Feasibility of video-based joint hypermobility assessment in individuals with suspected Ehlers-Danlos syndromes/generalised hypermobility spectrum disorders: a single-site observational study protocol

Abstract

IntroductionEhlers-Danlos syndromes (EDS)/generalised hypermobility spectrum disorders (G-HSD) affect the connective tissue of the body and present with a heterogeneous set of symptoms that pose a challenge for diagnosis. One of the main diagnostic criteria of EDS/G-HSD is generalised joint hypermobility, which is currently assessed by clinicians during a physical exam. However, the practice for measuring joint hypermobility is inconsistent between clinicians, leading to high inter-rater variability. Often patients are misdiagnosed with EDS/G-HSD based on an incorrect hypermobility assessment, leading to increased referral rates and resource utilisation at specialised EDS clinics that results in unnecessary emotional distress for patients. An objective, validated and scalable method for assessing hypermobility might mitigate these issues and result in improved EDS/G-HSD patient care.Methods and analysisThis study will examine the use of videos obtained using a smartphone camera to assess the range of motion (ROM) and hypermobility of the joints assessed in Beighton score and more (spine, shoulders, elbows, knees, ankles, thumbs and fifth fingers) in individuals with suspected EDS/G-HSD. Short videos of participants will be captured as they undergo a formal assessment of joint hypermobility at the GoodHope EDS Clinic at Toronto General Hospital. Clinicians will measure the ROM at each joint using a clinical-grade goniometer to establish ground truth measurements. Open-source human pose-estimation libraries will be used to extract the locations of key joints from the videos. Deterministic and machine learning systems will be developed and evaluated for estimating the ROM at each joint. Results will be analysed separately for each joint and human pose-estimation library.Ethics and disseminationThis study was approved by the Research Ethics Board of the University Health Network in Toronto on 26 April 2022. Participants will provide written informed consent. Findings from this study will be published in peer-reviewed journals and presented at conferences.Trial registration numberNCT05366114.

Automated, Vision-Based Goniometry and Range of Motion Calculation in Individuals With Suspected Ehlers-Danlos Syndromes/Generalized Hypermobility Spectrum Disorders: A Comparison of Pose-Estimation Libraries to Goniometric Measurements

“…The study protocol was approved by the Research Ethics Board of the University Health Network on 26 April 2022 (Study ID - 22-5073.2). A complete description of the protocol for this larger study is available [18] .…”

“…Short videos were taken of each movement in which only the participant was visible in the frame to facilitate better poseestimation. All movements were performed according to standard methods [18], [19]. The participants also performed the spine flexion and thumb-to-forearm opposition movements that are part of the Beighton exam, but these are not measured using a goniometer and were thus not analyzed further in this study.…”

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

“…Compared to other open-sourced 3D pose estimation libraries, such as OpenPose [19,25], BlazePose is computationally lightweight and can be deployed across various platforms, such as in a web browser as a JavaScript application. As a result of its versatility, BlazePose and other video-based pose estimation libraries have been used by researchers to develop different applications, including in the context of sports for movement abnormality detection [26], gait assessment [27], hypermobility assessment [28], yoga training [29], postural disorder monitoring for Parkinson's patients, [30] and spinal dysfunction risk estimation [31]. However, studies that explicitly examine the effectiveness of applying opensourced 3D pose-estimation library for range of motion evaluation remain scarce [32].…”