This purpose of this study was to investigate the reliability, minimal detectable change (MDC), and concurrent validity of active spinal mobility measurements using a gravity‐based bubble inclinometer and iPhone® application.
Two investigators each used a bubble inclinometer and an iPhone® with inclinometer application to measure total thoracolumbo‐pelvic flexion, isolated lumbar flexion, total thoracolumbo‐pelvic extension, and thoracolumbar lateral flexion in 30 asymptomatic participants using a blinded repeated measures design.
The procedures used in this investigation for measuring spinal mobility yielded good intrarater and interrater reliability with Intraclass Correlation Coefficients (ICC) for bubble inclinometry ≥ 0.81 and the iPhone® ≥ 0.80. The MDC90 for the interrater analysis ranged from 4° to 9°. The concurrent validity between bubble inclinometry and the iPhone® application was good with ICC values of ≥ 0.86. The 95% level of agreement indicates that although these measuring instruments are equivalent individual differences of up to 18° may exist when using these devices interchangeably.
The bubble inclinometer and iPhone® possess good intrarater and interrater reliability as well as concurrent validity when strict measurement procedures are adhered to. This study provides preliminary evidence to suggest that smart phone applications may offer clinical utility comparable to inclinometry for quantifying spinal mobility. Clinicians should be aware of the potential disagreement when using these devices interchangeably.
Level of Evidence:
2b (Observational study of reliability)
Inclinometer; range of motion; smart phone; spine
Objective: To assess the intrarater and interrater reliability among rheumatologists of a standardised protocol for measurement of shoulder movements using a gravity inclinometer.
Methods: After instruction, six rheumatologists independently assessed eight movements of the shoulder, including total and glenohumeral flexion, total and glenohumeral abduction, external rotation in neutral and in abduction, internal rotation in abduction and hand behind back, in random order in six patients with shoulder pain and stiffness according to a 6x6 Latin square design using a standardised protocol. These assessments were then repeated. Analysis of variance was used to partition total variability into components of variance in order to calculate intraclass correlation coefficients (ICCs).
Results: The intrarater and interrater reliability of different shoulder movements varied widely. The movement of hand behind back and total shoulder flexion yielded the highest ICC scores for both intrarater reliability (0.91 and 0.83, respectively) and interrater reliability (0.80 and 0.72, respectively). Low ICC scores were found for the movements of glenohumeral abduction, external rotation in abduction, and internal rotation in abduction (intrarater ICCs 0.35, 0.43, and 0.32, respectively), and external rotation in neutral, external rotation in abduction, and internal rotation in abduction (interrater ICCs 0.29, 0.11, and 0.06, respectively).
Conclusions: The measurement of shoulder movements using a standardised protocol by rheumatologists produced variable intrarater and interrater reliability. Reasonable reliability was obtained only for the movement of hand behind back and total shoulder flexion.
Reproducible measurements of the range of motion are an important prerequisite for the interpretation of study results. The digital inclinometer is considered to be a useful instrument because it is inexpensive and easy to use. No previous study assessed inter-observer reproducibility of range of motion measurements with a digital inclinometer by physical therapists in a large sample of patients.
Two physical therapists independently measured the passive range of motion of the glenohumeral abduction and the external rotation in 155 patients with shoulder pain. Agreement was quantified by calculation of the mean differences between the observers and the standard deviation (SD) of this difference and the limits of agreement, defined as the mean difference ± 1.96*SD of this difference. Reliability was quantified by means of the intraclass correlation coefficient (ICC).
The limits of agreement were 0.8 ± 19.6 for glenohumeral abduction and -4.6 ± 18.8 for external rotation (affected side) and quite similar for the contralateral side and the differences between sides. The percentage agreement within 10° for these measurements were 72% and 70% respectively. The ICC ranged from 0.28 to 0.90 (0.83 and 0.90 for the affected side).
The inter-observer agreement was found to be poor. If individual patients are assessed by two different observers, differences in range of motion of less than 20–25 degrees can not be distuinguished from measurement error. In contrast, acceptable reliability was found for the inclinometric measurements of the affected side and the differences between the sides, indicating that the inclimeter can be used in studies in which groups are compared.
Hip range of motion is an important component in assessing clinical orthopedic conditions of the hip, low back and lower extremities. However it remains unclear as to what constitutes the best tool for clinical measurement. The purpose of this study was to investigate the concurrent validity of passive range of motion (ROM) measurements of hip extension and hip internal and external rotation using a digital inclinometer and goniometer.
Clinical research laboratory
30 healthy subjects without pain, radicular symptoms or history of surgery in the low back or hip regions.
Main Outcome Measures:
Passive hip range of motion for extension, hip internal rotation and hip external rotation. A digital inclinometer and universal goniometer were utilized as the tools for comparisons between measurements.
There was a statistically significant difference (p < 0.05) between the goniometer and digital inclinometer in measured hip ROM except for measurements of right hip external rotation (p > 0.05). The mean difference between the goniometer and digital inclinometer in left hip extension, internal rotation and external rotation were 3.5°, 4.5° and 5.0° respectively. The mean difference between the two devices in right hip extension, internal rotation and external rotation were 2.8°, 4.2° and 2.6° respectively. On average, the difference between the goniometer and digital inclinometer in extension was 3.2°, internal rotation was 4.5° and external rotation was 3.8°. The digital inclinometer had greater measurement during EXT and ER. Furthermore, there was no statistically significant difference (p > 0.05) in hip ROM between the left and right side for either goniometric or digital inclinometer measurements.
This results of this study indicate that a significant difference exists between the two devices in all measurements with exception of right hip extension. The differences were noted to be between 3–5 degrees for all planes measured. These findings suggest that caution should be used if these two devices are to be used interchangeably to quantify passive hip range of motion in either clinical practice or when comparing studies that utilize different instruments.
Level of Evidence:
Goniometry, hip; lumbar, passive range of motion; validity
The aims of this study were to evaluate the construct validity (known group), concurrent validity (criterion based) and test-retest (intra-rater) reliability of manual goniometers to measure passive hip range of motion (ROM) in femoroacetabular impingement patients and healthy controls.
Passive hip flexion, abduction, adduction, internal and external rotation ROMs were simultaneously measured with a conventional goniometer and an electromagnetic tracking system (ETS) on two different testing sessions. A total of 15 patients and 15 sex- and age-matched healthy controls participated in the study.
The goniometer provided greater hip ROM values compared to the ETS (range 2.0-18.9 degrees; P < 0.001); good concurrent validity was only achieved for hip abduction and internal rotation, with intraclass correlation coefficients (ICC) of 0.94 and 0.88, respectively. Both devices detected lower hip abduction ROM in patients compared to controls (P < 0.01). Test-retest reliability was good with ICCs higher 0.90, except for hip adduction (0.82-0.84). Reliability estimates did not differ between the goniometer and the ETS.
The present study suggests that goniometer-based assessments considerably overestimate hip joint ROM by measuring intersegmental angles (e.g., thigh flexion on trunk for hip flexion) rather than true hip ROM. It is likely that uncontrolled pelvic rotation and tilt due to difficulties in placing the goniometer properly and in performing the anatomically correct ROM contribute to the overrating of the arc of these motions. Nevertheless, conventional manual goniometers can be used with confidence for longitudinal assessments in the clinic.
Introduction. The cervical sagittal translation mobility is related to neck pain. A practical method for measuring the specific cervical mobility is needed. The aim was to describe a simple method for measuring the cervical sagittal translation mobility and to evaluate its reliability in a clinical setting. Method. The head protraction and retraction ranges of thirty healthy seated subjects were measured from a dorsal reference plane by two physiotherapists utilizing a tape measure. A standard inclinometer/goniometer was used to minimize angular movements of the head during the translational movements. The measurements were made twice for each subject with a two-hours interval between each measurement. The inter-rater and intra-rater agreements were evaluated with intraclass correlation coefficients (ICCs) and with the distribution of the difference of the measurements. The systematic differences were analysed with the Wilcoxon signed rank test. Results. The intra-rater agreement was good. The inter-rater agreement was moderate in the first measurement and good in the second. A systematic difference was noted between raters in the first measurement but not in the second, possibly indicating a learning effect. Discussion. The method used in the study is simple and reliable and can be recommended for clinical use.
Reproducibility measurements of the range of motion are an important prerequisite for the interpretation of study results. The aim of the study is to assess the intra-rater and inter-rater reproducibility of the measurement of active Range of Motion (ROM) in patients with neck pain using the Cybex Electronic Digital Inclinometer-320 (EDI-320).
In an outpatient clinic in a primary care setting 32 patients with at least 2 weeks of pain and/or stiffness in the neck were randomly assessed, in a test- retest design with blinded raters using a standardized measurement protocol. Cervical flexion-extension, lateral flexion and rotation were assessed.
Reliability expressed by the Intraclass Correlation Coefficient (ICC) was 0.93 (lateral flexion) or higher for intra-rater reliability and 0.89 (lateral flexion) or higher for inter-rater reliability. The 95% limits of agreement for intra-rater agreement, expressing the range of the differences between two ratings were -2.5 ± 11.1° for flexion-extension, -0.1 ± 10.4° for lateral flexion and -5.9 ± 13.5° for rotation. For inter-rater agreement the limits of agreement were 3.3 ± 17.0° for flexion-extension, 0.5 ± 17.0° for lateral flexion and -1.3 ± 24.6° for rotation.
In general, the intra-rater reproducibility and the inter-rater reproducibility were good. We recommend to compare the reproducibility and clinical applicability of the EDI-320 inclinometer with other cervical ROM measures in symptomatic patients.
Assessment of shoulder mobility is essential for diagnosis and clinical follow-up of shoulder diseases. Only a few highly sophisticated instruments for objective measurements of shoulder mobility are available. The recently introduced DynaPort MiniMod TriGyro ShoulderTest-System (DP) was validated earlier in laboratory trials. We aimed to assess the precision (repeatability) and agreement of this instrument in human subjects, as compared to the conventional goniometer.
The DP is a small, light-weight, three-dimensional gyroscope that can be fixed on the distal upper arm, recording shoulder abduction, flexion, and rotation. Twenty-one subjects (42 shoulders) were included for analysis. Two subsequent assessments of the same subject with a 30-minute delay in testing of each shoulder were performed with the DP in two directions (flexion and abduction), and simultaneously correlated with the measurements of a conventional goniometer. All assessments were performed by one observer. Repeatability for each method was determined and compared as the statistical variance between two repeated measurements. Agreement was illustrated by Bland-Altman-Plots with 95% limits of agreement. Statistical analysis was performed with a linear mixed regression model. Variance for repeated measurements by the same method was also estimated and compared with the likelihood-ratio test.
Evaluation of abduction showed significantly better repeatability for the DP compared to the conventional goniometer (error variance: DP = 0.89, goniometer = 8.58, p = 0.025). No significant differences were found for flexion (DP = 1.52, goniometer = 5.94, p = 0.09). Agreement assessment was performed for flexion for mean differences of 0.27° with 95% limit of agreement ranging from −7.97° to 8.51°. For abduction, the mean differences were 1.19° with a 95% limit of agreement ranging from −9.07° to 11.46°.
In summary, DP demonstrated a high precision even higher than the conventional goniometer. Agreement between both methods is acceptable, with possible deviations of up to greater than 10°. Therefore, static measurements with DP are more precise than conventional goniometer measurements. These results are promising for routine clinical use of the DP.
Repeatability; Precision; Shoulder motion; Objective assessment; Dynaport; Gyroscope
The study is to provide a critical analysis of the research literature on clinimetric properties of instruments that can be used in daily practice to measure active cervical range of motion (ACROM) in patients with non-specific neck pain. A computerized literature search was performed in Medline, Cinahl and Embase from 1982 to January 2007. Two reviewers independently assessed the clinimetric properties of identified instruments using a criteria list. The search identified a total of 33 studies, investigating three different types of measurement instruments to determine ACROM. These instruments were: (1) different types of goniometers/inclinometers, (2) visual estimation, and (3) tape measurements. Intra- and inter-observer reliability was demonstrated for the cervical range of motion instrument (CROM), Cybex electronic digital instrument (EDI-320) and a single inclinometer. The presence of agreement was assessed for the EDI-320 and a single inclinometer. The CROM received a positive rating for construct validity. When clinical acceptability is taken into account both the CROM and the single inclinometer can be considered appropriate instruments for measuring the active range of motion in patients with non-specific neck pain in daily practice. Reliability is the aspect most frequently evaluated. Agreement, validity and responsiveness are documented less frequently.
Non-specific neck pain; Active range of motion; Reproducibility of results; Systematic review
To evaluate intra-rater and inter-rater reliability and measurement error in glenohumeral range of motion (ROM) measurements using a standard goniometer.
17 adult subjects with and without shoulder pathology were evaluated for active and passive range of motion. Fifteen shoulder motions were assessed by two raters to determine reliability. The intra-class correlation coefficients (ICC) were calculated and examined to determine if reliability of ICC ≥ 0.70 existed. The standard error of measurement (SEM) and the minimal clinical difference (MCD) were also calculated.
Thxe criterion reliability was achieved in both groups for intra-rater reliability of standing AROM abduction; supine AROM and PROM abduction, flexion, external rotation at 0° abduction; and for inter-rater reliability of supine AROM and PROM abduction, external rotation at 0° abduction. The SEM ranged from 4°-7° for intra-rater and 6°-9° for inter-rater agreement on movements that achieved the criterion reliability. The MCD ranged from 11°-16° for a single evaluator and 14°-24° for two evaluators.
Assessment of AROM and PROM in supine achieves superior reliability. The use of either a single or multiple raters affects the number of movements that achieved clinically meaningful reliability. Some movements consistently did not achieve the criterion and may not be the best movements to monitor treatment outcome.
Reliability; shoulder goniometric measurement
Even though technological progress has provided us with more and more sophisticated equipment for making goniometric measurements, the most commonly used clinical tools are still the universal goniometer and, to a lesser extent, the inclinometer. There is, however, no published study so far that uses an inclinometer for measurements in children with cerebral palsy (CP). The objective of this study was two-fold: to independently assess the intra and inter-examiner reliability for measuring the hip abduction range of motion in children with CP using two different instruments, the universal two-axis goniometer and electronic inclinometer. A pool of 5 examiners with different levels of experience as paediatric physiotherapists participated. The study did not compare both instruments because the measurement procedure and the hip position were different for each.
A prospective, observational study of goniometery was carried out with 14 lower extremities of 7 children with spastic CP. The inclinometer study was carried out with 8 lower extremities of 4 children with spastic CP. This study was divided into two independent parts: a study of the reliability of the hip abduction range of motion measured with a universal goniometer (hip at 0° flexion) and with an electronic inclinometer (hip at 90° flexion). The Intraclass Correlation Coefficient (ICC) was calculated to analyse intra and inter-examiner agreement for each instrument.
For the goniometer, the intra-examiner reliability was excellent (>0.80), while the inter-examiner reliability was low (0.375 and 0.475). For the inclinometer, both the intra-examiner (0.850-0.975) and inter-examiner reliability were excellent (0.965 and 0.979).
The inter-examiner reliability for goniometric measurement of hip abduction in children with CP was low, in keeping with other results found in previous publications. The inclinometer has proved to be a highly reliable tool for measuring the hip abduction range of motion in children with CP, which opens up new possibilities in this field, despite having some measurement limitations.
A variety of methods exist to measure ankle dorsiflexion range of motion (ROM). Few studies have examined the reliability of a novice rater. The purpose of this study was to determine the reliability of ankle ROM measurements using three different techniques in a novice rater.
Twenty healthy subjects (mean±SD, age=24±3 years, height=173.2±8.1 cm, mass=72.6±15.2 kg) participated in this study. Ankle dorsiflexion ROM measures were obtained in a weight-bearing lunge position using a standard goniometer, digital inclinometer, and a tape measure using the distance-to-wall technique. All measures were obtained three times per side, with 10 minutes of rest between the first and second set of measures. Intrarater reliability was determined using an intraclass correlation coefficient (ICC2,3) and associated 95% confidence intervals (CI). Standard error of measurement (SEM) and the minimal detectable change (MDC) for each measurement technique were also calculated.
The within-session intrarater reliability (ICC2,3) estimates for each measure are as follows: tape measure (right 0.98, left 0.99), digital inclinometer (right 0.96; left 0.97), and goniometer (right 0.85; left 0.96). The SEM for the tape measure method ranged from 0.4–0.6 cm and the MDC was between 1.1–1.5 cm. The SEM for the inclinometer was between 1.3–1.4° and the MDC was 3.7–3.8°. The SEM for the goniometer ranged from 1.8–2.8° with an MDC of 5.0–7.7°.
The results indicate that reliable measures of weight-bearing ankle dorsiflexion ROM can be obtained from a novice rater. All three techniques had good reliability and low measurement error, with the distance-to-wall technique using a tape measure and inclinometer methods resulting in higher reliability coefficients (ICC2,3=0.96 to 0.99) and a lower SEM compared to the goniometer (ICC2,3=0.85 to 0.96).
Level of Evidence:
goniometry; inclinometer; talocrural joint
Posterior shoulder tightness (PST) has been implicated in the etiology of numerous shoulder disorders. Although reliable and valid measures have been described for the non‐operative population one does not exist for the post‐operative population.
Blinded repeated measures design.
Investigate the intrarater reliability, minimal detectable change at the 90% confidence interval (MDC90) and construct validity of an inclinometric measurement designed to quantify PST in the post‐operative population.
One investigator performed PST measurements on the operative shoulder of 23 participants. Passive internal and external rotation measurements were performed for the validity component of the investigation.
Intrarater reliability using an intraclass correlation coefficient (ICC) model 3,k was good (ICC = 0.79). The MDC90 indicated that a change of greater than or equal to 8 degrees would be required to be 90% certain that a change in the measurement would not be the result of inter‐trial variability or measurement error. Construct validity was supported by a statistically significant relationship between PST and internal rotation r = 0.54 and by a relationship between PST and external rotation r = 0.30 which was not statistically significant.
The sidelying procedure described in this investigation appears to be a reliable and valid means for quantifying PST in the post‐operative population. Moreover, the use of inclinometry provides an absolute angle of tightness that may be used for intersubject comparison, documenting change, and to determine reference values.
Level of Evidence:
Therapy, level 2b
capsule; flexibility; mobility; range of motion
Background: It is important to deal with the scapula when developing rehabilitation strategies for the shoulder complex. This requires clinical measurement tools that are readily available and easy to apply and which provide a reliable evaluation of scapula motion.
Method: Twenty six patients were assessed in two repeat tests within a single testing session. Patients exhibiting a wide spectrum of shoulder pathology were selected. The angle of scapular upward rotation was measured during total shoulder abduction. The measurement protocol was performed twice during a single testing session by a single tester. Results of the two tests were compared and the reliability assessed by intraclass correlation coefficients (ICCs).
Results: There was no significant difference in the scapula measurements taken during the two tests at each testing position. Overall, there was very good intrarater reliability (ICC = 0.88). The ICC ranged from 0.81 (at 135°) to 0.94 (at both resting and end of total shoulder abduction range).
Conclusion: The Plurimeter-V gravity inclinometer can be used effectively and reliably for measuring upward rotation of the scapula in all ranges of shoulder abduction in the coronal plane.
Cervical spine ROM movements taken accurately with reliable measuring devices are important in outcome measures as well as in measuring disability.
To compare the active cervical spine ROM in healthy young adult population using 4 different goniometers.
Subjects were tested during active cervical spine ROM. The devices were a single hinge inclinometer, single bubble carpenter's inclinometer, dual bubble goniometers and Cybex EDI 320 electrical inclinometer. All subjects were tested for rotational limits along each of the orthogonal axes of movement. There are 3 trials for each movement direction, except rotation was not measured with the Cybex as per manual suggestions. The subjects were randomly assigned to the sequence of devices.
Twenty-seven student volunteers (19 men and 8 women) were tested. Ages ranged from 21 to 41, mean age of 27.6 years of age.
Active cervical spine ROM trials for each measurement was used to calculate mean and standard deviation. An overall analysis of variance (ANOVA) and Bonferroni adjusted T-test were determined in order to calculate reliability and significance.
The cost of the instruments were not used in determining reliability or significance. The single hinge inclinometer was found to be a reliable measure but not likely valid. The Cybex EDI 320 was found to be the best measuring device; however, the 2 instruments whose cost were in-between the single hinge inclinometer and the electrical goniometer were just as reliable as the more expensive device. The AMA Guides of Impairment were used as the normative data to compare these devices.
Since the devices could measure reliably, whether expensive or more cost effective for students they would likely make adequate devices for training students on the methods for measuring ROM. There is previous data to suggest that older populations have gender differences and age differences with ROM. This study could not measure that and would make a useful follow-up study.
Cervical Spine; ROM; Goniometers
To assess scapular-positioning patterns using a static measurement technique.
Design and Setting:
We used a 4–within-factor design to compare scapular upward rotation among subjects. The within factors included side (dominant, nondominant), plane of motion (scapular, sagittal), direction of motion (ascending, descending), and level of humeral rotation (rest, 30°, 60°, 90°, 120°).
Twenty-seven subjects with unimpaired shoulders.
We measured scapular position and glenohumeral range of motion using a digital inclinometer and goniometer, respectively. All measurements were performed bilaterally.
Between-session repeatability was poor to excellent depending on humeral-elevation angle. The scapular plane demonstrated significantly more scapular upward rotation than did the sagittal plane at 120° of humeral elevation.
The scapula demonstrated a consistent pattern of downward rotation initially from rest to 30° of humeral elevation, followed by an upward rotation after 30° of humeral elevation to the highest level (120°). Scapular upward rotation is greater in the scapular plane than in the sagittal plane. Therefore, overhead rehabilitation exercises should be performed in the scapular plane, especially in subjects with rotator cuff tendinopathy.
scapular upward rotation; glenohumeral; inclinometer; scapular plane
We aimed to investigate the reliability and reproducibility of a magnetic tracking technique for the assessment of overall cervical spine motion (principal and coupled movements). Ten asymptomatic male volunteers with a mean age of 29.3 years (range 20–37 years) were included in the study. Flexion, extension, left and right lateral bending and left and right axial rotation were measured using a magnetic tracking device (MTD) mounted onto a custom head-piece. For rotational movements in the frontal and sagittal planes the results were compared with the measurements of two standard inclinometers. Intra-observer, inter-observer and intra-instrument reliability was assessed with the intraclass correlation coefficient method. There were no significant differences for all motion measurements between the MTD and the inclinometer. High inter-observer reliability was found in flexion, extension, axial rotation and lateral bending indicating that the testing routine is applicable for different examiners. The intra-observer variability was high in flexion and extension, whereas in lateral bending the reliability coefficients were lower and displayed a fair to good reliability for most of the measurements with the MTD. The results of the MTD were found to be highly comparable with the inclinometer results with an inter-instrument correlation coefficient ranging from 0.88 to 0.99. The MTD is a reliable, reproducible method for three-dimensional motion analysis of the cervical spine and therefore a valuable method both for the clinical assessment of various degenerative and traumatic disorders and as a supplement of different therapeutic procedures and rehabilitation.
Three-dimensional motion analysis; Kinematics; Cervical spine; Electromagnetic tracking device; Inclinometer
A number of sporting and daily activities involve rotation of the spine. The ability to quantify motion of the spine in a clinical setting usually relies on the use of a device to measure angles (goniometer or inclinometer) or visual assessment. Standardized measurement criteria exist for measuring rotation at the cervical and lumbar spine. Little has been written regarding established methods for measuring thoracic spine rotation. Thoracic rotation may be measured in a seated position, half-kneeling position, or quadruped position. Steps should be taken to minimize motion of surrounding segments such as the shoulder and hips, which may improve measurement accuracy. Key words: inclinometer, goniometer, range of motion
Few studies have investigated the use of a 3-dimensional gyroscope for measuring the range of motion (ROM) in the impaired shoulder. Reproducibility of digital inclinometer and visual estimation is poor. This study aims to investigate the reproducibility of a tri axial gyroscope in measurement of anteflexion, abduction and related rotations in the impaired shoulder.
Fifty-eight patients with either subacromial impingement (27) or osteoarthritis of the shoulder (31) participated. Active anteflexion, abduction and related rotations were measured with a tri axial gyroscope according to a test retest protocol. Severity of shoulder impairment and patient perceived pain were assessed by the Disability of Arm Shoulder and Hand score (DASH) and the Visual Analogue Scale (VAS). VAS scores were recorded before and after testing.
In two out of three hospitals patients with osteoarthritis (n = 31) were measured, in the third hospital patients with subacromial impingement (n = 27).
There were significant differences among hospitals for the VAS and DASH scores measured before and after testing. The mean differences between the test and retest means for anteflexion were −6 degrees (affected side), 9 (contralateral side) and for abduction 15 degrees (affected side) and 10 degrees (contralateral side).
Bland & Altman plots showed that the confidence intervals for the mean differences fall within −6 up to 15 degrees, individual test - retest differences could exceed these limits.
A simulation according to ‘Generalizability Theory’ produces very good coefficients for anteflexion and related rotation as a comprehensive measure of reproducibility. Optimal reproducibility is achieved with 2 repetitions for anteflexion.
Measurements were influenced by patient perceived pain. Differences in VAS and DASH might be explained by different underlying pathology. These differences in shoulder pathology however did not alter the reproducibility of testing. The use of a tri axial gyroscope is a simple non invasive and reproducible method for the recording of shoulder anteflexion and abduction. Movements have to be repeated twice for reproducible results.
Reproducibility; Shoulder; Tri axial gyroscope; Range of motion; Shoulder function; Generalizability theory
Diagrammatic recording of finger joint angles by using two criss-crossed paper strips can be a quick substitute to the standard goniometry. As a preliminary step toward clinical validation of the diagrammatic technique, the current study employed healthy subjects and non-professional raters to explore whether reliability estimates of the diagrammatic goniometry are comparable with those of the standard procedure.
The study included two procedurally different parts, which were replicated by assigning 24 medical students to act interchangeably as 12 subjects and 12 raters. A larger component of the study was designed to compare goniometers side-by-side in measurement of finger joint angles varying from subject to subject. In the rest of the study, the instruments were compared by parallel evaluations of joint angles similar for all subjects in a situation of simulated change of joint range of motion over time. The subjects used special guides to position the joints of their left ring finger at varying angles of flexion and extension. The obtained diagrams of joint angles were converted to numerical values by computerized measurements. The statistical approaches included calculation of appropriate intraclass correlation coefficients, standard errors of measurements, proportions of measurement differences of 5 or less degrees, and significant differences between paired observations.
Reliability estimates were similar for both goniometers. Intra-rater and inter-rater intraclass correlation coefficients ranged from 0.69 to 0.93. The corresponding standard errors of measurements ranged from 2.4 to 4.9 degrees. Repeated measurements of a considerable number of raters fell within clinically non-meaningful 5 degrees of each other in proportions comparable with a criterion value of 0.95. Data collected with both instruments could be similarly interpreted in a simulated situation of change of joint range of motion over time.
The paper goniometer and the standard goniometer can be used interchangeably by non-professional raters for evaluation of normal finger joints. The obtained results warrant further research to assess clinical performance of the paper strip technique.
Clinical Measurement, Reliability, Descriptive Study
To establish intrarater and interrater reliability of the Side-lying Thoraco-lumbar Rotation Measurement (STRM) and to explore frequencies and magnitude of rotational differences that exist in various musculoskeletal conditions.
Limitation in thoracic rotation could lead to increased motion at adjacent areas (i.e., shoulders and low back). This could potentially lead to excessive strain and subsequent injury from repetitive stress. Currently, there is no well-established method to reliably measure and objectively quantify thoraco-lumbar spine rotation.
Intrarater reliability was assessed by a single investigator performing three STRM measurements on 10 participants on two consecutive days. Interrater reliability was assessed by two independent examiners, performing the STRM on 30 participants. Reliability was assessed using the intraclass correlation coefficient (ICC) statistic. To explore the incidence and magnitude of side-to-side thoraco-lumbar rotation differences, the STRM was measured on 156 participants of various musculoskeletal conditions.
The intrarater reliability of the STRM was excellent (ICC=.94). The interrater reliability was good (ICC=.88). Fifty four percent of the sample exhibited greater than a 10% side-to-side difference in the STRM while twenty percent exhibited greater than a 20% side-to-side difference.
The STRM can be used as a reliable and objective method to quantify thoraco-lumbar spine rotation. It also appears that a large percentage of patients with varied musculoskeletal complaints may have greater than a 10-20% asymmetry in spinal rotational movement. Future research is needed to determine the clinical applicability and relevance of these findings.
Level of Evidence: 4
Thoraco-lumbar rotation; reliability
Objectives. To compare the shoulder mobility, muscular strength, and quality of life (QOL) among breast cancer survivors with and without Tai Chi (TC) Qigong training to those of healthy individuals and to explore the associations between shoulder impairments and QOL in breast cancer survivors with regular TC Qigong training. Methods. Eleven breast cancer survivors with regular TC Qigong training, 12 sedentary breast cancer survivors, and 16 healthy participants completed the study. Shoulder mobility and rotator muscle strength were assessed by goniometry and isokinetic dynamometer, respectively. QOL was assessed using the Functional Assessment of Cancer Therapy-Breast (FACT-B) questionnaire. Results. Goniometric measurements of the active range of motion in the flexion, abduction, and hand-behind-the-back directions were similar among the three groups. The TC Qigong-trained breast cancer survivors had significantly higher isokinetic peak torques of the shoulder rotator muscles (at 180°/s) than untrained survivors, and their isokinetic shoulder muscular strength reached the level of healthy individuals. Greater shoulder muscular strength was significantly associated with better functional wellbeing in breast cancer survivors with TC Qigong training. However, no significant between-group difference was found in FACT-B total scores. Conclusions. TC Qigong training might improve shoulder muscular strength and functional wellbeing in breast cancer survivors.
The clinimetric properties of knee goniometry are essential to appreciate in light of its extensive use in the orthopaedic and rehabilitative communities. Intra-observer reliability is thought to be satisfactory, but the validity and inter-rater reliability of knee goniometry often demonstrate unacceptable levels of variation. This study tests the validity and reliability of measuring knee range of motion using goniometry and photographic records.
Design: Methodology study assessing the validity and reliability of one method ('Marker Method') which uses a skin marker over the greater trochanter and another method ('Line of Femur Method') which requires estimation of the line of femur. Setting: Radiology and orthopaedic departments of two teaching hospitals. Participants: 31 volunteers (13 arthritic and 18 healthy subjects). Knee range of motion was measured radiographically and photographically using a goniometer. Three assessors were assessed for reliability and validity. Main outcomes: Agreement between methods and within raters was assessed using concordance correlation coefficient (CCCs). Agreement between raters was assessed using intra-class correlation coefficients (ICCs). 95% limits of agreement for the mean difference for all paired comparisons were computed.
Validity (referenced to radiographs): Each method for all 3 raters yielded very high CCCs for flexion (0.975 to 0.988), and moderate to substantial CCCs for extension angles (0.478 to 0.678). The mean differences and 95% limits of agreement were narrower for flexion than they were for extension. Intra-rater reliability: For flexion and extension, very high CCCs were attained for all 3 raters for both methods with slightly greater CCCs seen for flexion (CCCs varied from 0.981 to 0.998). Inter-rater reliability: For both methods, very high ICCs (min to max: 0.891 to 0.995) were obtained for flexion and extension. Slightly higher coefficients were obtained for flexion compared to extension, and with the Marker compared to the Line of Femur Method. For intra- and inter-rater reliability, the mean differences (within 2 degrees) and 95% limits of agreement (within 5 degrees) were generally clinically acceptable for both methods.
Photography potentially offers a superior method of measurement over standard goniometry as visualising the centre of the knee is simplified in a two-dimensional plane and the permanent record provides greater assessor transparency as well as opportunity to confer. The Marker and Line of Femur Methods have moderate to substantial validity, but the inter- and intra-rater repeatability for trained observers are excellent with both methods yielding small mean differences with narrow limits of agreement. The Line of Femur Method offers the added advantage that it does not rely on inter-clinician consistency in identifying the greater trochanter.
This study was designed to validate a grading scheme for lateral nasal wall insufficiency with interrater and intrarater reliability measures. Representative endoscopic videos depicting varied degrees of lateral nasal wall insufficiency were collated into a 30-clip video (15 clips in duplicate). This was rated by five reviewers for a total of 150 observations. Interrater and intrarater reliability were determined using Fleiss kappa and intraclass correlation coefficient (ICC) statistics, respectively. Good agreement was established between reviewers (interrater reliability), with a Fleiss kappa of 0.7733 (p < 0.01). Analysis of intrarater variability with the ICC revealed a very strong agreement (ICC = 0.88; p < 0.01). The proposed grading system is shown to have good interrater and intrarater reliability. It provides a reliable instrument for assessing lateral wall insufficiency.
Collapse; grading; internal valve; lateral nasal wall; lateral wall; nasal valve; obstruction
To evaluate the reliability and agreement of digital tender point (TP) examination in chronic low back pain (LBP) patients.
Hospital-based validation study.
Among sick-listed LBP patients referred from general practitioners for low back examination and return-to-work intervention, 43 and 39 patients, respectively (18 women, 46%) entered and completed the study.
Main outcome measures
The reliability was estimated by the intraclass correlation coefficient (ICC), and agreement was calculated for up to ±3 TPs. Furthermore, the smallest detectable difference was calculated.
TP examination was performed twice by two consultants in rheumatology and rehabilitation at 20 min intervals and repeated 1 week later. Intrarater reliability in the more and less experienced rater was ICC 0.84 (95% CI 0.69 to 0.98) and 0.72 (95% CI 0.49 to 0.95), respectively. The figures for inter-rater reliability were intermediate between these figures. In more than 70% of the cases, the raters agreed within ±3 TPs in both men and women and between test days. The smallest detectable difference between raters was 5, and for the more and less experienced rater it was 4 and 6 TPs, respectively.
The reliability of digital TP examination ranged from acceptable to excellent, and agreement was good in both men and women. The smallest detectable differences varied from 4 to 6 TPs. Thus, TP examination in our hands was a reliable but not precise instrument. Digital TP examination may be useful in daily clinical practice, but regular use and training sessions are required to secure quality of testing.
Rheumatology; Statistics & Research Methods; Pain Management