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Accuracy and inter-observer reliability of visual estimation compared to clinical goniometry of the elbow

  • Elbow
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To test the hypothesis that visual estimation by a trained observer is as accurate and reliable as clinical goniometry for measuring elbow range of motion.

Methods

Instrument validity and inter-observer reliability of visual estimation was evaluated on a consecutive series of 50 elbow contractures. Four observers with different levels of elbow experience first estimated extension and flexion of the contracted elbows and then measured them with a blinded goniometer.

Results

Instrument validity for visually-based goniometry was extremely high. ICC scores were 0.97 for both extension and flexion estimations. Systematic error was negligible (1°) with upper limits of agreement being 9° (95% CI: 7°–11°) and 8° (95% CI: 6°–10°), respectively, for extension and flexion. For the expert surgeon, 92% of the visual estimates were within 5° of the value obtained by clinical goniometry. Between experienced observers (elbow surgeon and physician assistant), the ICC’s were very high—0.96 for extension and 0.93 for flexion. The systematic errors were low, from −1° to 1° with upper limit of agreement being 11° (95% CI: 8°–14°). However, agreement was poor between an inexperienced study coordinator and the others (ICC’s: 0.51–0.38, systematic errors: 8°–18°, upper limit of agreement: 32°–40°). The accuracy of the visual estimations made by the experienced elbow surgeon was as good as the measurements taken with a goniometer by the physician assistant or the clinical fellow and better than those taken by an inexperienced study coordinator.

Conclusions

The trained human eye is highly capable of accurately estimating the range of motion of the elbow, compared to conventional clinical goniometry, depending on the experience of the observer.

Level of evidence

Diagnostic study, Level II.

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Notes

  1. The data on goniometric measurements are the same as data used in an arm of this investigation in which photographs were used to measure range of motion and compared to measurements taken by standard clinical goniometry [5].

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Acknowledgments

The authors gratefully acknowledge the assistance of Doulas V. Kautz, PA-C, and Charlene L. Blanchard, for the goniometric measurements they made for this study, and Robert A. Vierkant, for his guidance regarding the ICC analyses.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Center for Sports Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA

    Davide Blonna, Peter C. Zarkadas, James S. Fitzsimmons & Shawn W. O’Driscoll

  2. Department of Orthopaedics and Traumatology, University of Turin Medical School, Turin, Italy

    Davide Blonna

  3. Department of Orthopedics, Lion’s Gate Hospital, North Vancouver, BC, Canada

    Peter C. Zarkadas

Authors
  1. Davide Blonna
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  2. Peter C. Zarkadas
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  3. James S. Fitzsimmons
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  4. Shawn W. O’Driscoll
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Corresponding author

Correspondence to Shawn W. O’Driscoll.

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Blonna, D., Zarkadas, P.C., Fitzsimmons, J.S. et al. Accuracy and inter-observer reliability of visual estimation compared to clinical goniometry of the elbow. Knee Surg Sports Traumatol Arthrosc 20, 1378–1385 (2012). https://doi.org/10.1007/s00167-011-1720-9

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  • DOI: https://doi.org/10.1007/s00167-011-1720-9

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