Validity and reliability of a finger training tool for assessing metacarpal phalangeal joint ranges of motion in asymptomatic participants.

This pilot study aims to evaluate concurrent validity using the goniometer as a reference tool and test-retest reliability of flexion of metacarpal phalangeal joint (MCP) measurements taken from a finger training device (air-guitar system) in healthy participants. There were ten self -reported asymptomatic participants recruited to test the devices. The measurements of all metacarpophangeal joints of the dominant hands were conducted using a finger goniometer and the air-guitar system. Two measuring sessions were conducted on the same day. The concurrent validity of the air-guitar indicated by strong concordance correlation coefficient (0.62-0.90) with the goniometer and mean difference (approximately 1°) between the two instruments are well below the limit of 5°. The test-retest reliability of MCP measurements from the air-guitar glove (0.82-0.99) was acceptable as a clinically meaningful measurement tool as the intraclass correlation coefficients were higher than 0.7. The standard error of measurement and minimal detectable change of the air-guitar are similar to those of the goniometer. The air-guitar tracking features, when used as a home-based therapy tool, may assist in monitoring change of MCP flexion over a time course with good reliability and strongly associated with the measurements from the goniometer.

Goniometry and fleximetry measurements to assess cervical range of motion in individuals with chronic neck pain: a validity and reliability study.

PURPOSE: To assess the test-retest and inter-rater reliability of goniometry and fleximetry in measuring cervical range of motion in individuals with chronic neck pain. METHODS: A reliability study. Thirty individuals with chronic neck pain were selected. Cervical range of motion was measured by goniometry and fleximetry at two time points 7 days apart. To characterize the sample, we used the numerical pain rating scale, Pain-Related Catastrophizing Thoughts Scale, and Neck Disability Index. Intraclass correlation coefficient (ICC), standard error of measurement (SEM) and minimum detectable change (MDC) were calculated. Correlations between goniometry and fleximetry measurements were performed using Spearman's correlation coefficient (rho). RESULTS: For goniometry, we found excellent test-retest reliability (ICC ≥ 0.986, SEM ≤ 1.89%, MDC ≤ 5.23%) and inter-rater reliability (ICC ≥ 0.947, SEM ≤ 3.91%, MDC ≤ 10.84%). Similarly, we found excellent test-retest reliability (ICC ≥ 0.969, SEM ≤ 2.71%, MDC ≤ 7.52%) and inter-rater reliability (ICC ≥ 0.981, SEM ≤ 1.88%, MDC ≤ 5.20%) for fleximetry. Finally, we observed a strong correlation between the goniometry and the fleximetry for all cervical movements (rho ≥ 0.993). CONCLUSION: Goniometry and fleximetry measurements are reliable for assessing cervical range of motion in individuals with chronic neck pain.

The optimal measurement method considering reliability and validity in the anterior knee laxity of anterior cruciate ligament tears.

INTRODUCTION: To seek an optimal measurement method with high reliability and high validity for evaluation of the anterior knee laxity on stress radiographs and comparing the translation values to those of KT-2000 arthrometer. METHODS: Anterior knee laxity in 77 patients was measured preoperatively using the TelosTM and the KT-2000 arthrometer. Side-to-side difference measurements were taken using three conventional measuring methods and one proposed method (Modified Lateral). The knee position on the stress radiograph was evaluated and scored based on the stress radiograph qualifying criteria depending on stress film correctiveness. Intraclass correlation coefficients were analyzed to evaluate the reliability of the measurement methods and were compared between high (Group H) and low (Group L) radiograph quality score groups for each method. Validity was assessed by comparing the KT-2000 and the TelosTM using Pearson correlation (r value). RESULTS: The Modified Lateral method showed the best Intraclass Correlation Coefficients (ICCs), followed by Center to Center, and Medial to Medial and Lateral to Lateral methods without considering the quality of Telos. In the comparison between groups based on Telos quality for intra-rater reliability, the Medial to Medial (MM) method demonstrated the best reliability in both groups (MM: ICCs, Group H = 0.942, Group L = 0.917, P = 0.693). As for inter-rater reliability, the Modified Lateral (ML) method exhibited the best reliability in both groups (ML: ICCs, Group H = 0.923, Group L = 0.882, P = 0.547). The value measured using the ML method in Telos showed the highest correlation coefficient with the KT-2000 measured value in both groups H and L. There were no statistically significant differences among the correlation coefficient values. CONCLUSION: The Modified Lateral method is recommended for its high reliability, taking into account the differences in bilateral knee positions and anatomical discriminability on stress radiographs when evaluating anterior knee translation with Telos. It also best reflected the KT-2000 arthrometer. LEVEL OF EVIDENCE: Case Series, Level IV.

Hybridized deep learning goniometry for improved precision in Ehlers-Danlos Syndrome (EDS) evaluation.

BACKGROUND: Generalized Joint Hyper-mobility (GJH) can aid in the diagnosis of Ehlers-Danlos Syndrome (EDS), a complex genetic connective tissue disorder with clinical features that can mimic other disease processes. Our study focuses on developing a unique image-based goniometry system, the HybridPoseNet, which utilizes a hybrid deep learning model. OBJECTIVE: The proposed model is designed to provide the most accurate joint angle measurements in EDS appraisals. Using a hybrid of CNNs and HyperLSTMs in the pose estimation module of HybridPoseNet offers superior generalization and time consistency properties, setting it apart from existing complex libraries. METHODOLOGY: HybridPoseNet integrates the spatial pattern recognition prowess of MobileNet-V2 with the sequential data processing capability of HyperLSTM units. The system captures the dynamic nature of joint motion by creating a model that learns from individual frames and the sequence of movements. The CNN module of HybridPoseNet was trained on a large and diverse data set before the fine-tuning of video data involving 50 individuals visiting the EDS clinic, focusing on joints that can hyperextend. HyperLSTMs have been incorporated in video frames to avoid any time breakage in joint angle estimation in consecutive frames. The model performance was evaluated using Spearman's coefficient correlation versus manual goniometry measurements, as well as by the human labeling of joint position, the second validation step. OUTCOME: Preliminary findings demonstrate HybridPoseNet achieving a remarkable correlation with manual Goniometric measurements: thumb (rho = 0.847), elbows (rho = 0.822), knees (rho = 0.839), and fifth fingers (rho = 0.896), indicating that the newest model is considerably better. The model manifested a consistent performance in all joint assessments, hence not requiring selecting a variety of pose-measuring libraries for every joint. The presentation of HybridPoseNet contributes to achieving a combined and normalized approach to reviewing the mobility of joints, which has an overall enhancement of approximately 20% in accuracy compared to the regular pose estimation libraries. This innovation is very valuable to the field of medical diagnostics of connective tissue diseases and a vast improvement to its understanding.

Reliability and validity of the medial standing overhead arm reach (SOAR) test as a measure of functional hip adduction motion.

OBJECTIVE: The Posterior Standing Overhead Arm Reach (SOAR) test has been previously reported as a reliable clinical measure of closed chain hip extension motion. The proposed Medial SOAR test expands on that testing approach to provide a similar measure of functional hip adduction motion. This was a preliminary intrarater and interrater reliability and validity study of the Medial SOAR test as a measure of functional hip adduction. DESIGN: Cross-sectional. SETTING: University motion analysis laboratory. PARTICIPANTS: Fifty hips were assessed in 25 (22 female) asymptomatic participants (mean age = 23.4 years, SD = 0.8). MAIN MEASURES: Maximum hip adduction during the Medial SOAR test was measured with a standard goniometer independently by two examiners. The test was also performed using three-dimensional motion capture. The intrarater and interrater reliability of the goniometric measure was determined using intraclass correlation coefficients, and the relationship between measures obtained via goniometry and three-dimensional motion capture was assessed with Pearson correlations and Bland-Altman analysis. RESULTS: Intrarater reliability (ICC2,3) was 0.88 (95% CI = 0.80-0.92) for Examiner 1 and 0.87 (95% CI = 0.79-0.92) for Examiner 2. The standard error of measurement and minimal detectable change were less than 3.0°. Interrater reliability demonstrated an intraclass correlation coefficient = 0.62 (95% CI = 0.28-0.79). Pearson correlations were significant with low-to-moderate associations (r = 0.49, P < 0.001; r = 0.24, P = 0.045). CONCLUSIONS: Similar to the previously reported Posterior SOAR test, the Medial SOAR test demonstrated acceptable intrarater and interrater reliability, along with low-to-moderate associations with three-dimensional motion capture. The Medial SOAR test has the potential to provide a reliable and accurate assessment of closed chain hip adduction.

Reliability and clinical utility of a novel telehealth-based goniometry approach to measure range of motion of the digits of the hand.

BACKGROUND: Range of motion (ROM) is an outcome measure commonly used when treating acute and chronic hand injuries and conditions. Increased adoption of telehealth service provision in hand therapy practice, influenced by the advent of COVID-19, has led to the need for a valid and reliable approach to measure the range of motion of the digits of the hand when providing hand therapy services using telehealth. PURPOSE: To determine if performing manual goniometry during a livestream teleconsultation is reliable and clinically useful to measure the range of motion of the fifth digit when providing hand therapy services using telehealth. STUDY DESIGN: Clinical measurement, repeated-measures study. METHODS: According to a measurement protocol, 12 independent raters (who currently provide hand therapy services) each obtained several screen-based goniometric range of motion measurements of the fifth digit at 2-time points. Raters were surveyed on the clinical utility of the telehealth-based goniometry approach. Measures of relative and absolute reliability were calculated to evaluate test-retest and inter-rater reliability. Free-text responses were analyzed using content analysis. RESULTS: Inter-rater reliability was excellent for all flexion and extension measures (intraclass correlation coefficient [ICC] ≥ 0.89) but poor for the arc of motion (ICC ≤ 0.67). Test-retest reliability was poor (ICC ≤ 0.43). No statistically significant differences between test and retest measurements were observed (P ≥ 0.24). The overall coefficient of variation indicated good precision (14.69%). Measurement error (≤6.07º) and limits of agreement (≤6.33) had acceptable levels to support clinical use. Content analysis revealed several practical considerations. CONCLUSIONS: This study suggests that performing manual goniometry during a livestream teleconsultation is unreliable for measuring the range of motion of the fifth digit. However, when combined with patient-reported and functional outcomes, this approach may be suitable to facilitate a range of motion assessment for certain functions of telehealth service provision in hand therapy practice.

Analysis of the concurrent validity and reliability of five common clinical goniometric devices.

Measurement errors play an important role in the development of goniometric equipment, devices used to measure range of motion. Reasonable validity and reliability are critical for both the device and examiner before and after to testing in human subjects. The objective is to evaluate the concurrent validity and reliability of five different clinical goniometric devices for the purpose of establishing an acceptable measurement error margin for a novel device. We explored the validity and inter- and intrarater reliability scores of five goniometric devices namely (i) the universal goniometer (UG), a two-armed hand-held goniometer, (ii) the inclinometer (IC), featuring a single base, fluid level, and gravity-weighted inclinometer, (iii) the digital inclinometer (DI), functioning as both a DI and dynamometer, (iv) the smartphone application (SA), employing gyroscope-based technology within a smartphone platform application and (v) the modified inclinometer (MI), a gravity pendulum-based inclinometer equipped with a specialized fixing apparatus. Measurements were obtained at 12 standard angles and 8 human shoulder flexion angles ranging from 0° to 180°. Over two testing sessions, 120 standardized angle measurements and 160 shoulder angle measurements from 20 shoulders were repetitively taken by three examiners for each device. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable change (MDC) were calculated to assess reliability and validity. Concurrent validity was also evaluated through the execution of the 95% limit of agreement (95% LOA) and Bland-Altman plots, with comparisons made to the UG. The concurrent validity for all device pairs was excellent in both study phases (ICC > 0.99, 95% LOA - 4.11° to 4.04° for standard angles, and - 10.98° to 11.36° for human joint angles). Inter- and intrarater reliability scores for standard angles were excellent across all devices (ICC > 0.98, SEM 0.59°-1.75°, MDC 1°-4°), with DI showing superior reliability. For human joint angles, device reliability ranged from moderate to excellent (ICC 0.697-0.975, SEM 1.93°-4.64°, MDC 5°-11° for inter-rater reliability; ICC 0.660-0.996, SEM 0.77°-4.06°, MDC 2°-9° for intra-rater reliability), with SA demonstrating superior reliability. Wider angle measurement however resulted in reduced device reliability. In conclusion, our study demonstrates that it is essential to assess measurement errors independently for standard and human joint angles. The DI is the preferred reference for standard angle testing, while the SA is recommended for human joint angle testing. Separate evaluations across the complete 0°-180° range offer valuable insights.

A webcam-based machine learning approach for three-dimensional range of motion evaluation.

BACKGROUND: Joint range of motion (ROM) is an important quantitative measure for physical therapy. Commonly relying on a goniometer, accurate and reliable ROM measurement requires extensive training and practice. This, in turn, imposes a significant barrier for those who have limited in-person access to healthcare. OBJECTIVE: The current study presents and evaluates an alternative machine learning-based ROM evaluation method that could be remotely accessed via a webcam. METHODS: To evaluate its reliability, the ROM measurements for a diverse set of joints (neck, spine, and upper and lower extremities) derived using this method were compared to those obtained from a marker-based optical motion capture system. RESULTS: Data collected from 25 healthy adults demonstrated that the webcam solution exhibited high test-retest reliability, with substantial to almost perfect intraclass correlation coefficients for most joints. Compared with the marker-based system, the webcam-based system demonstrated substantial to almost perfect inter-rater reliability for some joints, and lower inter-rater reliability for other joints (e.g., shoulder flexion and elbow flexion), which could be attributed to the reduced sensitivity to joint locations at the apex of the movement. CONCLUSIONS: The proposed webcam-based method exhibited high test-retest and inter-rater reliability, making it a versatile alternative for existing ROM evaluation methods in clinical practice and the tele-implementation of physical therapy and rehabilitation.

Measurement Repeatability and Reproducibility of Virtual Goniometry of a Set of Acquired Images in Youths with Arthrogryposis Multiplex Congenita.

OBJECTIVES: To evaluate the intra-rater repeatability and the inter-rater reproducibility of using a virtual goniometer to measure upper and lower extremity joint range of motion (ROM) in youths with arthrogryposis multiplex congenita (AMC). METHODS: Youths presenting with AMC aged 8 to 21 years old were recruited. ROM of the upper and lower limbs were assessed remotely during a teleassessment on a video-conferencing platform. Screen captures were taken and ROM were measured by two raters, two-weeks apart, using a virtual goniometer. Intraclass correlation coefficient (ICC) and associated 95% confidence interval (CI) were calculated to assess intra-and inter-rater repeatability and reproducibility. RESULTS: Nine participants were included with a median age of 15.9 years (range: 11.3 to 20.8 years). The overall intra-rater ICC was 0.997 (95% CI:0.996 to 0.997) for the first rater and 0.993 (95% CI:0.992 to 0.994) for the second rater. The inter-rater ICC ranged from 0.410 (95% CI:-0.392; 0.753) for forearm pronation to 0.998 (95% CI:0.996; 0.999) for elbow flexion. CONCLUSIONS: Results of the current study suggest that virtual goniometry is reproducible and repeatable for the ROM of most joints. Future studies should evaluate procedural reliability and validity of the proposed method for youth with complex conditions.

Reliability of a human pose tracking algorithm for measuring upper limb joints: comparison with photography-based goniometry.

BACKGROUND: Range of motion (ROM) measurements are essential for diagnosing and evaluating upper extremity conditions. Clinical goniometry is the most commonly used methods but it is time-consuming and skill-demanding. Recent advances in human tracking algorithm suggest potential for automatic angle measuring from RGB images. It provides an attractive alternative for at-distance measuring. However, the reliability of this method has not been fully established. The purpose of this study is to evaluate if the results of algorithm are as reliable as human raters in upper limb movements. METHODS: Thirty healthy young adults (20 males, 10 females) participated in this study. Participants were asked to performed a 6-motion task including movement of shoulder, elbow and wrist. Images of movements were captured by commercial digital cameras. Each movement was measured by a pose tracking algorithm (OpenPose) and compared with the surgeon-measurement results. The mean differences between the two measurements were compared. Pearson correlation coefficients were used to determine the relationship. Reliability was investigated by the intra-class correlation coefficients. RESULTS: Comparing this algorithm-based method with manual measurement, the mean differences were less than 3 degrees in 5 motions (shoulder abduction: 0.51; shoulder elevation: 2.87; elbow flexion:0.38; elbow extension:0.65; wrist extension: 0.78) except wrist flexion. All the intra-class correlation coefficients were larger than 0.60. The Pearson coefficients also showed high correlations between the two measurements (p < 0.001). CONCLUSIONS: Our results indicated that pose estimation is a reliable method to measure the shoulder and elbow angles, supporting RGB images for measuring joint ROM. Our results presented the possibility that patients can assess their ROM by photos taken by a digital camera. TRIAL REGISTRATION: This study was registered in the Clinical Trials Center of The First Affiliated Hospital, Sun Yat-sen University (2021-387).

Measurement of compensatory wrist joint rotation using three-dimensional motion analysis in patients with unilateral proximal congenital radioulnar synostosis.

OBJECTIVE: This study aims to investigate compensatory rotational movements of the wrist joint in patients with proximal congenital radioulnar synostosis (CRUS), using a valid and reliable three-dimensional (3D) motion analysis technique. METHODS: A total of 26 patients (6 females, 14 males; mean age=15.3 years; and age range=6-32 years) who were diagnosed with unilateral proximal CRUS but were not operated were enrolled in this study. Patients were then categorized into 2 groups: Group I included 5 patients younger than 10 years, and Group II included 15 patients older than 10 years. Eighteen light-reflective skin markers were placed on the bony landmarks of both upper limbs, and both distal forearms were fixed using a U-shaped device to minimize forearm rotation. Each patient grasped the handle of an instrument that used a goniometer to measure wrist rotation; maximal passive pronation and supination angles of the wrist were measured in this manner and also using 3D motion analysis. RESULTS: There was a significant correlation between measurements by the goniometer and 3D motion analysis (r=0.985, p<0.001). The test-retest reliability of the 3D motion analysis was acceptable for both the affected side (ICC=0.992) and the contralateral normal side (ICC=0.997) with low standard measurement errors (1.3° and 0.8°, respectively). Although no significant difference was observed in the range of the wrist rotation between the affected and contralateral sides in Group I (p=0.686), there was a significant difference in the wrist rotation between the affected and contralateral sides in Group II (p=0.001). Further, the pronation angle of the wrist joint was significantly larger in the affected side than that in the contralateral normal side in Group II (p=0.001). CONCLUSION: The 3D motion analysis technique seems to be a valid and reliable method to measure the rotation of the wrist joint. Unilateral proximal CRUS patients older than 10 years of age may develop rotational hypermobility of the wrist joint compared to the contralateral normal side as a compensatory phenomenon. LEVEL OF EVIDENCE: Level III, Diagnostic Study.

Quantification of morning stiffness to assess disease activity and treatment effects in rheumatoid arthritis.

OBJECTIVES: The clinical parameter of morning stiffness is widely used to assess the status of RA, but its accurate quantitative assessment in a clinical setting has not yet been successful. This lack of individual quantification limits both personalized medication and efficacy evaluation in the treatment of RA. METHODS: We developed a novel technology to assess passive resistance of the MCP III joint (stiffness) and its passive range of motion (PRoM). Within this pilot study, 19 female postmenopausal RA patients and 9 healthy controls were examined in the evening as well as the morning of the following day. To verify the specificity of the biomechanical quantification, 11 patients with RA were assessed both prior to and ∼3 h after glucocorticoid therapy. RESULTS: While the healthy controls showed only minor changes between afternoon and morning, in RA patients the mean PRoM decreased significantly by 18% (s.d. 22) and stiffness increased significantly by 20% (s.d. 18) in the morning compared with the previous afternoon. We found a significant positive correlation between RA activity and biomechanical measures. Glucocorticoids significantly increased the mean PRoM by 16% (s.d. 11) and reduced the mean stiffness by 23% (s.d. 22). CONCLUSION: This technology allowed mechanical stiffness to be quantified in MCP joints and demonstrated high sensitivity with respect to disease status as well as medication effect in RA patients. Such non-invasive, low-risk and rapid assessment of biomechanical joint stiffness opens a novel avenue for judging therapy efficacy in patients with RA and potentially also in other non-RA inflammatory joint diseases.

No differences in clinical outcomes and graft healing between anteromedial and central femoral tunnel placement after single bundle ACL reconstruction.

PURPOSE: The purpose of this study was to compare clinical outcomes and graft healing after anterior cruciate ligament (ACL) reconstruction with anteromedial and central femoral tunnel placement. METHODS: During 2016 and 2018, 110 consecutive patients underwent single bundle ACL reconstruction; 85 patients met the inclusion criteria, and each patient underwent 3D-CT within 1 week and MRI 1.5 years after the operation. The central point of the femoral tunnel and signal/noise quotient (SNQ) of three regions of interest (ROI) in the intra-articular graft were measured to analyse the tunnel position and graft healing extent. Clinical assessments, including functional scores, KT-2000 arthrometer measurements and pivot-shift tests, were evaluated at the 2-year follow-up. Patients were divided into two groups depending on the femoral tunnel position: the anteromedial position group (Group A) and the centre position group (Group B). RESULTS: Seventy-one patients were available for the 2-year follow-up and MRI examination: 34 patients in Group A and 35 patients in Group B, and 2 patients were excluded for an eccentric tunnel position. No graft failure occurred, and compared with the preoperative assessment outcomes, the outcomes of both groups improved at the final follow-up. Group A was significantly better than Group B regarding the KT-2000 arthrometer measurements (P = 0.031). No significant differences were observed in terms of functional scores, pivot-shift test results, or the SNQ between groups. CONCLUSIONS: No differences in clinical outcomes or graft healing were found between AM and central femoral tunnel placements in single bundle ACL reconstruction. Therefore, satisfactory clinical outcomes, knee stability and graft healing can be obtained for both femoral tunnel placements. LEVEL OF EVIDENCE: II.

Feasibility and reliability of a web-based smartphone application for joint position measurement.

OBJECTIVE: Measurement of joint angles is usually performed using a simple goniometer, which can often be time-consuming and inaccurate, however smartphones can measure angles, this technology could be used to measure joint position. Studies of smartphone applications for this purpose lack consistency and homogeneity. The aim of the current study is to analyse the reliability and accuracy of 3 inertial motion unit-based smartphone applications for goniometric measurement, using 3 different industry standards as external controls. METHODS: In the first 2 phases of the study, measurements of angles between 90° and 165° (simulating knee extension) using 3 smartphone applications were analysed against the 3 industry standards. In the third phase, the smartphone's raw data was individually analysed against a digital inclinometer across the x, y and z axes. RESULTS AND CONCLUSION: Results from the 3 phases of this study indicate a high degree of reliability and validity of the applications compared with the industry standards, with no clinically significant deviations. Thus, this technology could be used in a clinical setting. However, further clinical research, focussing on joint motions with greater than a single degree of freedom, is required before the use of such applications for joint position measurement in clinical practice.

Anterolateral ligament reconstruction improves the clinical and functional outcomes of anterior cruciate ligament reconstruction in athletes.

PURPOSE: To compare the outcomes of anterior cruciate ligament (ACL) reconstruction with those of combined ACL and anterolateral ligament (ALL) reconstruction in ACL-deficient knees. The objective of this study was to improve knowledge regarding the treatment of ACL-deficient knees with combined ACL and ALL reconstruction. Combined ACL and ALL reconstruction has been hypothesized to result in better clinical and functional outcomes than isolated ACL reconstruction (ACLR). METHODS: One-hundred and seven adult male athletes with ACL tears and high-grade pivot shifts were randomized into two groups. Those in group A (n = 54) underwent ACLR, while those in group B (n = 53) underwent combined ACL and ALL reconstruction. The median age was 26 (18-40) and 24 (18-33) years in groups A and B, respectively, and the median follow-up was 60 (55-65) months. Physical examination findings, instrumented knee laxity tested using a KT-1000 arthrometer, and International Knee Documentation Committee Scale (IKDC) scores were used to evaluate the outcomes. RESULTS: One-hundred and two patients were available for follow-up: 52 in group A and 50 in group B. Postoperatively, the pivot shift was normal in 43 (82.7%) and 48 (96%) patients in groups A and B, respectively (p < 0.001). The median instrumented knee laxity was 2.5 ± 0.7 (1.2-6.1) mm in patients in group A and 1.2 ± 0.7 (1.2-3.2) mm in patients in group B (p < 0.001). Additionally, 44 (84.6%) patients in group A had normal IKDC scores and 3 (5.8%) had nearly normal scores, while 48 (96.0%) patients in group B had normal IKDC scores and 2 (4%) had nearly normal scores (p < 0.001). CONCLUSION: Combined ACL and ALL reconstruction, compared with isolated ACLR resulted in favourable clinical and functional outcomes, as demonstrated by decreased rotational instability and instrumented knee laxity, a lower graft rupture rate and better postoperative IKDC scores. LEVEL OF EVIDENCE: 1.

The Effect of Hip Joint Mobilizations Using a Mobilization Belt on Hip Range of Motion and Functional Outcomes.

CONTEXT: Joint mobilizations have been studied extensively in the literature for the glenohumeral joint and talocrural joint (ankle). Consequently, joint mobilizations have been established as an effective means of improving range of motion (ROM) within these joints. However, there is a lack of extant research to suggest these effects may apply within another critical joint in the body, the hip. OBJECTIVE: To examine the immediate effects of hip joint mobilizations on hip ROM and functional outcomes. Secondarily, this study sought to examine the efficacy of a novel hip mobilization protocol. DESIGN: A prospective exploratory study. SETTING: Two research labs. PATIENTS OR OTHER PARTICIPANTS: The study included 19 active male (n = 8) and female (n = 11) college students (20.56 [1.5] y, 171.70 [8.6] cm, 72.23 [12.9] kg). INTERVENTIONS: Bilateral hip mobilizations were administered with the use of a mobilization belt. Each participant received hip joint mobilization treatments once during 3 weekly sessions followed immediately by preintervention and postintervention testing/measurements. Testing for each participant occurred once per week, at the same time of day, for 3 consecutive weeks. Hip ROM was the first week, followed by modified Star Excursion Balance Test the second week and agility T test during the third week. MAIN OUTCOMES MEASURES: Pretest and posttest measurements included hip ROM for hip flexion, extension, abduction, adduction, internal and external rotation, as well as scores on the modified Star Excursion Balance Test (anterior, posterolateral, and posteromedial directions) and agility T test. RESULTS: A significant effect for time was found for hip adduction, internal and external rotation ROM, as well as the posterolateral and posteromedial directions of the modified Star Excursion Balance Test. A separate main effect for both limbs was found for adduction and internal rotation ROM. CONCLUSION: Isolated immediate changes in ROM and functional outcomes were evident. Further evaluation is needed.

Reliability of assessment methods for scapular dyskinesis in asymptomatic subjects: A systematic review.

OBJECTIVE: The aim of this systematic review was to evaluate the available published evidence on the intra- and inter-rater reliabilities of assessment methods used for identifying and measuring scapular dyskinesis (SD) in asymptomatic subjects. METHODS: A systematic electronic literature search was performed in PubMed, Physiotherapy Evidence Database, Scopus, and the Cochrane Library, and studies on the intra- and inter-rater reliabilities of physical examination tests used for identifying SD in asymptomatic people were identified. Methodological quality of the studies meeting the inclusion criteria was assessed using the Quality Appraisal of Reliability Studies (QAREL) checklist by two reviewers. The overall level of evidence of this systematic review was determined by the Modified Cochrane Back Pain Criteria based on previous research which was modified for reliability studies of the shoulder complex. RESULTS: The literature search generated 388 results, and only 14 articles met the inclusion criteria. In these studies, reliabilities of two qualitative and five quantitative methods for the assessment of SD were analyzed. The QAREL checklist revealed that 12 studies had moderate risk of bias and 2 had high risk of bias. Additionally, none of the studies were of high quality. On the basis of the Modified Cochrane Back Pain Criteria, the overall level of evidence was moderate. Most of the studies including quantitative measurement methods found good to excellent inter- and intra-rater reliability values. Most of the studies including qualitative methods found low-to-moderate intra- and inter-rater reliability values. CONCLUSION: Considering the available published evidence, there is lack of high-quality studies evaluating the inter- and intra-rater reliabilities of qualitative or quantitative methods used for the assessment of SD. There are no qualitative methods with high reliability that are fit for clinical applications. Some quantitative methods with higher reliability are present, but clinicians should be aware of the methodological flaws that studies evaluating these methods suffer from. LEVEL OF EVIDENCE: Level II, Diagnostic study.

Validity and Intrarater Reliability Using a Smartphone Clinometer Application to Measure Active Cervical Range of Motion Including Rotation Measurements in Supine.

CONTEXT: Technological advances have given smartphones the capabilities of sensitive clinical measurement equipment at lesser cost and higher availability. The Clinometer is a smartphone application that can be used to measure the joint range of motion in a clinical setting, but psychometric properties of the tool's use measuring cervical range of motion (CROM) are not established. OBJECTIVES: The purpose of this study was to examine the validity and intrarater reliability of the Clinometer application for the measurement of CROM (ie, flexion, extension, rotation, lateral flexion) and to determine the minimal detectable change and SEM. DESIGN: A blinded, repeated-measures correlational design was employed. SETTING: The study was conducted collaboratively between 2 athletic training clinics. PARTICIPANTS: A convenience sample of healthy adults ages 18-30 years were recruited. Participants with any history in the last 3 months of cervical or thoracic pathology, pain, or any musculoskeletal injury were excluded. MAIN OUTCOME MEASURES: Three repetitions of each motion were measured by a primary researcher with a goniometer. The same researcher then conducted 3 blinded measurements with the Clinometer application following the same procedure. A second researcher, blinded to the goniometer measurements, recorded the results. Thirty minutes later, testing was repeated with the application. The Pearson correlation was calculated to determine validity of the application compared with goniometry. RESULTS: The measurements between devices had moderate to excellent concurrent validity, with the coefficients ranging between 0.544 and 0.888, P < .01. Test-retest reliability of the CROM measurement using the application was moderate to excellent, with intraclass correlation coefficients ranging between .774 and .928. Across all movements, the SEM ranged from 1.17° to 2.01°, and the minimal detectable change ranged from 1.18° to 2.02°. CONCLUSION: The Clinometer application is a valid and reliable instrument for measuring active CROM. LEVEL OF EVIDENCE: clinical measurement, level 1b.

A Mobile Application to Measure Trunk Flexion Angles in Lifting Tasks.

Occupational Abstract The aim of this project was to develop and test an application capable of quickly and repeatedly measuring trunk flexion angles during sagittal plane lifting tasks. The developed application uses the built-in accelerometer in mobile devices to approximate trunk flexion angle, as the user follows an operator as they perform a lift. A black line is superimposed over the camera feed, allowing the user to approximate the angle of inclination of a line connecting the operator's seventh cervical and first sacral vertebrae-thereby estimating the trunk flexion angle. The magnitude of this angle and its velocity have been linked to the development of occupational low back pain; thus the application provides ergonomists a more refined means of screening tasks beyond currently available survey tools.

TECHNICAL ABSTRACT Background The majority of quantitative postural analysis tools used in biomechanics laboratories are either infeasible or impractical for applied ergonomic field use. Survey tools do exist but are subjective in nature. Purpose To develop an application for handheld mobile devices that can quickly, reliably, and accurately measure the trunk flexion angle in order to afford more detailed and objective ergonomic analyses. Methods The application, Trunk Angle Goniometer (TAG), was programed using Xcode (Apple Inc. Cupertino, CA). Sixteen participants measured the trunk angle of lifts in the sagittal plane using TAG installed on an iPad (Apple Inc., Cupertino, CA). To establish the accuracy of the application, comparisons were made to gold standard (manual anatomical landmark digitization) measures of maximum trunk angle, maximum trunk velocity, and the root-mean square (RMS) difference between trunk angle time histories. Precision was also assessed between raters (inter-rater reliability), between trials assessing the same lift (intra-rater reliability) and between trials assessing similar lifts (test-retest reliability). Results TAG generally underestimated the true magnitude of trunk flexion by 5 ° to 15 °, and overestimated flexion velocity by approximately 10 °/sec. RMS errors were between 8.6 ° and 13.4 °. Performance measures showed fair to good test-retest reliability between 0.631 and 0.709. Overall the application had an excellent inter-rater reliability above 0.95 for all measures; however, suffered from low intra-rater reliability (0.381 to 0.520) but these dramatically increased when averages were taken across multiple trials (from 0.739 to 0.838). Conclusions TAG performed well for quantifying angles in the sagittal plane. The approach has the added benefit of being able to assess lifting tasks in real time, combined with its relatively cheap cost, the approach shows promise for field-work and assessments.

Assessment of Interrater and Intrarater Reliability of Cervical Range of Motion (CROM) Goniometer.

PURPOSE: The current study was designed to assess interrater and intrarater validity of cervical range of motion measurements performed with a CROM goniometer. Material and Methods. The study involved 95 healthy university students (31 males and 64 females) aged 20-24 years. Two examiners performed measurements of cervical range of motion using a CROM goniometer. The same subjects were examined again after two weeks, in the same conditions. The results acquired by one rater during the first and the second examination were compared for reproducibility, while the results obtained by the two examiners were compared to assess validity and reliability of the tool. Cronbach's alpha was applied to determine intrarater reliability, and the values of correlations were used to assess the interrater agreement. RESULTS: Analysis of the results showed both intrarater and interrater agreement in all the measures of cervical range of motion. The highest intrarater and interrater concordance was observed in the measure of extension. Intrarater agreement for Examiner 1 was reflected by Cronbach's alpha = 0.85, and for Examiner 2 by Cronbach's alpha = 0.89. As for the interrater agreement in the measure of extension, the value of correlation in both the first and the second measurement amounted to r = 0.89. CONCLUSIONS: Measurements performed with the CROM goniometer show interrater and intrarater agreement in assessments of cervical range of motion. The CROM goniometer can be recommended for use in daily clinical practice.