Throughout the rehabilitation process, measuring joint range of motion (ROM) is essential to understand joint kinematics. The universal goniometer (UG) is the most common tool used in the clinical setting for joint ROM measurement. However, a review of the literature examining the reliability of the UG has demonstrated considerable variation in results and highlighted the necessity of introducing a more reliable tool. This study aimed to investigate the reliability of a 2-dimensional video analysis system, PnO Clinical Movement Data TM (PnO CMD TM) compared to the UG. Three testers examined range of motion of eight healthy candidates. Passive sagittal plane motion of the hip, knee and ankle joint was measured with and without markers. ICC values >0.60 were considered to be satisfactory. Most intratester ICC values for PnO CMD TM were found to be above the satisfactory limit (ICC=0.60-0.99). Intratester ICC values for the UG ranged considerably (ICC=0.34-0.94), and some values were below the satisfactory limit. Intertester ICC values across all the joints for PnO CMD TM with markers were found to be above the satisfactory limits (ICC=0.94-0.99). PnO CMD TM was found to be more reliable than the UG. Use of markers was found to increase the reliability. The present work introduces using advanced technology in joint ROM measurement.
Introduction: The universal goniometer (UG) is commonly used in clinical practice to measure lower limb joint range of motion (ROM). Reliability of the UG is essential to ensure consistency of measurement between and within practitioners. Clinically, it is important to understand how reliability may be affected by various factors. Methods: An electronic and manual literature search was conducted to determine the reliability of the UG. A variety of search terms were used to search between 1980 and July 2015. Papers sourced were graded according to the Scottish Intercollegiate Guideline Network guidelines. Papers reviewed included both measurements of healthy subjects and those with different pathologies. Active and passive lower limb ROM were studied and intratester and intertester reliability were examined. Results: Twenty one studies were included and fully reviewed. Most studies indicated that UG reliability was best when used to measure ROM in healthy subjects in comparison to patients. The limited number of studies measuring active motion compromised the ability to make comparisons with measuring of passive ROM. It was reported from the studies investigating both intratester and intertester reliability that intratester reliability was higher than intertester reliability. Reliability of measurements varied depending on the joint measured. Tester training and standardisation of the measurement procedure led to increased reliability and there was a suggestion that involving two testers in the measurement procedure may have a beneficial effect. Conclusion: This literature review highlights variation in study methodology employed, which reduces the ability to directly compare studies. Clinicians should be aware of the variability of 3 reliability of the UG and the effect of different factors when interpreting measurements taken with this instrument. Further research is required to investigate the effect different factors may have on the reliability of the UG and the possibility of using protocols and technology to increase reliability when measuring joint ROM.
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