Research Article: Heightened clinical utility of smartphone versus body-worn inertial system for shoulder function B-B score

Date Published: March 20, 2017

Publisher: Public Library of Science

Author(s): Claude Pichonnaz, Kamiar Aminian, Céline Ancey, Hervé Jaccard, Estelle Lécureux, Cyntia Duc, Alain Farron, Brigitte M. Jolles, Nigel Gleeson, Antoine Nordez.


The B-B Score is a straightforward kinematic shoulder function score including only two movements (hand to the Back + lift hand as to change a Bulb) that demonstrated sound measurement properties for patients for various shoulder pathologies. However, the B-B Score results using a smartphone or a reference system have not yet been compared. Provided that the measurement properties are comparable, the use of a smartphone would offer substantial practical advantages. This study investigated the concurrent validity of a smartphone and a reference inertial system for the measurement of the kinematic shoulder function B-B Score.

Sixty-five patients with shoulder conditions (with rotator cuff conditions, adhesive capsulitis and proximal humerus fracture) and 20 healthy participants were evaluated using a smartphone and a reference inertial system. Measurements were performed twice, alternating between two evaluators. The B-B Score differences between groups, differences between devices, relationship between devices, intra- and inter-evaluator reproducibility were analysed.

The smartphone mean scores (SD) were 94.1 (11.1) for controls and 54.1 (18.3) for patients (P < 0.01). The difference between devices was non-significant for the control (P = 0.16) and the patient group (P = 0.81). The analysis of the relationship between devices showed 0.97 ICC, −0.6 bias and −13.2 to 12.0 limits of agreement (LOA). The smartphone intra-evaluator ICC was 0.92, the bias 1.5 and the LOA −17.4 to 20.3. The smartphone inter-evaluator ICC was 0.92, the bias 1.5 and the LOA −16.9 to 20.0. The B-B Score results measured with a smartphone were comparable to those of an inertial system. While single measurements diverged in some cases, the intra- and inter-evaluator reproducibility was excellent and was equivalent between devices. The B-B score measured with a smartphone is straightforward and as efficient as a reference inertial system measurement.

Partial Text

This study focused on the development and validation of the shoulder function B-B Score measured by means of a smartphone. Using shoulder function scores derived from a dedicated smartphone application, the study aimed at the technical and clinical validation of them within various shoulder pathologies. Provided that the score is valid, it can offer a valuable alternative to concurrent assessment methods as it is accessible and quickly performed.

This study aimed at the technical and clinical validation of a B-B Score smartphone application for shoulder function evaluation. The results showed that the B-B Score acquired by means of a smartphone was valid and reproducible for the measurement of shoulder function of groups of patients including those presenting with rotator cuff conditions, proximal humerus fractures or adhesive capsulitis. It displayed excellent intra- and inter-evaluator reproducibility and discriminative power. Conversely, single measurements may offer reduced precision in some circumstances. The assessments acquired using either a smartphone or a reference inertial system displayed comparable measurement properties across a wide-range of clinimetrics.




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