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An App Provides Reliable Finger Measurement Faster Than a Goniometer
Jeremy Smalley, MD; Eric Angermeier, MD; William Barfield, PhD; Kyle Kokko, PhD, MD
Medical University of South Carolina, Charleston, SC

Introduction: In orthopaedic hand clinics, measurement of finger joint motion is commonly performed using mechanical goniometers, producing results that are accurate and precise but time-consuming. Recent studies have validated the use of a smartphone clinometer for measuring motion of the shoulder and knee. We investigated a custom iOS application for finger measurement designed to provide equivalent precision and superior efficiency compared to a mechanical goniometer with paper recording.

Methods: Examinations of finger range of motion were conducted by two orthopaedic hand surgeons and five residents using the custom iOS application (app) and an off-the-shelf mechanical goniometer. Plastic anatomic models of the hand, glued in flexion for standardization, were examined. The examiners followed a printed protocol and familiarized themselves with the devices before starting. Each hand examination measured the flexion angles of the thumb MP and IP joints and the finger MCP, PIP, and DIP. The angle was immediately recorded when captured in the app. Goniometric measurements were recorded on paper in a pre-printed grid. Examiners measured each hand twice with each device, for a total of 8 exams and 112 data points per examiner and 784 measurements overall. Each hand examination was timed.

Results: The app and the goniometer both demonstrated high reliability for repeated and comparative measurements as tested by ICC. The Cronbach's alpha score for the goniometer was 0.929 and for the app, 0.938. Pearson correlation coefficient between device measurements was 0.845. The app provided more rapid and statistically significant data acquisition with mean times of 2:13 for the app and 2:52 for the goniometer.

Discussion: The app is a similarly reliable measurement instrument to the goniometer and allows significantly faster capture of the range of motion of finger joints than a mechanical goniometer.

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