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Comparison of the Validity of Goniometer and Visual Assessments of Angular Joint Positions of the Hand and Wrist
Peter Murray, MD; Kimberly McVeigh, OTR/CHT
Mayo Clinic, Jacksonville, FL

Introduction: The purpose of this study is to compare goniometric and visual assessments of angular hand and wrist joint positions as measured by board certified hand surgeons and certified hand therapists. We hypothesized that visual estimation is similar to goniometric measurements of hand and wrist joints
Methods: The wrist, metacarpalphalangeal and proximal interphalangeal joints were evaluated in different positions by 40 observers: 20 board certified hand surgeons and 20 certified hand therapists. Each observer estimated the position of each joint reproducibly positioned in low profile splints in this progression: visual estimation followed by goniometer measurement. The control measurement was determined by obtaining multiple plain radiographs of the hand and wrist positioned in each splint. Control measurements were digitally determined by a radiologist. Authors and study volunteers were blinded to the results of control measurements. For each joint position, the mean difference between the visual measurement and goniometer measurement was estimated with a 95% confidence interval. A pre-defined acceptable difference between visual and goniometer assessed joint angles was defined as 5 degrees compared to radiograph controls. The standard deviations of differences and median absolute differences between visual and goniometer assessed joint angles were calculated. Bland-Altman plots were constructed and the lower and upper limits of agreement estimated. Absolute differences between visual and goniometer measured joint angles and radiograph measurements were compared using Wilcoxon signed rank tests. Comparisons of measurement results between surgeons and hand therapists were also made using a Wilcoxon rank sum test.
Results: Neither visual assessments nor goniometer assessments were significantly closer to measurements obtained on radiographs. However goniometer measurements overall were closer to radiographic assessments than visual assessments. In particular, goniometer measurements of the PIP joint were statistically closer to the radiographic control than visual assessment of the PIP joint (p<001). Differences in measured joint angles between visual and goniometer assessments, visual and radiograph assessments, and goniometer and radiograph assessments were not statistically different among assessments made by surgeons and hand therapists.
Conclusions: Based on this study, there is a statistical advantage to measuring the angular position of the PIP joint with a goniometer compared to visual estimation but no statistical advantage to measuring the angular position of the MCP or wrist joint with a goniometer compared to visual estimation. There is no difference in the accuracy of measurement of joints in this study when comparing board certified hand surgeons and certified hand therapists.


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