Validation of an on-screen application-based measurement of shoulder range of motion over telehealth medium.

Shoulder range-of-motion (ROM) assessment is vital for the follow-up evaluation of operated patients and for the outcome-based research studies. The aim of this study was to investigate the accuracy and reliability of a remote on-screen application (app)-based method of shoulder ROM measurement through a telehealth medium. A consultant shoulder surgeon, a board-certified orthopedic resident, and a graduate medical doctor served as the examiners. The cohort consisted of 24 healthy volunteers and 16 symptomatic patients with expected shoulder ROM deficits. Shoulder ROM was first examined physically using a goniometer in the clinic and then over Zoom remote conferencing using the protractor extension app of the Chrome browser. Instrument validity was examined by comparing the goniometer method with the protractor app-based method of the expert shoulder consultant using Bland-Altman analysis. It showed only minor mean differences between the healthy volunteers and the patients in elevation (2.0° and 5.0°, respectively), abduction (2.0° and 3.0°, respectively), external rotation with the elbow adducted (1.9° and 0.2°, respectively), external rotation with the elbow abducted at 90° (0.4° and 4°, respectively), and internal rotation with elbow abducted at 90° (2.3° and 1.2°, respectively), with limits of agreement that were below the well-established minimal clinically important difference values. The intraclass correlation coefficient (ICC) values varied between 0.83 and 0.96 for the volunteers and between 0.90 and 0.98 for the patients, indicating excellent correlation between the 2 methods. The interobserver reliability between 2 examiners for the protractor app-based method as evaluated by ICC scores was excellent; it ranged between 0.86 and 0.98 for the volunteers and between 0.88 and 0.99 for the patients. Comparison of the protractor app-based method with the gold-standard goniometer method for the resident and the graduate doctor showed excellent ICC values. A protractor app-based method of measuring shoulder ROM over a telehealth medium is accurate and reliable compared with a clinical goniometer method. This validated method can be used during remote telehealth consultation with significant benefits of saving patients travel and time during the COVID-19 (coronavirus disease 2019) pandemic and even later.

Sahu D ，Shah D ，Joshi M ，Shaikh S ，Gaikwad P ，Shyam A ... -  《-》

Remote visual estimation of shoulder range of motion has generally high interobserver reliability but limited accuracy.

Surgeon visual estimation of shoulder range of motion (ROM) is commonplace in the outpatient office setting and routinely reported in clinical research, but the reliability and accuracy of this practice remain unclear. The purpose of this study is to establish the reliability and accuracy of remote visual estimation of shoulder ROM in healthy volunteers and symptomatic patients among a large group of shoulder surgeons. Our hypothesis is that remote visual estimation would be reliable and accurate compared with the digital goniometer method. Fifty shoulder surgeon members of the PacWest Shoulder and Elbow Society independently determined the active shoulder forward flexion (FF), internal rotation at 90° abduction (IR90), external rotation at 90° abduction, external rotation at the side , and maximal spinal level reached with internal rotation (IRspine) through visual estimation of video recordings taken from 10 healthy volunteers and 10 symptomatic patients. Variations in measurements were quantified using the interobserver reliability through calculation of the intraclass correlation coefficient. Accuracy was determined through comparison with digital goniometer measurements obtained with an on-screen protractor application using Bland-Altman mean differences and 95% limits of agreement. The interobserver reliability among examiners showed moderate to excellent correlation, with intraclass correlation coefficient ranging from 0.768 to 0.928 for the healthy volunteers and 0.739 to 0.878 for the symptomatic patients. Accuracy was limited, with upper limits of agreement exceeding the established minimal clinically important differences (MCIDs) for FF (20° vs. MCID of 14°) and IR90 (25° vs. 18°) in the healthy volunteers and for FF (33° vs. 16°), external rotation at 90° abduction (21° vs. 18°), and IR90 (31° vs. 20°) in the symptomatic patients. Despite generally high intersurgeon reliability in the visual estimation of shoulder ROM, there was questionable accuracy when compared to digital goniometer measurements,with measurement errors often exceeding established MCID values. Given the potential implications for the clinical response to treatment and the significance of research findings, the adoption of validated instruments to measure ROM and the standardization of examination procedures should be considered.

Hwang S ，Ardebol J ，Ghayyad K ，Pak T ，Bonadiman JA ，Denard PJ ，Menendez ME ，PacWest Shoulder Study Group ... -  《-》

Validation of an innovative method of shoulder range-of-motion measurement using a smartphone clinometer application.

An accurate and reliable measurement of shoulder range of motion (ROM) is important in the evaluation of the shoulder. A smartphone digital clinometer application is a potentially simpler method for measuring shoulder ROM. The goal of this study was to establish the reliability and validity of shoulder ROM measurements among varying health care providers using a smartphone clinometer application in healthy and symptomatic adults. An attending surgeon, fellow, resident, physician assistant, and student served as examiners. Bilateral shoulders of 24 healthy subjects were included. Fifteen postoperative patients served as the symptomatic cohort. Examiners measured ROM of each shoulder, first using visual estimation and then using a goniometer and smartphone clinometer in a randomized fashion. The interobserver reliability among examiners showed significant correlation, with average intraclass correlation coefficient [ICC(2,1)] values of 0.61 (estimation), 0.69 (goniometer), and 0.80 (smartphone). All 5 examiners had substantial agreement with the gold standard in healthy subjects, with average ICC(2,1) values ranging from 0.62 to 0.79. The interobserver reliability in symptomatic patients showed significant correlation, with average ICC(2,1) values of 0.72 (estimation), 0.79 (goniometer), and 0.89 (smartphone). Examiners had excellent agreement with the gold standard in symptomatic patients, with an average ICC(2,1) value of 0.98. The smartphone clinometer has excellent agreement with a goniometer-based gold standard for measurement of shoulder ROM in both healthy and symptomatic subjects. There is good correlation among different skill levels of providers for measurements obtained using the smartphone. A smartphone-based clinometer is a good resource for shoulder ROM measurement in both healthy subjects and symptomatic patients.

Werner BC ，Holzgrefe RE ，Griffin JW ，Lyons ML ，Cosgrove CT ，Hart JM ，Brockmeier SF ... -  《-》

Accuracy of a Smartphone Software Application Compared With a Handheld Goniometer for Measuring Shoulder Range of Motion in Asymptomatic Adults.

Typically, shoulder range of motion (ROM) measurements are performed in a clinic setting, where physicians, physical therapists (PTs), and occupational therapists make use of a goniometer. To determine the accuracy of a smartphone-based ROM software application (app) in assessing active shoulder ROM and compare the measurements with traditional goniometry as measured by a PT. Cohort study (diagnosis); Level of evidence, 2. This prospective, nonblinded study was conducted at a single institution with adult asymptomatic participants with full active ROM of both shoulders. Participants were enrolled between June 1 and 15, 2021. Each participant self-assessed their active shoulder ROM using the PeerWell smartphone app. A single PT concurrently measured each participant's active shoulder ROM using a handheld universal goniometer. Bilateral shoulder ROM (forward flexion, abduction [AB], external rotation, internal rotation [IR], and extension) was measured 2 times for each participant. Interrater reliability between the smartphone app and PT measurements as well as intrarater reliability for each method of measurement were assessed using the intraclass correlation coefficient (ICC), and limits of agreement were analyzed for the difference in measurement methods. Data were analyzed for 60 shoulders (30 right, 30 left) from 30 participants (mean age, 31.4 ± 11.7 years; 73% female). The interrater reliability between the 2 methods was excellent for all movements (ICCs, 0.90-0.96). For all movements except shoulder AB, the mean difference in the measurements between the 2 methods was <1.3°; the mean difference in AB ROM was 2.08°. For all movements except IR, both PTs and the app showed excellent intrarater reliability (ICCs >0.90); for IR, good intrarater reliability (ICC ≥0.75) was observed. The PeerWell smartphone app provided measurements comparable with manual measurements taken by a PT using a goniometer. These data provide evidence that the smartphone app is a reliable and valid tool for measuring shoulder ROM and show promise for measuring and monitoring patient ROM remotely.

Soeters R ，Damodar D ，Borman N ，Jacobson K ，Shi J ，Pillai R ，Mehran N ... -  《Orthopaedic Journal of Sports Medicine》

Reliability and validity analyzes of Kinect V2 based measurement system for shoulder motions.

Telerehabilitation systems provide some advantages against the classic rehabilitation methods. The ability of the shoulders depends on active motion range of them to do activities in daily life and to do sports. To evaluate the shoulder motions, range of motion (ROM) measurement is a basic method. Clinical goniometer and digital goniometer are the most commonly used measurement tools. However, these measurement tools have some deficiencies and difficulties. In this paper, we consider a Kinect One Sensor (Kinect V2) based measurement system for shoulder motions as an alternative method. The aim of this study is to examine the reliability and validity analyzes of the proposed shoulder measurement system. Three systems were used to evaluate validity of the Kinect V2 to measure shoulder motions: Kinect V2 based system, clinical goniometer and digital goniometer. One expert physical therapist measured shoulder abduction, flexion, external rotation, internal rotation and extension ROM values using a clinical goniometer and a digital goniometer in 40 healthy volunteers (22 males, 18 females, and 19-33 years old). All poses for each shoulder motion were captured with the Kinect V2 based system again and the ROM values were calculated. These procedures were carried out with all of the volunteer participants in three repetitions. In reliability for Kinect V2 based shoulder motion measurement system, we used the intraclass correlation coefficients (ICC), standard error of the measure (SEM), minimal detectable change (MDC). The validity test includes the 95% limits of agreement (LOA) and mean difference between the Kinect V2 based system and the both of the goniometer systems for measuring shoulder motions. The high ICC values show that the Kinect V2 based shoulder motion measurement system has very good intra-rater reliability for abduction, flexion, external rotation, internal rotation shoulder poses. For extension pose, it has good reliability result according to the ICC value. The validity analysis gives good results for all shoulder poses except internal rotation between Kinect V2 and clinical/digital goniometer. As a result, Kinect V2 based measurement system is a reliable and valid alternative telerehabilitation tool for shoulder motions.

Çubukçu B ，Yüzgeç U ，Zileli R ，Zileli A ... -  《-》