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).

A reliability and validity study on upper limb range of motion measurement using mobile sensor compared with goniometers / Estudio de confiabilidad y validez sobre la medición del rango de movimiento de las extremidades superiores utilizando un sensor móvil en comparación con goniómetro

Introduction: The use of tele-rehabilitation devices to aid physiotherapy has gained popularity in recent years. In particular, measuring limb range of motion with a wearable mobile sensor can facilitate rehabilitation therapies by providing more efficient progress monitoring and reducing clinicians’ workload. This study aimed to examine the test-retest reliability and validity of using a wearable mobile sensor to measure upper limb range of motion (ROM).Materials and methods: Participants were recruited by convenient sampling. They were instructed to perform four kinds of upper limb movements including shoulder flexion, abduction, external rotation and elbow flexion, from which the ROM was measured by Mobile sensors REBEE (XCLR8 Technologies) and a standard goniometer (Model 12-1000) in each movement. Each kind of movements and the two ROM measurements were performed twice for the evaluation of test-retest reliability using Intraclass Correlation Coefficients (ICC). Pearson's correlations were computed between the ROM measured by the mobile sensors and the goniometer in each movement to assess construct validities of the mobile sensors. The agreement (95% mean difference) between the two sets of measurement was illustrated by Bland-Altman plots.Results: Thirty-four asymptomatic young Asian adults (15 males) participated in this study (Mage ± SD, 24.2 ± 3.82 years). The ICC for the ROM measured by the sensors were between 0.94 and 0.99, p <0.01 and for the goniometer measurements were between 0.95 and 0.98, p <0.01 in the four movements, indicating excellent reliability in both measurement methods. The Pearson's correlation between the sensor’s and goniometric ROM measurements in four kinds of movements ranged from r =0.96 to 0.99, p <0.01, indicating a very strong construct validity for using the mobile sensors to measure upper limb ROM. The mean difference between the two measurements ranged from 0.13 degrees to 7.6 degrees...(AU)

Introducción: El uso de dispositivos de tele-rehabilitación para ayudar a la fisioterapia ha ganado popularidad en los últimos años. En particular, medir el rango de movimiento de las extremidades con un sensor móvil portátil puede facilitar las terapias de rehabilitación al proporcionar una supervisión del progreso más eficiente y reducir la carga de trabajo de los médicos. Este estudio tuvo como objetivo examinar la confiabilidad y la validez test-retest del uso de un sensor móvil portátil para medir el rango de movimiento de las extremidades superiores (ROM).Materiales y métodos: Los participantes fueron reclutados mediante muestreo conveniente. Se les indicó que realizaran cuatro tipos de movimientos de las extremidades superiores, incluida la flexión del hombro, la abducción, la rotación externa y la flexión del codo, a partir de los cuales se midió el ROM con los sensores móviles REBEE (XCLR8 Technologies) y un goniómetro estándar (Modelo 12-1000) en cada movimiento. . Cada tipo de movimientos y las dos mediciones de ROM se realizaron dos veces para la evaluación de la confiabilidad test-retest utilizando coeficientes de correlación intraclase (ICC). Se calcularon las correlaciones de Pearson entre el ROM medido por los sensores móviles y el goniómetro en cada movimiento para evaluar la validez de constructo de los sensores móviles. La concordancia (diferencia media del 95%) entre los dos conjuntos de medidas se ilustró mediante gráficos de Bland-Altman.Resultados: Treinta y cuatro adultos jóvenes asiáticos asintomáticos (15 hombres) participaron en este estudio (Mage ± SD, 24,2 ± 3,82 años). El ICC para el ROM medido por los sensores estuvo entre 0.94 y 0.99, p <0.01 y para las mediciones del goniómetro estuvo entre 0.95 y 0.98, p <0.01 en los cuatro movimientos, lo que indica una excelente confiabilidad en ambos métodos de medición...(AU)

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.

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.

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.

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.

Use of an Instrumented Ankle Arthrometer and External Strain Gauge to Assess Ankle Dorsiflexion Motion and Plantarflexor Stiffness.

BACKGROUND: Ankle dorsiflexion motion and plantarflexor stiffness measurement offer clinical insight into the assessment and treatment of musculoskeletal and neurologic disorders. We aimed to determine reliability and concurrent validity of an ankle arthrometer in quantifying dorsiflexion motion and plantarflexor stiffness. METHODS: Ten healthy individuals were assessed for dorsiflexion motion and plantarflexor stiffness using an ankle arthrometer with a 6 degree-of-freedom kinematic linkage system and external strain gauge to apply dorsiflexion torque. Two investigators each performed five loads to the ankle at different combinations of loads (10 or 20 Nm), rates (2.5 or 5 Nm/sec), and knee angles (10° or 20°). Anteroposterior displacement and inversion-eversion rotation were also assessed with arthrometry, and functional dorsiflexion motion was assessed with the weightbearing lunge (WBL) test. RESULTS: Good-to-excellent intrarater reliability was observed for peak dorsiflexion (intraclass correlation coefficient [ICC][2,k] = 0.949-0.988) and plantarflexor stiffness (ICC[2,k] = 0.761-0.984). Interrater reliability was good to excellent for peak dorsiflexion (ICC[2,1] = 0.766-0.910) and poor to excellent for plantarflexor stiffness (ICC[2,1] = 0.275-0.914). Reliability was best for 20-Nm loads at 5 Nm/sec. Strong correlations were observed between peak dorsiflexion and anteroposterior displacement (r = 0.666; P = 0.035) and WBL distance (r = -0.681; P = 0.036). CONCLUSIONS: Using an ankle arthrometer to assess peak dorsiflexion and plantarflexor stiffness seems reliable when performed to greater torques with faster speeds; and offers consistency with functional measures. Use of this readily available tool may benefit clinicians attempting to quantify equinus and dorsiflexion deficits in pathological populations.

Effects of static stretching as compared to autogenic inhibition and reciprocal inhibition muscle energy techniques in the management of mechanical neck pain: a randomized controlled trial.

OBJECTIVE: To compare the effects of static stretching with autogenic inhibition and reciprocal inhibition muscle energy techniques on pain, disability and range of motion in patients with mechanical neck pain. METHODS: A parallel design randomised controlled trial was conducted at Fauji Foundation Hospital and Railway-General Hospital, Rawalpindi, Pakistan, from April to November, 2017, and comprised of patients aged 18-70 years with neck pain of moderate intensity scoring 4-8 on numeric pain rating scale with limited or painful range of motion. The patients were randomly allocated via lottery method into static stretching group, autogenic inhibition muscle energy technique group and reciprocal inhibition muscle energy technique group. All the subjects received five consecutive treatments sessions. Outcome measurements included numeric pain rating scale score, neck disability index score and goniometry for cervical range of motion. Data was collected at baseline and after first and fifth sessions, and was analysed using SPSS 21. RESULTS: Of the 78 subjects, there were 26(33.3%) in each of the three groups. Of them 7 were lost to follow-up and the study was completed by 71(91%) subjects. The overall mean age was 41.55±11.89 years (p>0.05). There was no significant difference between the groups at baseline (p>0.05). However, at first and second follow-up, there was a significant difference (p<0.05) between the groups in terms of immediate and short-term relief, except for immediate effects related to range of motion (p=0.056). CONCLUSIONS: Significant difference existed among static stretching, autogenic inhibition and reciprocal inhibition groups in terms of pain, disability and range of motion in patients with mechanical neck pain.

Wrist ROM measurements using smartphone photography: Reliability and validity.

No one has validated measuring the wrist's active range of motion (ROM) using smartphone images in patients. It is not known whether pathological factors affect the accuracy of this measurement technique. The purpose of this study was to assess if smartphone photography is as reliable and valid as manual goniometry for measuring wrist joint ROM. We reviewed 38 wrists in 38 patients (21 women and 17 men) with a mean age of 45 years (range, 26-60). Smartphones were used to take digital photos of injured wrists at extremes of wrist motion, including flexion, extension, radial and ulnar deviation. The mean difference in measured ROM between the two measurement methods (digital photos and handheld goniometer) was compared using Student's t test and the relationship determined using Pearson correlation coefficients. Bland-Altman analysis was used to define the limits of agreement (LOA). No significant difference was found when comparing the wrist ROM in the four positions using manual goniometry and digital measurements from photos taken by a surgeon. Between the goniometer measurements and digital photos taken by a surgeon, the Pearson coefficients were high, with most being above 0.8 for the four positions. The Pearson coefficients also show the smartphone measurements were highly precise. There was high reliability between the photographs taken by surgeons and by patients, as well as high interobserver reliability. Smartphone photography is a reliable and valid method to measure wrist joint ROM in patients. This measurement method can be used to measure outcomes.

Inertial motion capture validation of 3D knee kinematics at various gait speed on the treadmill with a double-pose calibration.

BACKGROUND: Inertial motion capture (IMC) is rapidly gaining in popularity to evaluate gait in clinical settings. Previous examinations of IMC knee kinematics were often limited to the sagittal plane and IMC calibration has not been thoroughly investigated. RESEARCH QUESTION: The objective was to validate IMC 3D knee kinematics calibrated with a double-pose during gait with reference to optical motion capture (OMC). The hypotheses are that IMC can estimate adequately knee kinematics and that both systems will detect similarly the changes with gait speed. METHODS: Twenty-four healthy participants walked on the treadmill at gait speed of 0.6, 0.8, 1.0 and 1.2 m/s. Knee kinematics were obtained simultaneously with two magnetic and inertial measurement units and passive markers fixed on the KneeKG system. OMC was calibrated with a functional anatomical approach and the IMC with a double-pose. RESULTS: Root mean square differences of the two systems yielded 3-6° for knee flexion, adduction and external rotation. Knee kinematics were more similar during the stance phase than the swing phase. Gait speed showed a significant progressive effect on the three knee angles that was similarly detected by the two systems. SIGNIFICANCE: IMC 3D knee kinematics can be obtained independently with a simple calibration and only two magnetic and inertial measurement units at an acceptable level of error especially during stance.

Accuracy of an electrogoniometer relative to optical motion tracking for quantifying wrist range of motion.

Methods for capturing wrist range of motion (RoM) vary in complexity, cost, and sensitivity. Measures by manual goniometer, though an inexpensive modality, provide neither dynamic nor objective motion data. Conversely, optical motion capture systems are widely used in three-dimensional scientific motion capture studies but are complex and expensive. The electrogoniometer bridges the gap between portability and objective measurement. Our study aims to evaluate the accuracy of a 2 degree of freedom electrogoniometer using optical motion capture as the reference for in vivo wrist motion. First, a mechanical system constructed from two plastic pipes and a universal joint mimicked a human wrist to assess the inherent accuracy of the electrogoniometer. Simulations of radial/ulnar deviation (R/U), flexion/extension (F/E) and circumduction were evaluated. Second, six subjects performed three RoM tasks of R/U deviation, F/E, and circumduction for evaluation of the in vivo accuracy. Bland-Altman analysis quantified the accuracy. The mechanical experiment reported greater accuracy than the in vivo study with mean difference values less than ±1°. The in vivo accuracy varied across RoM tasks, with mean differences greatest in the F/E task (7.2°). Smaller mean differences values were reported in the R/U deviation task (-0.8°) and the circumduction task (1.2°).