A technical support tool for joint range of motion determination in functional diagnostics - an inter-rater study

Abstract

BackgroundThe examination of joint range of motion (RoM) is part of musculo-skeletal functional diagnostics, used, for example, in occupational examinations. Various examination methodologies exist that have been optimized for occupational medical practice, which means they were reduced to the most necessary and feasible measures and examinations for efficiency and usability reasons. Because of time constraints in medical examinations in occupational settings, visual inspection is commonly used to quantify joint RoM. To support medical examiners, an inertial sensor-based measurement system (CUELA) was adapted for joint RoM examination in these settings. The objective of the present study was to evaluate the measurement tool in functional diagnostics under conditions close to clinical practice.MethodsThe joint RoM of twenty healthy subjects were examined by three physicians, who were simultaneously using the measurement tool. Physicians were blinded to the measurement results and the other physicians. Active RoM was examined on the cervical, thoracic and lumbar spine while passive RoM was examined on the shoulder, elbow, wrist, hip, and knee, resulting in a total of 40 joint examination angles. The means, standard deviations, intraclass correlation coefficients (ICC3,k), and Bland-Altman-Plots were calculated using MatLab for statistical analysis.ResultsMost measurement results were in accordance with expected joint RoMs. All examinations showed an acceptable repeatability. In active RoM examinations, the ICC of inter-rater reliability varied between 0.79 and 0.95. In passive RoM examination the ICC varied between 0.71 and 0.96, except examination angles at the elbow and knee extension (ICC: 0.0-0.77).ConclusionThe reliability and objectivity of active RoM examinations were improved by the measurement tool compared with examiners. In passive RoM examinations of upper and lower extremities, the increase of objectivity by the measurements was limited for some examination angles by external factors such as the individual examiner impact on motion execution or the given joint examination conditions. Especially the elbow joint examination requires further development to achieve acceptable reliability. A modification in the examination method to reduce the examiner impact on measurement and the implementation of a more complex calibration procedure could improve the objectivity and reliability of the measurement tool in passive joint RoM examination to be applicable on nearly the whole body.

Assessment of Scapulothoracic, Glenohumeral, and Elbow Motion in Adhesive Capsulitis by Means of Inertial Sensor Technology: A Within-Session, Intra-Operator and Inter-Operator Reliability and Agreement Study

“…However, results were comparable to reported reliability and agreement results of other studies assessing the reliability and agreement of ST or humerothoracic range of motion measurements by means of inertial sensors in healthy persons. Schiefer et al [18] reported a within-session ICC for humerothoracic abd-adduction of 0.96 in healthy persons which is in line with the reported within-session ICC-values in this study during functional task performance in persons with AC [18]. Bouvier et al [17] described the performance of standardized analytical movements in healthy persons; there were lower intra-operator reliability results for humerothoracic abd-adduction and ext-internal rotation than for flexion-extension [17].…”

“…We furthermore aim to formulate recommendations regarding parameter selection when using inertial sensor movement analysis to evaluate treatment efficacy and follow up progress. It is hypothesized that, in line with previous research [14][15][16][17][18], in general good reliability and agreement results will be found for ST, GH, and elbow joint range of motion assessment, but that reliability and agreement results will depend on the complexity of the assessment movement task.…”

“…Furthermore, with regard to the reliability of GH joint angles, no literature is available. Instead, two studies were found describing appropriate reliability results for humerothoracic range of movement assessment in persons without shoulder complaints [17,18]. However, in one of these studies, range of motion was assessed during passive arm movement, which does not resemble daily life movement [18].…”

Mobile assessment of the lower limb kinematics in healthy persons and in persons with degenerative knee disorders: A systematic review

“…According to the Downs and Black checklist [27], 12 studies were of substantial quality [30][31][32][33][34][35][36][37][38], 10 of moderate quality [39][40][41][42][43][44][45][46][47][48] and one of low quality [49]. Within the studies on kinematics in healthy persons, the methodological quality was 60% on average (range between 42-75%).…”

Development and evaluation of RAMP II - a practitioner’s tool for assessing musculoskeletal disorder risk factors in industrial manual handling

“…In OCRA this corresponds to about 45 for both flexion and extension, while a flexion angle of 30 and an extension angle of 40 is used in RAMP II. For flexion without external pressure (Barter, Emanuel, and Truett 1957), the value of 45 used in OCRA corresponds to about 54-73% of ROM (Houy 1983;Boone and Azen 1979;Ryu et al 1991;AAOS 1988;Schiefer et al 2015;Marshall, Mozrall, and Shealy 1999). Because the ROM was reported to decrease by up to 27% when gripping objects (Gehrmann, Kaufmann, and Li 2008), 30 as used in RAMP II may better reflect the 50% of ROM for flexion of a working population for jobs involving the gripping of large and small objects.…”