Reliability of a smartphone app to objectively monitor performance outcomes in degenerative cervical myelopathy: an observational study
Authors: Touzet Alvaro Yanez , Houhou Tatiana , Rahic Zerina , Kolias Angelos , Yordanov Stefan , Anderson David B. , Laufer Ilya , Li Maggie , Grahovac Gordan , Kotter Mark R. N. , Davies Benjamin M. 
Published: February 2024

Objectives

To assess the reliability of the MoveMed battery of performance outcome measures.

Design

Prospective observational study.

Setting

Decentralised secondary care in England, United Kingdom.

Participants

Seven adults aged 59.5 (SD 12.4) who live with degenerative cervical myelopathy (DCM) and possess an approved smartphone.

Primary and secondary outcome measures

The primary outcome was to determine the test-retest reliability of the MoveMed performance outcomes using the intra-class correlation of agreement (ICCagreement). The secondary outcome was to determine the measurement error of the MoveMed performance outcomes using both the standard error of agreement of the mean (SEMagreement) and the smallest detectable change of agreement (SDCagreement). Criteria from the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) manual were used to determine adequate reliability (i.e., ICCagreement≥ 0.7) and risk of bias. Disease stability was controlled for using two minimum clinically important difference (MCID) thresholds obtained from the literature on the patient-derived modified Japanese Orthopaedic Association (P-mJOA): namely, MCID ≤1 point and MCID ≤2 points.

Results

All tests demonstrated moderate-to-excellent test-retest coefficients and low measurement errors. In the MCID ≤1 group, ICCagreementvalues ranged from: 0.84–0.94 in the Fast Tap Test, 0.89–0.95 in the Hold Test, 0.95 in the Typing Test, and 0.98 in the Stand and Walk Test. SEMagreementvalues ranged from ±1 tap, ±1–3% stability score points, ±0.06 keys per second, and ±10 steps per minute, respectively. SDCagreementvalues were ±3 taps, ±4–7% stability score points, ±0.2 keys per second, and ±27 steps per minute. In the MCID ≤2 group, ICCagreementvalues ranged from: 0.61–0.91, 0.75–0.77, 0.98, and 0.62, respectively; SEMagreementvalues from: ±1 tap, ±2–4% stability score points, ±0.06 keys per second, and ±10 steps per minute; and SDCagreementvalues from: ±3–7 taps, ±7–10% stability score points, ±0.2 keys per second, and ±27 steps per minute. Furthermore, the Fast Tap, Hold, and Typing Tests obtained sufficient ratings (ICCagreement≥ 0.7) in both MCID≤1 and MCID≤2 groups. No risk of bias factors from the COSMIN Risk of Bias checklist were recorded. Overall, ‘very good’ quality evidence of sufficient reliability was found for the MoveMed battery in DCM.

Conclusions

Criteria from COSMIN provide ‘very good’ quality evidence of the reliability of the MoveMed tests in an adult population living with DCM.

Strengths and limitations of this study

Criteria from the COSMIN manual support the reliability of MoveMed’s battery of performance outcome measures.

Criteria from the COSMIN manual rate the methodological quality of the evidence at ‘very good’.

Self-reported outcome measures and data elements were used in a decentralised secondary setting.

Primary and secondary outcomes were used to assess reliability.

Study design and analyses were performed by individuals formally trained in clinimetrics.