How do we measure up?
Measuring a patient's range of movement at the affected joint is a baseline assessment when seeing a physiotherapist or surgeon. This is used as an objective tool before and after surgery or to mark improvements while recovering from injury. It is invaluable in providing objective markers to monitor a patient's progress.
What is used in today's practice?
Eyeballing
With the tools available to clinicians today, sometimes it's quicker and easier to just make an educated guess on the range of movement of a joint. Many clinicians use this method either by way of percentage, fraction or in degrees. Its quick, easy and free but has poor reliability when being used by the same clinician and multiple clinicians.(1) It should not be the gold standard in assessment today.
The Universal Goniometer (UG)
The UG was first medically used in the 1800’s (2). It has been a trusty piece of equipment for clinicians with it being small and inexpensive. It takes a static range of movement measurements whereby the patient must passively move the joint to its end range while the clinician takes the measurement as efficiently as able. It can be painful and difficult for the patient to get these measurements as they are most often taken after surgical procedures or injuries.
There are also questions on the reliability of the UG when used both by the same clinician and by multiple clinicians due to variance in positioning (3). This matters because as well as being an important input for clinical decisions, range of movement is a motivational tool for both the clinician and patient providing positive reinforcement that their hard work is paying off.
Smart Phone Goniometer
Provides simple, fast measurements of joint range of movement with reliability being similar to the humble goniometer. (4) Measurements can be taken quicker causing less discomfort to the patient but similar to the standard goniometer there is some limitation with inter app reliability and again can only assess one joint at a time.
Smartphone goniometers are accessible with almost everyone having a hand held device and there is lots of competition in the app market.
Marker Less Motion Capture
3D camera technology to assess the range of movement of multiple joints at one time. This is highly accurate (5) and takes the measurements in the background allowing the patient to carry out an active assessment decreasing the amount of time required to carry out and discomfort to a patient. This technology is easy to set up, requires minimal calibration and gives objective, precise and repeatable measurements. It’s a little more expensive than traditional measuring tools but has many benefits (another blog post coming soon!).
Welcoming the future
Overall there is new technology coming through to the medical world to help us provide more accurate quicker measurements which is important when recording objective data and for psychological positive reinforcement while recovering from injury.
At Vitrue our goal is to help physiotherapy in moving into the tech savvy 21st century offering patients a higher gold standard level of care.
References
(1) Whitcroft KL, Massough l, Amifreyz R, Bannister G. Comparison of methods of measuring active cervical range of motion. 2010 Sep 1;35(19):E976-8
(2) http://broughttolife.sciencemuseum.org.uk/broughttolife/objects/display?id=10428
(3) Susan W. Muir, BScPT PhD,1 Charlene Luciak Corea, BScPT,2 and Lauren Beaupre, Evaluating change in clinical status: reliability and measures of agreement for the assessment of glenohumeral range of motion. N Am J Sports Phys Ther. 2010 Sep; 5(3): 98–110.
(4) Simon J. Otter, Brunilda Agalliu, Nicola Baer et al. The reliability of a smartphone goniometer application compared with a traditional goniometer for measuring first metatarsophalangeal joint dorsiflexion. Journal of Foot and Ankle Research 2015 8:30
https://doi.org/10.1186/s13047-015-0088-3, Published: 23 July 2015
(5) Lee SH, Yoon C, Chung SG, Kim HC, Kwak Y, Park H, Kim K. Measurement of shoulder range of motion in patients with adhesive capsulitis using a kinect. PLoS One. 2015;10(6)