Reliability Analysis of In-person and Virtual Goniometric Measurements of the Upper Extremity

Background Virtual healthcare has forced clinicians to modify or eliminate parts of the musculoskeletal evaluation such as motion assessment. Although acceptable to excellent levels of in-person goniometric reliability is achievable, reliability of virtual assessments is unknown. Purpose To determine if similar upper extremity goniometric measurements could be obtained in-person and virtually. Study Design Reliability study; classroom setting Methods Publicly recruited sample over 18 years of age with no upper extremity injuries. Each subject was tested in a standing position with dominant arm facing the clinicians to visualize the landmarks for goniometer placement. Flexion and extension of the shoulder, elbow and wrist were measured. Prior to performing in-person goniometric measurements for each joint, an image was captured of each pre-determined joint position using a mobile device with a camera. This image represented the screenshot on a virtual platform. Four clinicians performed in-person measurements twice during the same session on each subject. The following week clinicians measured virtual images using the same techniques. Inter-rater and intra-rater reliability were determined via intraclass correlation coefficients (ICC). Results Inter-rater reliability for five of the six in-person (ICC≥0.81) and virtual measurements (ICC≥0.78 ) were classified as excellent. In-person wrist extension (ICC=0.60) and virtual wrist flexion (ICC=0.65) were classified as good. Intra-rater reliability for individual clinicians were between good and excellent for the in-person measurements (ICC:0.61-0.96) and virtual measurements (ICC:0.72-0.97). There were a greater number of excellent ICC values for the virtual measurements (90%) compared to in-person measurements (70%). There were statistically significant differences between in-person and virtual sessions for five of six measurements (p≤0.006). Only elbow extension did not differ between sessions (p=0.966). Conclusion Virtual assessment compared to goniometric measurements showed good to excellent inter- and intra-rater reliabilities (ICC > 0.60), which suggests clinicians can utilize goniometry either in person or on a virtual platform. Level of Evidence 3b ©The Author(s)