Baseline 12-1014 Plastic Finger Goniometer

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The repeated measures 2x2x10 ANOVAs revealed that the main effect of goniometer was insignificant. The main effect of trial was significant for the MCP joint in imitated extension in study part I-A and in all study part II-A subgroups. The main effect of rater was significant for the MCP joint in study part I-A and in all study part II-A subgroups. Trial by rater interaction effect was observed in all the subgroups except for that of the DIP joint in position of imitated flexion. Goniometer by trial interaction was observed only in the DIP joint extension subgroup of the study part II-A. The 2x10 ANOVAs showed that goniometer and rater effects were insignificant in approximately half of the trial-position-joint data sets. Most of the two-way ANOVAs resulted in significant goniometer by rater interaction. Insignificance of all effects was observed only in the study part I-A, for the first trial measurements of the DIP joint and for the second trial measurements of the PIP joint in flexion. Goldsmith N, Juzl E: Inter-rater reliability of two trained raters using a goniometer for the measurement of finger joints. Br J Hand Ther. 1998, 3: 11-12. cited by Burr et al. [26] Chiu HY: A method of two-dimensional measurement for evaluating finger motion impairment. A description of the method and comparison with angular measurement. J Hand Surg Br. 1995, 20: 691-695. 10.1016/S0266-7681(05)80138-X. Range of motion (ROM) measurements are a critical component of the hand surgeon’s physical examination for many diagnoses. Used to establish a quantitative marker for digit function, ROM measurements are used to establish baseline movement, assess clinical improvements, and in some pathologies guide indications for treatment. Thus, it is important that tools used to evaluate ROM be accurate and precise. Multiple methods currently exist for finger ROM measurements, including visual estimation, manual goniometry, photographic goniometry, diagrammatic recordings, goniometric gloves, and radiographic imaging. 1 - 4 Although the accuracy of manual goniometry has been debated, 2 this method is thought to have high interrater reliability 5 and remains a universal technique used by hand surgeons and hand therapists. Power analysis prior to the study was performed for a 2-sample t test for noninferiority, which calculated a sample size of 13 subjects based on a mean difference of 5°, a standard deviation of 10% of the expected measurement, α of 0.05, and a power of 0.80. Five degrees of difference is the accepted standard error in manual goniometry of the hand. 8, 9 For this study, the authors elected to include a larger sample size (n = 50).

Weir JP: Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM. J Strength Cond Res. 2005, 19: 231-240.Milanese S et al. Reliability and concurrent validity of knee angle measurement: Smart phone app versus universal goniometer used by experienced and novice clinicians. Manual Therapy, 2014; 5: 1–6. The smartphone is an increasingly pervasive tool that could add value in a hand surgeon’s clinic. Because clinical treatment decisions and follow-up examinations for certain disease processes are based primarily on ROM measurements, the use of smartphone photography goniometry is an attractive method for incorporating telemedicine into a hand surgeon’s practice. Smartphone photography goniometry may also decrease economic costs and increase access to care for both patients and providers. 22, 23 Specifically in the case of the patient with Dupuytren disease, initial visits and subsequent long-term follow-up without the need for surgical intervention could all be conducted via the remote transfer of a smartphone photograph, thus eliminating patient travel costs, reducing clinic load, and increasing the availability of care. Long-term follow-up of patients could also be more consistent, as the barriers to follow-up are dramatically diminished. Two weeks before the study, the participants were sent step-by-step instructions with the appropriate images of the procedure and the equipment. At least a week before the study, the equipment and procedures were demonstrated to the participants live. Example try-angles, triangle rulers, and paper strips were distributed for individual training at home. Taking into account the unusual manipulative task of the diagrammatic goniometry, the participants learned to copy printed angles by using the paper goniometer individually or as participants of another study. Two days before the study, the participants were required to answer a short quiz testing the knowledge of their tasks in the study. Procedures on the day of study A pilot exploration employing a healthy subject and 17 raters was performed to elucidate possible technical problems of the study. Pratt AL, Burr N, Stott D: An investigation into the degree of precision achieved by a team of hand therapists and surgeons using hand goniometry with a standardised protocol. Hand Ther. 2004, 9: 116-121.

Hayen A, Dennis RJ, Finch CF: Determining the intra- and inter-observer reliability of screening tools used in sports injury research. J Sci Med Sport. 2007, 10: 201-210. 10.1016/j.jsams.2006.09.002.

In the replicate study parts A, the subjects used their individual try-angle sets at the 10 evaluation stations (Figure 1, Additional file 2). The values of the angles of individual try-angles were randomly distributed across the finger joints and across the subjects. The angles of the individual try-angles of the same subject were of different magnitude, and none of the subjects had the same combination of the angle magnitudes (Additional file 3). Raters of the study parts A had to obtain twice the MCP, PIP, and DIP joint angles in each of the two positions (flexion and extension) by using both goniometers (Additional file 2) .

The subjects’ task in all study parts was to stabilize their left ring finger joints in postures set up by grasping a funnel or a triangle ruler and by applying appropriate try-angles over the dorsal aspect of the joint (Figure 2a). Goniometer. (2008, August 30). In Wikipedia, The Free Encyclopedia. Retrieved 11:12, September 14, 2008, from http://en.wikipedia.org/wiki/Goniometer. 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. Results Portney LG, Watkins MP: Foundations of Clinical Research: Applications to Practice. 2008, NJ, Prentice Hall: Upper Saddle River, 3rd Groth GN, VanDeven KM, Phillips EC, Ehretsman RL: Goniometry of the proximal and distal interphalangeal joints, Part II: placement preferences, interrater reliability, and concurrent validity. J Hand Ther. 2001, 14: 23-29. 10.1016/S0894-1130(01)80021-1.Macionis V: A technique for graphical recording of range of motion using an improvised paper goniometer. J Hand Ther. 2011, 24: 374-377. 10.1016/j.jht.2011.05.003. To find whether the try-angle guides significantly changed the observed angles of the PIP joint, multiple Wilcoxon signed-rank tests with Bonferroni correction were performed for each rater-instrument-position-subposition data set in respect to the baseline joint angles obtained by using the smallest standard angles. Then the standard differences between the angles of the appropriate try-angles (i.e., between the standard angles) were calculated in respect of the smallest standard angles. Next, the lowest significant standard differences were found between the smallest standard angles and the angles of the try-angles, application of which produced significant changes in the observed PIP joint angles (Additional file 6). The lowest significant standard differences were compared with each other and with the corresponding values of the MDC derived from the SEMs of the study parts A. Analysis of reliability of the diagram evaluation Lewis E, Fors L, Tharion WJ: Interrater and intrarater reliability of finger goniometric measurements. Am J Occup Ther. 2010, 64: 555-561. 10.5014/ajot.2010.09028. Interobserver reliability of smartphone photograph goniometry was tested via intraclass correlation coefficients (ICCs) and Pearson correlation coefficients for both trained and untrained photograph measurements. Using the guidelines developed by Cicchetti and Sparrow, 10 an ICC less than 0.40 corresponds to poor clinical reliability, an ICC between 0.4 and 0.59 corresponds to fair clinical reliability, an ICC between 0.60 and 0.74 corresponds to good clinical reliability, and an ICC between 0.75 and 1.00 corresponds to excellent clinical reliability. Smith RP, Dias JJ, Ullah A, Bhowal B: Visual and computer software-aided estimates of Dupuytren's contractures: correlation with clinical goniometric measurements. Ann R Coll Surg Engl. 2009, 91: 296-300.

Hopkins WG: Measures of reliability in sports medicine and science. Sports Med. 2000, 30: 1-15. 10.2165/00007256-200030010-00001. Record measurements correctly (both active and passive range of motion should be measured and recorded respectively). [1] Flowers KR, LaStayo P: Effect of total end range time on improving passive range of motion. J Hand Ther. 1994, 7: 150-157. 10.1016/S0894-1130(12)80056-1. Two photographs from the same patient depict contractures in the left small finger and the right middle finger.

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All the blanks with the recorded angles of the joints were scanned. The scanned diagrams were magnified, and their angles were measured to the nearest degree by the same researcher with ImageJ program. Each diagram was measured at least twice without reference to the previous results. If the results of the two computerized measurements were different, the diagram was remeasured again. If 2 identical measurements were not obtained, mean of the measurements was found and rounded off to the nearest degree. To assess intra-rater and inter-rater reliability of the latter procedure, two invited medical students remeasured 48 randomly chosen scanned diagrams. Computerized evaluation instead of a simple use of a traditional protractor was chosen to equalize varying sizes of the hand drawn diagrams and to avoid errors of hand-done measurements. Independence of observations There are limited validity studies on goniometry, but they have found high criterion validity in measurements of knee joint angles when compared to x-ray joint angles. [3] [4] Reliability depends on the joint and motion being assessed but generally the universal goniometer has been shown to have good to excellent reliability, and is more reliable than visual estimation especially with inexperienced examiners. Some research argues that the reliability of the measurement from a goniometer depends on the type used [5] [6] while some did not see any significant difference between some instruments. [7] [8] Overall, research shows high intra- and inter-rater reliability of the universal goniometer, with reliability in non-expert examiners improved with clear instructions on goniometric alignment, therefore where possible he same therapist should perform all measures to improve accuracy. Evidence is mixed on on the number of measures to take, or whether taking an average of repeated measures improves assessment. Sources of error when using goniometry can come from our expectations of what the ROM is, reading the wrong side of the scale on the goniometer, a change in the patient’s motivation to perform, or taking successive measurements at different times of the day. [9] The procedure protocol also included relaxation of the subject’s hand between the measurements and short breaks between the evaluation sessions. As the length of the evaluation sessions differed from rater to rater, the intervals between sessions also varied. The participants were free to choose longer brakes if they felt tired. Evaluation of diagrams Burr N, Pratt AL, Stott D: Inter-rater and intra-rater reliability when measuring interphalangeal joints: comparison between three hand-held goniometers. Physiotherapy. 2003, 89: 641-652. 10.1016/S0031-9406(05)60097-1.