Goniometric reliability in a clinical setting. Shoulder measurements

The purpose of this study was to examine the intratester and intertester reliabilities for clinical goniometric measurements of shoulder passive range of motion (PROM) using two different sizes of universal goniometers. Patients were measured without controlling therapist goniometric placement technique or patient position during measurements. Repeated PROM measurements of shoulder flexion, extension, abduction, shoulder horizontal abduction, horizontal adduction, lateral (external) rotation, and medial (internal) rotation were taken of two groups of 50 subjects each. The intratester intraclass correlation coefficients (ICCs) for all motions ranged from .87 to .99. The ICCs for the intertester reliability of PROM measurements of horizontal abduction, horizontal adduction, extension, and medial rotation ranged from .26 to .55. The intertester ICCs for PROM measurements of flexion, abduction, and lateral rotation ranged from .84 to .90. Goniometric PROM measurements for the shoulder appear to be highly reliable when taken by the same physical therapist, regardless of the size of the goniometer used. The degree of intertester reliability for these measurements appears to be range-of-motion specific.     

Reliability of goniometric measurements and visual estimates of knee range of motion obtained in a clinical setting

The purpose of this study was to examine the intratester and intertester reliability for goniometric measurements of knee flexion and extension passive range of motion (PROM). In addition, parallel-forms reliability for PROM measurements of the knee obtained by use of a goniometer and by visual estimation was examined. The intertester reliability for visual estimates of the PROM of the knee was also examined. Repeated measurements were obtained on 43 patients in a clinical setting. The intraclass correlation coefficients (ICCs) for intratester reliability of measurements obtained with a goniometer were .99 for flexion and .98 for extension. Intertester reliability for measurements obtained with a goniometer was .90 for flexion and .86 for extension. The ICCs for parallel-forms reliability for measurements obtained with a goniometer and by visual estimation ranged from .82 to .94. The intertester reliability for measurements obtained by visual estimation was .83 for flexion and .82 for extension. Results suggest clinicians should use a goniometer to take repeated PROM measurements of a patient's knee to minimize the error associated with these measurements.     

Reliability and validity of shoulder tightness measurement in patients with stiff shoulders

The purposes of this study were (1) to examine intratester and intertester reliability of measurement of anterior and posterior shoulder tightness in patients with stiff shoulders (SS), and (2) to assess construct validity by determining the relations between shoulder tightness, shoulder range of motion (ROM), and self-report measures of functional limitation. Anterior and posterior shoulder tightness were measured by two testers in below-chest abduction and cross-chest adduction tests with an inclinometer, respectively, in 16 patients with SS. Both the intratester and intertester reliability for shoulder tightness measurements were good (intratester ICC=0.84 and 0.91; intertester ICC=0.82 and 0.89). The limit of intra-tester and inter-tester agreement (mean, -0.3+/-4.4 degrees ) was acceptable as compared to the standard deviations of the measurements (range, 6.2-7.4 degrees ). Significant relationships between internal rotation and posterior shoulder tightness (R2=0.448, P=0.002), external rotation and anterior shoulder tightness (R2=0.499, P=0.003), and functional disabilities and posterior shoulder tightness (R2=0.432, P=0.006) were found. Significant correlations between shoulder internal rotation and cross-chest adduction, shoulder external rotation and below-chest abduction were observed, indicating that internal and external rotations might be related to posterior and anterior shoulder stiffness. The study also revealed significant relationship between functional disabilities and cross-chest adduction. Below-chest abduction and cross-chest adduction were found to provide reliable data. The construct validity of the abduction and adduction tests is supported by the relationship among these measurements, shoulder ROM, and functional disabilities in patients with SS.     

Active movement measurements of the shoulder girdle in healthy subjects with goniometer and tape measure techniques: A study on reliability and validity

In response to the current need to develop objective measurement techniques for active movements of the shoulder girdle, this study had two goals: 1) to evaluate the reliability of the active range of motion (AROM) of shoulder girdle in elevation, protraction, and retraction with use of a goniometer and a tape measure and 2) to present the criterion-related validity of the reliable movements. Thirty healthy subjects performed two trials of each shoulder girdle AROM. They were assessed by two physical therapists, who used both evaluation techniques on two occasions. The generalizability theory was used to compute intratester (test-retest) and intertester reliability using dependability coefficients (?) and standard errors of measurement (SEMs). The shoulder girdle movements were then evaluated with a movement analysis system (Optotrak 3020). The Pearson product-moment correlation coefficient (r) and paired t-tests were used to compare the results of clinical measurements with those of the movement analysis system. Overall, the reliability with the tape measure was good (? = 0.78–0.91; SEM's = 0.7–1.1 cm) for the elevation motion. The goniometer was only reliable for intratester measures (? = 0.78–0.79; SEM = 2.7°) for the elevation motion. Retraction was reliable with the tape measure alone (? = 0.76–0.84; SEM's = 0.5–0.7 cm). The criterion-related validity analysis revealed that measuring shoulder girdle elevation with the tape measure and goniometer, and retraction with the tape measure were not valid when evaluated against a gold standard, thus, both techniques have limitations in assessing true elevation and retraction measurements.     

Reliability of cervical range of motion using the OSI CA 6000 spine motion analyser on asymptomatic and symptomatic subjects

Cervical range of motion (ROM) is evaluated in both clinical and research settings. This study's purpose was to determine if ROM data obtained with the OSI CA 6000 Spine Motion Analyser (SMA) from asymptomatic and symptomatic cervical subjects were reliable within and between testers. Cervical ROM was measured in all three planes in 30 adult asymptomatic and 20 adult symptomatic subjects. A standardized protocol was used to fit each subject with the OSI SMA cervical hardware. Subjects were tested in a seated position with the trunk stabilized. Subjects performed four trials of each pain-free cervical motion during testing. The hardware was completely removed and replaced by the same tester and ROM trials in all three planes were repeated for intratester asymptomatic and symptomatic reliability. The same procedure was completed by a second tester for asymptomatic intratester and intertester reliability. Repeated measures analysis of variance and intraclass correlation coefficients (ICC [2,1 and 2 k]) were used to analyse intra- and intertester reliability data. Intratester ICCs were 0.85 or higher (except for flexion 0.76) for asymptomatic subjects and 0. 87 or higher (except for flexion 0.68) for symptomatic subjects for all motions. Intertester ICCs were 0.88 or higher for all motions. Standard error of measurements were less than 3.92 degrees for all motions. Measures of cervical spinal ROM obtained with the OSI SMA showed good intertester reliablity for all motions, and good intratester reliability for all motions with the exception of the motion of flexion for one of the examiners, which showed moderate reliability.     

Active movement measurements of the shoulder girdle in healthy subjects with goniometer and tape measure techniques: a study on reliability and validity

In response to the current need to develop objective measurement techniques for active movements of the shoulder girdle, this study had two goals: 1) to evaluate the reliability of the active range of motion (AROM) of shoulder girdle in elevation, protraction, and retraction with use of a goniometer and a tape measure and 2) to present the criterion-related validity of the reliable movements. Thirty healthy subjects performed two trials of each shoulder girdle AROM. They were assessed by two physical therapists, who used both evaluation techniques on two occasions. The generalizability theory was used to compute intratester (test-retest) and intertester reliability using dependability coefficients (phi) and standard errors of measurement (SEMs). The shoulder girdle movements were then evaluated with a movement analysis system (Optotrak 3020). The Pearson product-moment correlation coefficient (r) and paired t-tests were used to compare the results of clinical measurements with those of the movement analysis system. Overall, the reliability with the tape measure was good (phi = 0.78-0.91; SEM's = 0.7-1.1 cm) for the elevation motion. The goniometer was only reliable for intratester measures (phi = 0.78-0.79; SEM = 2.7 degrees) for the elevation motion. Retraction was reliable with the tape measure alone (phi = 0.76-0.84; SEM's = 0.5-0.7 cm). The criterion-related validity analysis revealed that measuring shoulder girdle elevation with the tape measure and goniometer, and retraction with the tape measure were not valid when evaluated against a gold standard, thus, both techniques have limitations in assessing true elevation and retraction measurements.     

Intratester and intertester reliability of the cervical range of motion device

The purpose of this study was to investigate the intratester and intertester reliability of the Cervical Range of Motion instrument (CROM) for measuring cervical flexion, extension, lateral flexion, and rotation. Twenty able-bodied subjects were tested by two testers on two different occasions. Pearson product-moment correlations for intratester reliability ranged from .63 to .90 for tester one and from .62 to .91 for tester two. Intertester reliability was good. Coefficients ranged from .80 to .87 for session one and .74 to .85 for session two. Paired data t-tests showed that there were no significant differences between testers or sessions (p = .01). The results suggest that the CROM has acceptable intratester and intertester reliability. The CROM has many benefits including ease of application and reliability. More research is needed on patients with cervical dysfunction.     

Reliability of wound surface area measurements.

The purpose of this study was to establish intratester and intertester reliability of four methods of measuring wound surface area from transparency film tracings. Wound area measurements were obtained in 31 subjects with venous stasis ulcers. After tracing each wound on transparency film, wound area was calculated by (1) multiplying length and width measurements with a ruler, (2) placing the transparency film over graph paper and counting the squares, (3) using a planimeter, and (4) using a digitizer. Intraclass correlation coefficients (ICCs) for intratester measurements were .99 for each method. The ICC values for intertester measurements ranged from .97 to .99. The results of this study indicate that intratester and intertester wound measurements can be taken reliably with the graph paper, planimeter, and digitizer methods. The graph paper technique may be preferable in most clinical settings, because it is low in cost and easy to use.     

Reliability and responsiveness of a goniometric device for measuring the range of motion in the dart-throwing motion plane

Background: Dart-throwing motion (DTM) is an important component of wrist function and, consequently, has the potential to become an evaluation tool in rehabilitation. However, no measurement method is currently available to reliably measure range of motion (ROM) of the wrist in the DTM plane. Objectives: To determine the reliability and responsiveness of a goniometric device to measure wrist ROM in the DTM plane. Methods: ROM of the wrist in the DTM plane was measured in 70 healthy participants. The intra-class correlation coefficient (ICC) was used to evaluate the relative reliability of measurement, and a Bland–Altman analysis conducted to establish its absolute reliability, including the 95% limits of agreement (95% LOA). The standard error of the measurement (SEM) and minimal detectable change at the 95% confidence level (MDC₉₅) were calculated as measures of responsiveness. Results: The intra-rater ICC was 0.87, and an inter-rater ICC of 0.71. There was no evidence of a fixed or proportional bias. For intra- and inter-rater reliability, 95% LOA ranged from ?13.83 to 11.12 and from ?17.75 to 16.19, respectively. The SEM and MDC₉₅ were 4.5° and 12.4°, respectively, for intra-rater reliability, and 6.0° and 16.6°, respectively, for inter-rater reliability. Conclusion: The ROM of the wrist in the DTM plane was measured with fair-to-good reliability and responsiveness and, therefore, has the potential to become an evaluation tool for rehabilitation.     

The reliability and minimal detectable change of shoulder mobility measurements using a digital inclinometer

The present study investigated the intrarater reliability, interrater reliability and minimal detectable change at the 90% confidence interval (MDC₉₀) of active shoulder range of motion measurements using digital inclinometry. Two investigators each measured two repetitions of active flexion, abduction, external rotation (ER), and internal rotation (IR) on the nondominant shoulder of 30 asymptomatic participants in a blinded repeated measures design. Results indicated good intrarater reliability with Intraclass Correlation Coefficients (ICCs) (3, k) of Flexion=0.83, Abduction=0.91, ER=0.94 and IR=0.87. Interrater ICC values (2, k) were moderate to good with Flexion=0.58, Abduction=0.95, ER=0.88 and IR=0.93. The MDC₉₀ for the interrater analysis indicated that a change of equal to or greater than 8° (Flexion), 4° (Abduction), 8° (IR), and 9° (ER) would be required to be 90% certain that the change is not due to intertrial variability or measurement error. Digital inclinometry appears to be a reliable instrument for quantifying normal shoulder mobility when strict measurement protocols are adhered to. Clinicians and researchers should consider the MDC values presented when interpreting change values during subsequent measurement sessions.     

Between-Day Reliability of Scapular Locator for Measuring Scapular Position During Arm Elevation in Asymptomatic Participants

ObjectiveThe aim of this study was to assess the between-day reliability of the scapular locator for measuring scapular rotations during arm elevation in patients without shoulder pain/conditions/disorders.MethodsTwenty-three asymptomatic individuals were measured during 2 sessions separated by 24 hours. One observer measured scapular position with a scapular locator while participants held their arms at 30°, 60°, 90°, and 120° elevation in the scapular plane. Three trials were performed for each arm position.ResultsAt 30°, between-day intraclass correlation coefficients (ICCs) for all scapular rotations were poor (ICC 0.10-0.40). At higher arm elevations (60°, 90°, and 120°), ICCs ranged from 0.73 to 0.93 for scapular upward rotation, 0.80 to 0.87 for posterior tilt, and 0.37 to 0.62 for scapular internal rotation. For all scapular rotations, the standard error of measurement was less than 6°, and the smallest detectable difference ranged from 11° to 18°.ConclusionThe findings indicate good to excellent reliability for measuring scapular upward/downward rotation and anterior/posterior tilt between 60° and 120° of shoulder elevation in the scapular plane. However, low reliability was found for all scapular rotations at 30° elevation, and for scapular internal rotation at higher arm elevation.     

Intra- and intertester reliability and criterion validity of the parallelogram and universal goniometers for measuring maximum active knee flexion and extension of patients with knee restrictions

OBJECTIVE: To examine the intra- and intertester reliability of the universal goniometer (UG) and parallelogram goniometer (PG), and to assess the criterion validity of the same instruments on subjects with knee restrictions. DESIGN: Reliability and validation study. SETTING: Radiology department at university hospital. PARTICIPANTS: Sixty subjects (34 men, 26 women; mean age, 52yr) with various knee restrictions. INTERVENTIONS: Sixteen goniometric measurements were collected per patient by 2 physical therapists. Subjects were evaluated in knee flexion and knee extension positions. To serve as a gold standard, radiographs were taken in both positions. MAIN OUTCOME MEASURES: Active knee flexion and knee extension on 2 goniometers, radiographs. Maximum active range of motion (AROM). RESULTS: The UG intratester reliability (intraclass correlation coefficients [ICCs]) was .997 in flexion and .972 to .985 in extension. The results were also high with the PG (ICC =.996,.953-.955) for flexion and extension, respectively. The intertester reliability was high for flexion (ICC =.977-.982) and for extension (ICC =.893-.926) when using the UG. For the PG, ICC results ranged from .959 to .970 for flexion and from .856 to .898 for extension. Criterion validity (r) varied from .975 to .987 for flexion and from .390 to .442 for extension with the UG, and from .976 to .985 for flexion and .423 to .514 for extension with the PG. CONCLUSION: Intra- and intertester reliability were high for both goniometers. The results for the criterion validity varied. Our study also revealed that it is preferable to use goniometry rather than visual estimations when measuring AROM. It is recommended that the same therapist take all the measurements when assessing AROM for UG and PG goniometric measurements on patients with knee restrictions.     

Concurrent validity and intertester reliability of universal and fluid-based goniometers for active elbow range of motion

The purposes of this study were 1) to establish the concurrent validity of the universal goniometer and the fluid-based goniometer and 2) to determine the intertester reliability of these two instruments. A correlational study was performed in which two testers used the universal goniometer and the fluid-based goniometer in measuring elbow range of motion in 30 healthy subjects. The fluid-based goniometer had high intertester reliability (R = .92), and the standard goniometer had poor reliability (R = .53). The Pearson product-moment correlation between the two instruments was .83. A significant difference was shown between the standard goniometer and the fluid-based goniometer by the t test (t = 4.4, df = 28, p less than .05). The results support the use of the fluid-based goniometer between testers on elbow range of motion; however, the two instruments cannot be used interchangeably.     

The compangle: a new goniometer for joint angle measurements of the hand. A technical note

The accuracy of joint angle measurement of the hand may be negatively influenced by joint swelling, deformation and other obstacles. We developed an alternative goniometer with clear ergonomic advantages, especially for the measurement of small joints. This new concept of goniometry is described and preliminary results on the reliability of the measurements are presented. The intraclass correlation coefficients (ICCs) and the standard error of measurements (SEMs) of the alternative goniometer are greater respectively smaller than a conventional goniometer, indicating a better intratester reliability.     

The Shoulder Medial Rotation Test: An Intertester and Intratester Reliability Study in Overhead Athletes With Chronic Shoulder Pain

Objective

The purpose of this study was to examine intertester and intratester reliability of the shoulder medial rotation test (MRT) and reliability differences depending on examiner expertise.

Methods

Seventeen athletes with chronic shoulder pain participated in the study. Four independent observers with different experience levels simultaneously rated MRT performance as “correct” or “incorrect,” after a standardized assessment protocol, the same day (for intertester reliability) and in a 7-day interval (for intratester reliability).

Results

The intrarater reliability was admissible for 2 experts and one novice, with κ values ranging between 0.32 to 0.76 and poor for one novice (κ < 0). Interrater agreement for all 4 assessors demonstrated slight agreement (κ = 0.06; 95% confidence interval: 0.06-0.47), increasing to fair agreement (κ = 0.33; 95% confidence interval: 0.21-0.69) when comparing the MRT findings between the 2 experienced assessors. Practice with the MRT in novices only marginally improved their level of agreement.

Conclusions

Reliability of the MRT for detecting movement control of the shoulder girdle was fair at best for experienced examiners and poor overall. Dexterity and repetitive performance of the test is necessary for correct interpretation of the MRT.     

Measurement properties of a hand-held inclinometer during straight leg raise neurodynamic testing

ObjectivesThe most common lower quarter neurodynamic test is the straight leg raise (SLR) test. Quantification of limb motion during SLR testing should utilize reliable and valid measurement tools that are highly sensitive to change. The purpose of this study was to determine the psychometric properties of a hand-held inclinometer commonly utilized during SLR testing.DesignCross-sectional measurement, intra-rater reliability and validity study.SettingResearch laboratory.ParticipantsTwenty individuals without pain in their low back or extremities and no history of nerve injury participated in the study.Main outcome measuresTwo repetitions of the SLR were performed in each limb in two ankle positions (plantar flexion and dorsiflexion). A digital inclinometer and digital goniometer were utilized as the comparisons for range of motion measurements.ResultsIntra-rater reliability for the hand-held inclinometer during SLR testing was excellent (ICCs, 0.95 to 0.98). The standard error of measurement was between 0.54° and 1.22° and the minimal detectable change was between 1.50° and 3.41°. Construct validity revealed hand-held inclinometer measurements were highly correlated with both the digital inclinometer and digital goniometer measures. The mean difference scores between hand-held inclinometer and digital inclinometer (～1.5°) and digital goniometer (～10°) suggest that the hand-held inclinometer better matches the construct measured by the digital inclinometer (limb elevation angle) compared to the digital goniometer (hip flexion angle).ConclusionsThe hand-held inclinometer is a valid method for measuring limb elevation angle during the SLR neurodynamic test in a research setting. The hand-held inclinometer has high reliability and low minimal detectable change when used in healthy individuals.     

Intertester reliability and concurrent validity of fluid-based and universal goniometers for active knee flexion

This study was designed 1) to determine the intertester reliability of the universal goniometer and the fluid-based goniometer and 2) to establish the concurrent validity of the fluid-based goniometer. Two testers measured active knee flexion of 20 healthy subjects (15 women, 5 men) using both instruments. The subjects had a mean age of 24.8 years (s = 5.5) and reported no previous history of pathological conditions of the right lower extremity. Using a correlational design, high intertester reliability was established for each instrument (universal goniometer, r = .87; fluid-based goniometer, r = .83). The concurrent validity of the fluid-based goniometer was also good for both testers (tester A, r = .83; tester B, r = .82). When the data were subjected to t tests, significant differences were found between the instruments for each tester (p less than .05). The results suggest that similar measurements will be obtained between therapists using the universal and fluid-based goniometers; however, the two instruments cannot be used interchangeably in the clinic.     

Pelvic tilt. Intratester reliability of measuring the standing position and range of motion

The purpose of this study was to examine intratester reliability of a test designed to measure the standing pelvic-tilt angle, active posterior and anterior pelvic-tilt angles and ranges of motion, and the total pelvic-tilt range of motion (ROM). After an instruction session, the pelvic-tilt angles of the right side of 20 men were calculated using trigonometric functions. Ranges of motion were determined from the pelvic-tilt angles. Intratester reliability coefficients (Pearson r) for test and retest measurements were .88 for the standing pelvic-tilt angle, .88 for the posterior pelvic-tilt angle, .92 for the anterior pelvic-tilt angle, .62 for the posterior pelvic-tilt ROM, .92 for the anterior pelvic-tilt ROM, and .87 for the total ROM. We discuss the factors that may have influenced the reliability of the measurements and the clinical implications and limitations of the test. We suggest additional research to examine intratester reliability of measuring the posterior pelvic-tilt ROM, intertester reliability of measuring all angles and ROM, and the pelvic tilt of many types of subjects.     

The reliability of a simplified water displacement instrument: a method for measuring arm volume

OBJECTIVES: To present a new water displacement measurement, the Simplified Water Displacement Instrument (SWDI), and to evaluate its intra- and intertester reliability. DESIGN: Reliability design. SETTING: Hospital setting. PARTICIPANTS: Fifty-six healthy people were studied. Intratester reliability was evaluated once a week for 4 weeks in 20 women and 10 men. Intertester reliability was assessed by 2 physical therapists in 26 people. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Coefficients of variation (CVs) and intraclass correlation coefficients (ICCs). RESULTS: The intratester reliability showed a CV range of 2.2% to 2.6% and an ICC range of .98 to .99. The intertester reliability showed a CV of 1.3% and an ICC of .99. There was a significant increase in arm volume in men compared with women. There were no significant differences in changes in volume over the 4 weeks. There was a significant greater right arm volume (3.3%) among the right-handed subjects (P<.001). CONCLUSIONS: Both intra- and intertester reliability were satisfactory for the SWDI.