Abstract
Purpose To determine the reliability of wrist range of motion (WROM) measurements based on
digital photographs taken by patients at home compared with traditional measurements
done in the office with a goniometer.
Methods Sixty-nine postoperative patients were enrolled in this study at least 3 months postoperatively.
Active and passive wrist flexion/extension and radial/ulnar deviation were recorded
by one of the two attending surgeons with a 1-degree resolution goniometer at the
last postoperative office visit. Patients were provided an illustrated instruction
sheet detailing how to take digital photographic images at home in six wrist positions
(active and passive flexion/extension, and radial/ulnar deviation). Wrist position
was measured from digital images by both the attending surgeons in a randomized, blinded
fashion on two separate occasions greater than 2 weeks apart using the same goniometer.
Reliability analysis was performed using the intraclass correlation coefficient to
assess agreement between clinical and photography-based goniometry, as well as intra-
and interobserver agreement.
Results Out of 69 enrolled patients, 30 (43%) patients sent digital images. Of the 180 digital
photographs, only 9 (5%) were missing or deemed inadequate for WROM measurements.
Agreement between clinical and photography-based measurements was “almost perfect”
for passive wrist flexion/extension and “substantial” for active wrist flexion/extension
and radial/ulnar deviation. Inter- and intraobserver agreement for the attending surgeons
was “almost perfect” for all measurements.
Discussion This study validates a photography-based goniometry protocol allowing accurate and
reliable WROM measurements without direct physician contact. Passive WROM was more
accurately measured from photographs than active WROM. This study builds on previous
photography-based goniometry literature by validating a protocol in which patients
or their families take and submit their own photographs.
Clinical Relevance Patient-performed photography-based goniometry represents an alternative to traditional
clinical goniometry that could enable longer-term follow-up, overcome travel-related
impediments to office visits, improve convenience, and reduce costs for patients.
Keywords
wrist goniometry - wrist range of motion - digital images - distance learning - remote
access
