Purpose
Information is limited regarding the validity and reliability of measurements made
during remote assessment of wrist range of motion (ROM) motion. We sought to determine
intra- and inter-observer agreement among visual estimation, direct goniometric measurement,
and patients’ self-taken digital photographs and line tracings by comparing the degree
differences among measurements. We hypothesized that inter- and intra-observer differences
would be less than 10° at least 90% of the time for all measurement modalities.
Methods
Thirty-seven patients were enrolled in this prospective cohort study. Visual estimation
immediately followed by direct goniometry of maximal active wrist ROM (extension [E],
flexion [F], radial deviation, and ulnar deviation) were independently and blindly
assessed by 3 different providers: a hand surgeon, a hand therapist, and an orthopedic
resident. Self-taken photographs and line tracings were blindly evaluated 3 weeks
later. Intra- and inter-observer agreement was described using the Bland–Altman method.
Results
The surgeon and hand therapist observed intra-observer agreement within 10° for visual
estimation of all 4 directions of motions greater than 90% of the time, but inter-observer
agreement for E/F was lower (76% to 86%). Intra-observer agreement by the resident
was within 10° 78% of the time for E/F. Intra-observer agreement for photographs and
tracings were lower than visual estimation for all observers. Inter-observer agreement
for photographs and tracings was higher than intra-observer agreement. The surgeon
and hand therapist agreed within 10° at least 76% of the time, the surgeon and resident
agreed within 10° at least 62% of the time, and the hand therapist and resident agreed
within 10° at least 54% of the time.
Conclusions
Visual estimation may be a valid method of remote assessment, but compared with goniometry,
measurements may be susceptible to observer bias. Self-taken photographs and line
tracings are unreliable, perhaps falsely lower owing to submaximal effort from task
distraction, and we question their current use for remote assessment of wrist ROM.
Clinical relevance
These results represent an initial step in evaluating potential methods of remote
assessment of wrist ROM.
Key words
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References
- Accuracy and reliability of three different techniques for manual goniometry for wrist motion: a cadaveric study.J Hand Surg Am. 2009; 34: 1422-1428
- Virtual outreach: economic evaluation of joint teleconsultations for patients referred by their general practitioner for a specialist opinion.BMJ. 2003; 327: 84
- Inter-tester comparison between visual estimation and goniometric measurement of ankle dorsiflexion.Physiother Theory Pract. 1998; 14: 107-113
- Comparison of visual estimation and goniometry for assessment of metacarpophalangeal joint angle.Physiotherapy. 1999; 85: 201-208
- Clinical Assessment Recommendations.2nd ed. American Society for Hand Therapy, Garner, NC1992: 62-63
- Reliability of passive wrist flexion and extension goniometric measurements: a multicenter study.Phys Ther. 1994; 74: 162-174
- The reliability of goniometric measurements of active and passive wrist motions.Am J Occup Ther. 1990; 44: 342-348
- Clinical measurement of range of motion: review of goniometry emphasizing reliability and validity.Phys Ther. 1987; 67: 1867-1872
- Joint angle measurement: a comparative study of the reliability of goniometry and wire tracing for the hand.Clin Rehabil. 1997; 11: 314-320
- Visual estimation of finger angles: do we need goniometers?.J Hand Surg Br. 2002; 27: 382-384
- The reliability of joint measurement.Physiotherapy. 1976; 62: 227-229
- Reliability of goniometric measurements.Phys Ther. 1978; 58: 1355-1360
- A study on the measurement of wrist motion range using the iPhone 4 gyroscope application.Ann Plast Surg. 2014; 73: 215-218
- A study to compare the reliability of composite finger flexion with goniometry for measurement of range of motion in the hand.Clin Rehabil. 2002; 16: 562-570
- Photography-based method for measuring wrist range of motion.J Wrist Surg. 2017; 6: 280-284
- Accuracy and validity of goniometer and visual assessments of angular joint positions of the hand and wrist.J Hand Surg Am. 2016; 41: e21-e35
- Comparative analysis of photograph-based clinical goniometry to standard techniques.Hand (N Y). 2015; 10: 248-253
- Smartphone photography utilized to measure wrist range of motion.J Hand Surg Eur Vol. 2018; 43: 187-192
- Difficult wrist fractures: perilunate fracture-dislocations of the wrist.Clin Orthop Relat Res. 1987; 214: 136-147
- A biomechanical study of normal functional wrist motion.Clin Orthop Relat Res. 1984; 187: 23-25
- What happened at Hawthorne? New evidence suggests the Hawthorne effect resulted from operant reinforcement contingencies.Science. 1974; 183: 922-932
- Remote measurement via the Internet of upper limb range of motion in people who have had a stroke.J Telemed Telecare. 2007; 13: 401-405
- In-home telerehabilitation compared with face-to-face rehabilitation after total knee arthroplasty: a noninferiority randomized controlled trial.J Bone Joint Surg Am. 2015; 97: 1129-1141
- Goniometer-apps in hand surgery and their applicability in daily clinical practice.Safety in Health. 2015; 1: 11
- Skype: a tool for functional assessment in orthopaedic research.J Telemed Telecare. 2012; 18: 94-98
- Reliability and effectiveness of smartphone technology for the diagnosis and treatment planning of pediatric elbow trauma.J Pediatr Orthop. 2016; 36: 483-487
- A comparison of elbow range of motion measurements: smartphone-based digital photography versus goniometric measurements.J Hand Surg Am. 2016; 41: 510-515.e1
Article info
Publication history
Published online: July 26, 2019
Accepted:
May 10,
2019
Received:
January 9,
2018
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2019 by the American Society for Surgery of the Hand. All rights reserved.
