Validity and reliability of using photography for measuring knee range of motion: a methodological study

Justine M Naylor, Victoria Ko, Sam Adie, Clive Gaskin, Richard Walker, Ian A Harris, Rajat Mittal, Justine M Naylor, Victoria Ko, Sam Adie, Clive Gaskin, Richard Walker, Ian A Harris, Rajat Mittal

Abstract

Background: The clinimetric properties of knee goniometry are essential to appreciate in light of its extensive use in the orthopaedic and rehabilitative communities. Intra-observer reliability is thought to be satisfactory, but the validity and inter-rater reliability of knee goniometry often demonstrate unacceptable levels of variation. This study tests the validity and reliability of measuring knee range of motion using goniometry and photographic records.

Design: Methodology study assessing the validity and reliability of one method ('Marker Method') which uses a skin marker over the greater trochanter and another method ('Line of Femur Method') which requires estimation of the line of femur.

Setting: Radiology and orthopaedic departments of two teaching hospitals.

Participants: 31 volunteers (13 arthritic and 18 healthy subjects). Knee range of motion was measured radiographically and photographically using a goniometer. Three assessors were assessed for reliability and validity.

Main outcomes: Agreement between methods and within raters was assessed using concordance correlation coefficient (CCCs). Agreement between raters was assessed using intra-class correlation coefficients (ICCs). 95% limits of agreement for the mean difference for all paired comparisons were computed.

Results: Validity (referenced to radiographs): Each method for all 3 raters yielded very high CCCs for flexion (0.975 to 0.988), and moderate to substantial CCCs for extension angles (0.478 to 0.678). The mean differences and 95% limits of agreement were narrower for flexion than they were for extension. Intra-rater reliability: For flexion and extension, very high CCCs were attained for all 3 raters for both methods with slightly greater CCCs seen for flexion (CCCs varied from 0.981 to 0.998). Inter-rater reliability: For both methods, very high ICCs (min to max: 0.891 to 0.995) were obtained for flexion and extension. Slightly higher coefficients were obtained for flexion compared to extension, and with the Marker compared to the Line of Femur Method. For intra- and inter-rater reliability, the mean differences (within 2 degrees) and 95% limits of agreement (within 5 degrees) were generally clinically acceptable for both methods.

Conclusion: Photography potentially offers a superior method of measurement over standard goniometry as visualising the centre of the knee is simplified in a two-dimensional plane and the permanent record provides greater assessor transparency as well as opportunity to confer. The Marker and Line of Femur Methods have moderate to substantial validity, but the inter- and intra-rater repeatability for trained observers are excellent with both methods yielding small mean differences with narrow limits of agreement. The Line of Femur Method offers the added advantage that it does not rely on inter-clinician consistency in identifying the greater trochanter.

Figures

Figure 1
Figure 1
Inconsistency in GT marker placement between experienced orthopaedic physiotherapists. (Note the position of the marker (black circle) in relation to the scar (black straight line)).
Figure 2
Figure 2
Different degrees of adiposity influence the ease with which bony landmarks can be identified.
Figure 3
Figure 3
Patient x-rays demonstrating measurement of angles in flexion and extension.

References

    1. Kettelkamp DB, Johnson RJ, Smidt GL, Chao EY, Walker M. An electrogoniometric study of knee motion in normal gait. J Bone Joint Surg Am. 1970;52:775–790.
    1. Laubenthal KN, Smidt GL, Kettelkamp DB. A quantitative analysis of knee motion during activities of daily living. Phys Ther. 1972;52:34–43.
    1. Myles CM, Rowe PJ, Walker CR, Nutton RW. Knee joint functional range of movement prior to and following total knee arthroplasty measured using flexible electrogoniometry. Gait Posture. 2002;16:46–54. doi: 10.1016/S0966-6362(01)00198-9.
    1. Insall J, Scott WN, Ranawat CS. The total condylar knee prosthesis. A report of two hundred and twenty cases. J Bone Joint Surg Am. 1979;61:173–180.
    1. Miner AL, Lingard EA, Wright EA, Sledge CB, Katz JN. Knee range of motion after total knee arthroplasty: how important is this as an outcome measure? J Arthroplasty. 2003;18:286–294. doi: 10.1054/arth.2003.50046.
    1. Chiu KY, Ng TP, Tang WM, Yau WP. Review article: knee flexion after total knee arthroplasty. J Orthop Surg (Hong Kong) 2002;10:194–202.
    1. Mounasamy V, Beizile E, Moskal J, Brown T. Stiffness following total knee arthroplasty: evaluation and treatment. European Journal of Orthopaedic Surgery & Traumatology. 2008;18:165–171. doi: 10.1007/s00590-007-0279-0.
    1. Harmer AR, Naylor JM, Crosbie J, Russell T. Land-based versus water-based rehabilitation following total knee replacement: a randomized, single-blind trial. Arthritis Rheum. 2009;61:184–191. doi: 10.1002/art.24420.
    1. Mook WR, Miller MD, Diduch DR, Hertel J, Boachie-Adjei Y, Hart JM. Multiple-ligament knee injuries: a systematic review of the timing of operative intervention and postoperative rehabilitation. J Bone Joint Surg Am. 2009;91:2946–2957. doi: 10.2106/JBJS.H.01328.
    1. Ritter MA, Harty LD, Davis KE, Meding JB, Berend ME. Predicting range of motion after total knee arthroplasty. Clustering, log-linear regression, and regression tree analysis. J Bone Joint Surg Am. 2003;85-A:1278–1285.
    1. Naylor JM, Harmer AR, Crosbie J, Fester N. Clinical networks--bridging the research-quality chasm. Aust J Physiother. 2007;53:284.
    1. Gajdosik RL, Bohannon RW. Clinical measurement of range of motion. Review of goniometry emphasizing reliability and validity. Phys Ther. 1987;67:1867–1872.
    1. Piriyaprasarth P, Morris ME. Psychometric properties of measurement tools for quantifying knee joint position and movement: a systematic review. Knee. 2007;14:2–8. doi: 10.1016/j.knee.2006.10.006.
    1. Brosseau L, Balmer S, Tousignant M, O'Sullivan JP, Goudreault C, Goudreault M, Gringras S. Intra- and intertester reliability and criterion validity of the parallelogram and universal goniometers for measuring maximum active knee flexion and extension of patients with knee restrictions. Arch Phys Med Rehabil. 2001;82:396–402. doi: 10.1053/apmr.2001.19250.
    1. Brosseau L, Tousignant M, Budd J, Chartier N, Duciaume L, Plamondon S, O'Sullivan JP, O'Donoghue S, Balmer S. Intratester and intertester reliability and criterion validity of the parallelogram and universal goniometers for active knee flexion in healthy subjects. Physiother Res Int. 1997;2:150–166. doi: 10.1002/pri.97.
    1. Edwards JZ, Greene KA, Davis RS, Kovacik MW, Noe DA, Askew MJ. Measuring flexion in knee arthroplasty patients. J Arthroplasty. 2004;19:369–372. doi: 10.1016/j.arth.2003.12.001.
    1. Johnson F. The knee. Clin Rheum Dis. 1982;8:677–702.
    1. Rothstein JM, Miller PJ, Roettger RF. Goniometric reliability in a clinical setting. Elbow and knee measurements. Phys Ther. 1983;63:1611–1615.
    1. Watkins MA, Riddle DL, Lamb RL, Personius WJ. Reliability of goniometric measurements and visual estimates of knee range of motion obtained in a clinical setting. Phys Ther. 1991;71:90–96. discussion 96-97.
    1. Cleffken B, van Breukelen G, Brink P, van Mameren H, Olde Damink S. Digital goniometric measurement of knee joint motion. Evaluation of usefulness for research settings and clinical practice. Knee. 2007;14:385–389. doi: 10.1016/j.knee.2007.07.004.
    1. Enwemeka CS. Radiographic verification of knee goniometry. Scand J Rehabil Med. 1986;18:47–49.
    1. Gogia PP, Braatz JH, Rose SJ, Norton BJ. Reliability and validity of goniometric measurements at the knee. Phys Ther. 1987;67:192–195.
    1. Lavernia C, D'Apuzzo M, Rossi MD, Lee D. Accuracy of knee range of motion assessment after total knee arthroplasty. J Arthroplasty. 2008;23:85–91. doi: 10.1016/j.arth.2008.05.019.
    1. Lenssen AF, van Dam EM, Crijns YH, Verhey M, Geesink RJ, van den Brandt PA, de Bie RA. Reproducibility of goniometric measurement of the knee in the in-hospital phase following total knee arthroplasty. BMC Musculoskelet Disord. 2007;8:83. doi: 10.1186/1471-2474-8-83.
    1. Karkouti E, Marks R. Reliability of Photographic Range of Motion Measurements in a Healthy Sample: Knee and Ankle Joint Measurement. Physiotherapy Canada. 1997;49:24–31.
    1. Lin LI. A concordance correlation coefficient to evaluate reproducibility. Biometrics. 1989;45:255–268. doi: 10.2307/2532051.
    1. Eliasziw M, Young SL, Woodbury MG, Fryday-Field K. Statistical methodology for the concurrent assessment of interrater and intrarater reliability: using goniometric measurements as an example. Phys Ther. 1994;74:777–788.
    1. Muller R, Buttner P. A critical discussion of intraclass correlation coefficients. Stat Med. 1994;13:2465–2476. doi: 10.1002/sim.4780132310.
    1. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1:307–310. doi: 10.1016/S0140-6736(86)90837-8.
    1. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–174. doi: 10.2307/2529310.
    1. Chaudhary R, Beaupre LA, Johnston DW. Knee range of motion during the first two years after use of posterior cruciate-stabilizing or posterior cruciate-retaining total knee prostheses. A randomized clinical trial. J Bone Joint Surg Am. 2008;90:2579–2586. doi: 10.2106/JBJS.G.00995.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit