Intra- and inter-rater reliability of joint range of motion tests using tape measure, digital inclinometer and inertial motion capturing

Laura Fraeulin, Fabian Holzgreve, Mark Brinkbäumer, Anna Dziuba, David Friebe, Stefanie Klemz, Marco Schmitt, Anna-Lena Theis A, Sarah Tenberg, Anke van Mark, Christian Maurer-Grubinger, Daniela Ohlendorf, Laura Fraeulin, Fabian Holzgreve, Mark Brinkbäumer, Anna Dziuba, David Friebe, Stefanie Klemz, Marco Schmitt, Anna-Lena Theis A, Sarah Tenberg, Anke van Mark, Christian Maurer-Grubinger, Daniela Ohlendorf

Abstract

Background: In clinical practice range of motion (RoM) is usually assessed with low-cost devices such as a tape measure (TM) or a digital inclinometer (DI). However, the intra- and inter-rater reliability of typical RoM tests differ, which impairs the evaluation of therapy progress. More objective and reliable kinematic data can be obtained with the inertial motion capture system (IMC) by Xsens. The aim of this study was to obtain the intra- and inter-rater reliability of the TM, DI and IMC methods in five RoM tests: modified Thomas test (DI), shoulder test modified after Janda (DI), retroflexion of the trunk modified after Janda (DI), lateral inclination (TM) and fingertip-to-floor test (TM).

Methods: Two raters executed the RoM tests (TM or DI) in a randomized order on 22 healthy individuals while, simultaneously, the IMC data (Xsens MVN) was collected. After 15 warm-up repetitions, each rater recorded five measurements.

Findings: Intra-rater reliabilities were (almost) perfect for tests in all three devices (ICCs 0.886-0.996). Inter-rater reliability was substantial to (almost) perfect in the DI (ICCs 0.71-0.87) and the IMC methods (ICCs 0.61-0.993) and (almost) perfect in the TM methods (ICCs 0.923-0.961). The measurement error (ME) for the tests measured in degree (°) was 0.9-3.3° for the DI methods and 0.5-1.2° for the IMC approaches. In the tests measured in centimeters the ME was 0.5-1.3cm for the TM methods and 0.6-2.7cm for the IMC methods. Pearson correlations between the results of the DI or the TM respectively with the IMC results were significant in all tests except for the shoulder test on the right body side (r = 0.41-0.81).

Interpretation: Measurement repetitions of either one or multiple trained raters can be considered reliable in all three devices.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. The range of motion measurements.
Fig 1. The range of motion measurements.
a) Shoulder test modified after Janda on the left-hand body side, b) modified Thomas test on the left-hand body side, c) retroflexion of the trunk after Janda in the modified version, d) fingertip-to-floor test and e) lateral inclination on the right-hand body side. The measurements were simultaneously recorded in the Xsens system (subjects wears the measurement suit) and the low cost devices.
Fig 2. The relationship between the low…
Fig 2. The relationship between the low cost device methods and the IMC method.
Here the means of the last five measurements of rater 1 were used for the plot.

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