The Validity, Reliability, and Sensitivity of a Smartphone-Based Seated Postural Control Assessment in Wheelchair Users: A Pilot Study

Abstract

Seated postural control is essential for wheelchair users to maintain proper position while performing activities of daily living. Clinical tests are commonly used to measure seated postural control, yet they are subjective and lack sensitivity. Lab-based measures are highly sensitive but are limited in scope and restricted to research settings. Establishing a valid, reliable, and accessible measurement tool of seated postural control is necessary for remote, objective assessments. Therefore, the purpose of this study was to examine the validity, reliability, and sensitivity of smartphone-based postural control assessments in wheelchair users. Eleven participants (age: 35.4 ± 17.9) completed two experimental visits 1-week apart consisting of three clinical tests: Trunk Control Test (TCT), Function in Sitting Test (FIST), and Tee-shirt Test, as well as, standardized instrumented balance tasks that manipulated vision (eyes open and closed), and trunk movement (functional reach and stability boundary). During these tasks, participants held a smartphone instrumented with a research-grade accelerometer to their chest. Maximum and root mean square (RMS) acceleration in the medial-lateral (ML) and anterior-posterior (AP) axes were derived. Participants were grouped into non-impaired and impaired postural groups based on FIST scores. Spearman rank-order correlations were conducted between the two devices' outcome measurements and between these measures and those of the clinical tests. Receiver operating characteristic (ROC) curves and the area under the curves (AUC) were determined to distinguish participants with and without impaired postural control. The reliability of outcome variables was assessed using inter-class correlations. Strong correlations between outputs derived from the smartphone and research-grade accelerometer were seen across balance tasks (ρ = -0.75-1.00; p ≤ 0.01). Numerous significant moderate correlations between clinical test outcomes and smartphone and research-grade RMS ML accelerometry were seen (ρ = -0.62 to 0.83 (p ≤ 0.044)]. On both devices, the AUC for ROC plots were significant for RMS ML sway during the eyes open task and functional stability boundary (p < 0.05). Reliability of smartphone accelerometry was comparable to the research-grade accelerometer and clinical tests. This pilot study illustrated that smartphone-based accelerometry may be able to provide a valid and reliable assessment of seated postural control and have the ability to distinguish between those with and without impaired postural control.

Keywords: clinical tests; measurement tool; seated postural control; smartphone technology; wheelchair users.

Figure 1

Illustration of two participants completing the seated postural control assessment. (A) represents a participant facing the side, (B) represents a participant facing forward, (C) depicts the research-grade accelerometer affixed to the back of the smartphone and the aligned axes orientation (ML, medial-lateral; AP, anterior-posterior), and (D) provides an example plot of accelerometry data from the smartphone and research-grade accelerometer, recorded during the Functional Stability Boundary Test.

Figure 2

Receiver operating characteristic (ROC) curves for root mean squared smartphone (A) and research-grade accelerometer (B) acceleration in the medial-lateral (ML) direction during all balance tasks.