer and more 'relevant' in its literature use.
This is a reliability study reviewing outcomes from a smart-phone App when used by different people over different days. The test-retest design answers the relaibility but does not determine if the measure is true (e.g. validity of the device).
Appear sound
Thank you for your attention to the previously raised issues with this manuscript. I hope you agree that it is a more robust article for the effort.
I am surprised at the author's decision to not test the App against known angles (or compare with a goniometre) and calculate validity. This would take less than an hour to conduct/analyse and would give the study credibility. As it stands, the authors have taken considerable effort to determine that a phone App can measure the same outcome (moderately at least) when used by different people but there is nothing to show that it measures correct angles.
The other concern (minor) is that there is still not enough information regarding the App used for readers to understand how they access it. Can the authors please indicate if the App comes pre-installed in Android phones or requires downloading separately (and if so, is there a cost involved) and credit the developers please. I note the third reviewer also commented on this.
No comment.
No comment.
No comment.
I have no further comments on this article. The authors have thoroughly revised the manuscript according to the reviewers comments and suggestions.
Non
Non
Non
Most of the comments have been corrected
Thank you
We received three consistent reviews for the paper. Although reviewers identified some merits of the paper, there are a number of issues that need to be rectified. Note that reviewer recommended references should only be cited if they are essential. Be sure that the ignorance of unjustified references won’t affect the final outcome of reviews on the revision.
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The reporting is clear but insufficient in its use of existing evidence in some areas. I have covered this more completely in the last section.
The research is well within the Aims and Scope of the journal of submission. The research question is well defined. There are some concerns with how it rationales the 'gap' it fills by not referring to current evidence in the field. The method of investigation needs further explanation but maybe appropriate if described more fully.
The findings add to a body of knowledge on the use of smartphones. Further information is needed in the methods to determine the reach or interest it may have. Data has been provided. Analysis requires some attention but what has been completed appears robust. Conclusion is sound.
Thank you for the opportunity to review the manuscript “Reliability of the functional ankle dorsiflexion range of motion measurement in young adults”. The article is well written, however there are some concerns that are prohibiting the recommendation for publication at this point.
Major concern: the measure capabilities of the app are not being compared to standard practice or ‘gold standard’ measures (e.g. analogue or digital inclinometers). The reliability of the app is not in question but the authors need to be very clear that this does not guarantee the outcomes are valid. The app could consistently measure incorrectly. Determining validity of the app against a known standard is strongly recommended prior to continuing for publication. This can be done comparing outcomes of the app to known angles (e.g. compare the app to a digital inclinometer and 0 degrees, 15 degrees and 45 degrees using solid and immovable reference points, such as inclinations on ramps).
Second recommendation would be to reduce the use of abbreviations, particularly non-standardised abbreviations such as ADROM. It introduces a risk of confusion, breaks sentence flow for the reader and rarely has an adequate effect on word count to be of value. I would recommend the abbreviation be replaced with ankle dorsiflexion ROM throughout. Furthermore, it may be prudent to identify the measure as weight bearing (e.g. weight-bearing ankle dorsiflexion ROM).
Final issue is that much of the literature cited in the background and discussion is > 5 years old. Many newer publications review Android and IOS apps in adults and children. It would be good to update some references, particularly as the Tilt-meter app, which is mentioned several times throughout the manuscript, was decommissioned in 2018.
Abstract
including the number of measures made and more information on the participant cohort would benefit.
Background
Good rationale for the need to measure weight-bearing ankle dorsiflexion ROM is given. Further breadth of referencing could be done for the last section where it is currently limited to Williams et al., for using IOS based measures given many other studies have investigated ankle dorsiflexion – e.g:
IOS measures of weight bearing ankle dorsiflexion:
Banwell, H.A., Uden, H., Marshall, N. et al. The iPhone Measure app level function as a measuring device for the weight bearing lunge test in adults: a reliability study. J Foot Ankle Res 12, 37 (2019). https://doi.org/10.1186/s13047-019-0347-9
Carlos Balsalobre-Fernández, Natalia Romero-Franco & Pedro Jiménez-Reyes (2019) Concurrent validity and reliability of an iPhone app for the measurement of ankle dorsiflexion and inter-limb asymmetries, Journal of Sports Sciences, 37:3, 249-253, DOI: 10.1080/02640414.2018.1494908
This section would also benefit from further rationale on why targeting android apps is important. It erroneously states that there are no publications reporting reliability of Android smart phone apps, which is incorrect (see below) – however the argument could be make that the majority of papers published within the last 5 years are all using Apple IOS based goniometers, and those using Android apps are not measuring dorsiflexion, e.g:
Motaz Abdalla Alawna, Bayram H. Unver, Ertugrul O. Yuksel; The Reliability of a Smartphone Goniometer Application Compared With a Traditional Goniometer for Measuring Ankle Joint Range of Motion. J Am Podiatr Med Assoc 1 January 2019; 109 (1): 22–29. doi: https://doi.org/10.7547/16-128
Methods
Could the authors begin this section with a study design description.
Participants: It would be good to include the age, height and body weight range of participants and offer some indication of where they were recruited from (e.g. a convenience sample of university students) and how recruitment was conducted..
Please indicate if inflammatory joint conditions were also an exclusion criteria.
Examiners: Raters need to be explained further. Does the experienced physiotherapist use this measure frequently in practice and had the final year physiotherapy student being instructed on how it was conducted prior to the study? Did they pilot the study first and refine the protocol?
Measurement of the functional ADROM: How was the measurement demonstrated to all participants, as a group on one on one.
Given the physiotherapist measured first each time, does this introduce potential order effects (e.g. increasing available ROM due to stretch from the first measure)?
Can the authors describe the timing and protocol between raters, e.g. could the person rest between? And how were the measures collected (on paper?).
Did the experienced physiotherapist complete and record measures in the presence of the student (or vice versa)?
I also question if 32 people is a large enough sample to ensure that raters don’t have memory of previous results. Also, can the authors discuss the limitations of ‘double dipping’ when you use both legs on the one person (Menz, 2004)
Menz, H. (2004). Two feet, or one person? Problems associated with statistical analysis of paired data in foot and ankle medicine. Foot, 14, 2 - 5.
Further information on the App, e.g. reference to its developers and which operating systems are required etc., and is it free to download or involve a subscription etc., .
Statistical procedure
How was all the data managed? It would benefit to include the participant characteristic management here (e.g. Descriptive statistics were used to describe participants…).
Can the authors rationalise the use of ICC random rather than two-way mixed effect (i.e. Model 2, 1 rather than Model 3, 1)?
The authors could consider using Bland Altman Plots to ensure the limits of agreement of raters is within an acceptable level. This could also be used to explore validity if the app is compared with a digital goniometer as recommended.
Results
Please change the word smallest to minimum in line 134.
Discussion
You could incorporate this paper into your discussion given it included a final year physiotherapy student and a novice (parent). It would offer you a clearer comparison that the Williams study.
Gosse G, Ward E, McIntyre A, Banwell HA. 2021. The reliability and validity of the weight-bearing lunge test in a Congenital Talipes Equinovarus population (CTEV) PeerJ 9:e10253 https://doi.org/10.7717/peerj.10253
Sentence beginning line 206 requires a reference.
Please replace comma’s for full stops when reporting the Minimal Detectable change (Lines 220 to 228).
References:
Evans, Rome & Peet, 2012 is not in the reference list. Please review to ensure all other references are included.
The manuscript was very clear, easy to read and was conducted well. Considering the language, I just found few suggestions and typing errors. In lines 79-83 (at the end of introduction) I would suggest to make two different sentences instead of one, and in the heading of table 2 there is a small spelling mistake.
In the Table 1, the Range is somewhat confusing, I would suggest to leave that out or show the range more understandable, like 19-27.
Fine, no comments to add.
Interesting study, no comments to add.
no comment
Some comments in general section
no comment
I have read the article ID 58796 under title “Reliability of the functional ankle dorsiflexion range of motion measurement in young adults”.
In this article, the authors reported their work using a mobile goniometer application Spirit Level Plus from Android smartphone and recruited 32 subjects in study. The overall, article writing is good and the results analyses are reasonably thorough. But although, the authors used new application to measure the ankle dorsiflexion, the study is still preferable that if the authors can take the following comments into consideration in preparing the final version.
I recommend that the authors make changes related to the comments below.
Reviewer comments:
-Figure 1, shown (weight bearing lunge test) but at the same time what the degree of knee flexion during test. Maybe the same subject when did re-test the degree of knee is different so I think that the best position is for the knee to be parallel to the foot, and the distance (to the nearest 0.lcm) from the end of the big toe to the wall using a tape measure on the floor and, for more information could see references:
- In line 297(Konor et al.);
- Bennell et al, 1998. Intra-rater and inter-rater reliability of a weight-bearing lunge measure of ankle dorsiflexion. Australian Journal of physiotherapy, 44(3), pp.175-180.
- O'Shea, S. and Grafton, K., 2013. The intra and inter-rater reliability of a modified weight-bearing lunge measure of ankle dorsiflexion. Manual therapy, 18(3), pp.264-268.
- Cejudo et al, 2014. A simplified version of the weight-bearing ankle lunge test: Description and test–retest reliability. Manual therapy, 19(4), pp.355-359.
Therefore, could the authors write how to adjust the angle of the knee during the test and retest please?
Some comments:
1- Line 2, I think the title is general, so it’s could be “Reliability of Android smartphone to measure the range of motion of ankle dorsiflexion” or smartphone application or…
2- Line 25-29, the authors should mention the application or the software name in the Methods
3- Line 66, “Several different measurement…” should put in new Paragraph
4- Line 74, the cited “Williams et al. (2015) not mention in references
5- Line 130, in results “Descriptive…...in Table 1” should be after line 93
6- Line 221, cited Williams et al. (2013) is the same (Williams, Caserta &Haines, 2013)?
7- Lines 220-227, these results for left leg or right leg or both?
8- In conclusions and depending on the results would you recommended for adoption the goniometer application Spirit Level Plus to measure the ankle ROM?
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