Abstract
Background: The range of motion (ROM) in ankle dorsiflexion during weight-bearing activities has important functional implications, including an elevated risk of injury when ROM is restricted. The integration of advanced digital technologies, particularly those utilizing artificial intelligence (AI), is becoming increasingly prevalent across professional domains. These tools have demonstrated effectiveness in enhancing diagnostic accuracy and improving patient outcomes in physical rehabilitation. This study aimed to assess the reliability of a portable 3D motion capture platform incorporating AI (Kinotek) compared to a standard plastic goniometer in evaluating weight-bearing ankle dorsiflexion ROM.
Methods: Twenty-four healthy participants (mean age: 29 ± 12 years; height: 172.7 ± 10.2 cm; weight: 70.3 ± 15 kg) were recruited. Each participant completed two test-retest trials of weight-bearing ankle dorsiflexion during a forward lunge. Intertrial reliability was evaluated using intraclass correlation coefficients (ICC(2, k)) with 95% confidence intervals (CI), comparing measurements obtained from the Kinotek system and the goniometer.
Results: The mean ± standard deviation (standard error of the mean) ROM values were 18.8 ± 6.67 (0.99) degrees for Kinotek and 14.61 ± 5.72 (0.86) degrees for the goniometer. The ICC (95% CI) values were 0.90 (0.82–0.94) for Kinotek and 0.79 (0.65–0.89) for the goniometer. The Pearson correlation coefficient (r) was 0.55.
Conclusion: The findings indicate that the Kinotek system demonstrates good-to-excellent reliability, whereas the goniometer exhibits moderate-to-good reliability in assessing weight-bearing ankle dorsiflexion ROM. The strong association observed supports the potential utility of AI-driven motion capture systems as reliable tools in both clinical and research contexts for evaluating weight-bearing ankle dorsiflexion.
Keywords
References
- Almansoof HS, Nuhmani S, Muaidi Q. Role of ankle dorsiflexion in sports performance and injury risk: A narrative review. Electron J Gen Med. 2023;20(5):em521. doi:10.29333/ejgm/13412DOI ↗Google Scholar ↗
- Zunko H, Vauhnik R. Reliability of the weight-bearing ankle dorsiflexion range of motion measurement using a smartphone goniometer application. PeerJ. 2021;9:e11977. doi:10.7717/peerj.11977DOI ↗Google Scholar ↗
- Malloy P, Morgan A, Meinerz C, Geiser C, Kipp K. The association of dorsiflexion flexibility on knee kinematics and kinetics during a drop vertical jump in healthy female athletes. Knee Surg Sports Traumatol Arthrosc. 2015;23(12):3550-3555. doi:10.1007/s00167-014-3222-zDOI ↗Google Scholar ↗
- Taylor JB, Wright ES, Waxman JP, Schmitz RJ, Groves JD, Shultz SJ. Ankle dorsiflexion affects hip and knee biomechanics during landing. Sports Health. 2022;14(3):328-335. doi:10.1177/19417381211019683DOI ↗Google Scholar ↗
- He Y, Fekete G, Sun D, et al. Lower limb biomechanics during the topspin forehand in table tennis: A systemic review. Bioengineering (Basel). 2022;9(8):336. doi:10.3390/bioengineering9080336DOI ↗Google Scholar ↗
- Baumbach SF, Braunstein M, Seeliger F, et al. Ankle dorsiflexion: What is normal? Development of a decision pathway for diagnosing impaired ankle dorsiflexion and gastrocnemius tightness. Arch Orthop Trauma Surg. 2016;136(9):1203-1211. doi:10.1007/s00402-016-2513-xDOI ↗Google Scholar ↗
- Johanson M, Baer J, Hovermale H, Phouthavong P. Subtalar joint position during gastrocnemius stretching and ankle dorsiflexion range of motion. J Athl Train. 2008;43(2):172-178. doi:10.4085/1062-6050-43.2.172DOI ↗Google Scholar ↗
- Mahieu NN, Witvrouw E, Stevens V, Van Tiggelen D, Roget P. Intrinsic risk factors for the development of Achilles tendon overuse injury: A prospective study. Am J Sports Med. 2006;34(2):226-235. doi:10.1177/0363546505279918DOI ↗Google Scholar ↗
- Backman LJ, Danielson P. Low range of ankle dorsiflexion predisposes for patellar tendinopathy in junior elite basketball players: A 1-year prospective study. Am J Sports Med. 2011;39(12):2626-2633. doi:10.1177/0363546511420552DOI ↗Google Scholar ↗
- Pascual Huerta J. The effect of the gastrocnemius on the plantar fascia. Foot Ankle Clin. 2014;19(4):701-718. doi:10.1016/j.fcl.2014.08.011DOI ↗Google Scholar ↗
- Hassan KA, Youssef RSE, Mahmoud NF, Eltagy H, El-Desouky MA. The relationship between ankle dorsiflexion range of motion, frontal plane projection angle, and patellofemoral pain syndrome. Foot Ankle Surg. 2022;28(8):1427-1432. doi:10.1016/j.fas.2022.08.003DOI ↗Google Scholar ↗
- Piva SR, Goodnite EA, Childs JD. Strength around the hip and flexibility of soft tissues in individuals with and without patellofemoral pain syndrome. J Orthop Sports Phys Ther. 2005;35(12):793-801. doi:10.2519/jospt.2005.35.12.793DOI ↗Google Scholar ↗
- de la Motte SJ, Lisman P, Gribbin TC, et al. Systematic review of the association between physical fitness and musculoskeletal injury risk: Part 3—Flexibility, power, speed, balance, and agility. J Strength Cond Res. 2019;33(6):1723-1735. doi:10.1519/JSC.0000000000002382DOI ↗Google Scholar ↗
- Dinh NV, Freeman H, Granger J, et al. Calf stretching in non-weight bearing versus weight bearing. Int J Sports Med. 2011;32(3):205-210. doi:10.1055/s-0030-1268505DOI ↗Google Scholar ↗
- Moreno-Pérez V, Soler A, Ansa A, et al. Acute and chronic effects of competition on ankle dorsiflexion ROM in professional football players. Eur J Sport Sci. 2020;20(1):51-60.Google Scholar ↗
- Mourcou Q, Fleury A, Diot B, Franco C, Vuillerme N. Mobile phone-based joint angle measurement for functional assessment and rehabilitation of proprioception. Biomed Res Int. 2015;2015:328142. doi:10.1155/2015/328142DOI ↗Google Scholar ↗
- Teyhen DS, Shaffer SW, Butler RJ, et al. What risk factors are associated with musculoskeletal injury in US Army Rangers? A prospective prognostic study. Clin Orthop Relat Res. 2015;473(9):2948-2958. doi:10.1007/s11999-015-4342-6DOI ↗Google Scholar ↗
- Medina McKeon JM, Hoch MC. The Ankle-Joint Complex: A Kinesiologic Approach to Lateral Ankle Sprains. J Athl Train. 2019;54(6):589-602. doi:10.4085/1062-6050-472-17DOI ↗Google Scholar ↗
- Abdulmassih S, Phisitkul P, Femino JE, Amendola A. Triceps surae contracture: Implications for foot and ankle surgery. J Am Acad Orthop Surg. 2013;21(7):398-407. doi:10.5435/JAAOS-21-07-398DOI ↗Google Scholar ↗
- Aquino MRC, Resende RA, Kirkwood RN, et al. Spatial-temporal parameters, pelvic, and lower limb movements during gait in individuals with reduced passive ankle dorsiflexion. Gait Posture. 2022;93:32-38. doi:10.1016/j.gaitpost.2022.01.010DOI ↗Google Scholar ↗
- Howe LP. The acute effects of ankle mobilizations on lower extremity joint kinematics. J Bodyw Mov Ther. 2017;21(4):775-780. doi:10.1016/j.jbmt.2016.11.007DOI ↗Google Scholar ↗
- Lima YL, Ferreira VMLM, de Paula Lima PO, Bezerra MA, de Oliveira RR, Almeida GPL. The association of ankle dorsiflexion and dynamic knee valgus: A systematic review and meta-analysis. Phys Ther Sport. 2018;29:61-69. doi:10.1016/j.ptsp.2017.07.003DOI ↗Google Scholar ↗
- Nakagawa TH, Petersen RS. Relationship of hip and ankle range of motion, trunk muscle endurance with knee valgus and dynamic balance in males. Physiother Sport. 2018;34:174-179. doi:10.1016/j.ptsp.2018.10.006DOI ↗Google Scholar ↗
- Rabin A, Kozol Z, Spitzer E, Finestone A. Ankle dorsiflexion among healthy men with different qualities of lower extremity movement. J Athl Train. 2014;49(5):617-623. doi:10.4085/1062-6050-49.3.14DOI ↗Google Scholar ↗
- Macrum E, Bell DR, Boling M, Lewek M, Padua D. Effect of limiting ankle-dorsiflexion range of motion on lower extremity kinematics and muscle-activation patterns during a squat. J Sport Rehabil. 2012;21(2):144-150. doi:10.1123/jsr.21.2.144DOI ↗Google Scholar ↗
- Stanley LE, Harkey M, Luc-Harkey B, et al. Ankle dorsiflexion displacement is associated with hip and knee kinematics in females following anterior cruciate ligament reconstruction. Res Sports Med. 2019;27(1):21-33. doi:10.1080/15438627.2018.1502180DOI ↗Google Scholar ↗
- Rabin A, Portnoy S, Kozol Z. The association of ankle dorsiflexion range of motion with hip and knee kinematics during the lateral step-down test. J Orthop Sports Phys Ther. 2016;46(11):1002-1009. doi:10.2519/jospt.2016.6621DOI ↗Google Scholar ↗
- Witvrouw E, Lysens R, Bellemans J, Cambier D, Vanderstraeten G. Intrinsic risk factors for the development of anterior knee pain in an athletic population: A two-year prospective study. Am J Sports Med. 2000;28(4):480-489. doi:10.1177/03635465000280040701DOI ↗Google Scholar ↗
- Noehren B, Hamill J, Davis I. Prospective evidence for a hip etiology in patellofemoral pain. Med Sci Sports Exerc. 2013;45(6):1120-1124. doi:10.1249/MSS.0b013e31828249d2DOI ↗Google Scholar ↗
- Greiwe RM, Saifi C, Ahmad CS, Gardner MJ. Anatomy and biomechanics of patellar instability. Oper Tech Sports Med. 2015;23(1):2-9. doi:10.1053/j.otsm.2014.10.001DOI ↗Google Scholar ↗
- Aderem J, Louw QA. Biomechanical risk factors associated with iliotibial band syndrome in runners: A systematic review. BMC Musculoskelet Disord. 2015;16:356. doi:10.1186/s12891-015-0808-7DOI ↗Google Scholar ↗
- D’Antoni F, Russo F, Ambrosio L, et al. Artificial intelligence and computer-aided diagnosis in chronic low back pain: A systematic review. Int J Environ Res Public Health. 2022;19(10):5971. doi:10.3390/ijerph19105971DOI ↗Google Scholar ↗
- Loria K. What’s the impact of AI on physical therapy? How artificial intelligence can enhance physical therapist services—and when PTs should use caution. APTA Mag. 2023;15(11):34-42.Google Scholar ↗
- Furness J, Schram B, Cox AJ, et al. Reliability and concurrent validity of the iPhone® compass application to measure thoracic rotation range of motion in healthy participants. PeerJ. 2018;6:e4431. doi:10.7717/peerj.4431DOI ↗Google Scholar ↗
- Kolber MJ, Hanney WJ. The reliability and concurrent validity of shoulder mobility measurements using a digital inclinometer and goniometer: A technical report. Int J Sports Phys Ther. 2012;7(3):306-313Google Scholar ↗
- Pottorf OA, Lee DJ, Czujko PN. Reliability and concurrent validity of mobile health technology for patient self-monitoring in physical rehabilitation. Shoulder Elbow Surg Int. 2022;6(3):506-511. doi:10.1016/j.jseint.2022.02.002DOI ↗Google Scholar ↗
- Reid S, Egen B. The validity and reliability of DrGoniometer, a smartphone application for measuring forearm supination. J Hand Ther. 2019;32:110-117. doi:10.1016/j.jht.2018.03.003DOI ↗Google Scholar ↗
- Salamh PA, Kolber M. The reliability, minimal detectable change, and concurrent validity of a gravity-based bubble inclinometer and iPhone application for measuring standing lumbar lordosis. Physiother Theory Pract. 2014;1:2-7. doi:10.3109/09593985.2013.800174DOI ↗Google Scholar ↗
- Shin SH, Ro DH, Lee OS, Oh JH, Kim SH. Within-day reliability of shoulder range of motion measurement with a smartphone. Man Ther. 2012;17:298-304. doi:10.1016/j.math.2012.02.010DOI ↗Google Scholar ↗
- Tayfur I, Afacan MA. Reliability of smartphone measurements of vital parameters: A prospective study using a reference method. Am J Emerg Med. 2019;37:1527-1530. doi:10.1016/j.ajem.2019.03.021DOI ↗Google Scholar ↗
- Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research [Published correction appears in J Chiropr Med, 2017, 16(4), 346]. J Chiropr Med. 2016;15(2):155-163. doi:10.1016/j.jcm.2016.02.012DOI ↗Google Scholar ↗
- Bosco FA, Aguinis H, Singh K, et al. Correlational effect size benchmarks. J Appl Psychol. 2015;100(2):431-449. doi:10.1037/a0038047DOI ↗Google Scholar ↗
- Chen B, Wang W, Hu G, et al. Concurrent validity of a markerless motion capture system for the assessment of shoulder functional movement. Med Novel Technol Devices. 2022;15:100131. doi:10.1016/j.medntd.2022.100131DOI ↗Google Scholar ↗
- Lempereur M, Brochard S, Leboeuf F, Rémy-Néris O. Validity and reliability of 3D marker-based scapular motion analysis: A systematic review. J Biomech. 2014;47(10):2219-2230. doi:10.1016/j.jbiomech.2014.04.028DOI ↗Google Scholar ↗
- Konor MM, Morton S, Eckerson JM, Grindstaff TL. Reliability of three measures of ankle dorsiflexion range of motion. Int J Sports Phys Ther. 2012;7(3):279-287.Google Scholar ↗
- Kim PJ, Peace R, Mieras J, Thoms T, Freeman D, Page J. Interrater and intrarater reliability in the measurement of ankle joint dorsiflexion is independent of examiner experience and technique used. J Am Podiatr Med Assoc. 2011;101(5):407-414. doi:10.7547/1010407DOI ↗Google Scholar ↗
- Pottorf O, Vapne D, Ghigiarelli J, Haase K. Reliability and concurrent validity of a markerless, single camera, portable 3D motion capture system for assessment of glenohumeral mobility. Int J Sports Phys Ther. 2023;18(5):1176-1185.Google Scholar ↗