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Smartphone Photography as a Tool to Measure Elbow Range of Motion
Megan Anne Conti Mica, MD; Eric Wagner, MD; Alex Shin, MD
Mayo Clinic, Rochester, MN

Introduction: In the evolving digital world, the ability to utilize digital photography via smartphones could provide a very important tool to evaluate elbow range of motion (ROM) postoperatively. The purpose of this study was to determine if digital photography is as reliable as clinical goniometry in measuring elbow ROM.

Methods: The validity and reliability of digital photography was examined using bilateral elbows of 32 normal participants (64 elbows). Digital photos were taken utilizing smartphones, measuring the angles at the extremes of flexion and extension with commerically available goniometry software. The photographs were obtained by another participant then by a researcher for comparison. Clinical goniometry measurements were taken after obtaining the digital photographs. Mean ROM, difference in ROM, then comparisons were performed utilizing T-test, a Bland Altman analysis, pearson coefficient and interclass analysis of variance.

Results: 32 patients (64 elbows) were measured, there was minimal difference in the overall mean in total arc of motion. Comparing measurements ascertained by smartphone base digital photography and the goniometer, there was no statistical difference between the groups (p<.9 on the left (L) and p<.88 on the right (R)) Examining the interclass correlation, the concordance coefficient for the left was 0.828 and 0.740 on the right. The Pearson coefficient was 0.845 on the left and 0.757 on the right. The Bland-Altman plots demonstrated 30 of 32 digital measurements were within the 95% confidence interval of the clinical measurements on the left, and 31 of 32 measurements were within the 95% confidence interval on the right. The measurements from the photography taken by the volunteer compared to the researcher showed no significant different (p<.66 (L) and p<.46 (R)). The left concordance and Pearson coefficients of 0.955 and 0.962, respectively, and were 0.941 and 0.957 on the right. When estimating interobserver reliability, the difference between researchers was negligible (<1o), with concordance coefficients of 0.793 (left) and 0.767 (right) and Pearson coefficients of 0.811 (left) and 0.780 (right). (Table 1)(Figure 1)

Summary: The use of smartphone digital photography to measure elbow range of motion proved to be a reliable, reproducible and accurate when compared to goniometric measurements. There was no significant difference as to whether a laymen or a medical expert took the photograph (Figure 2). These findings validate the concept of having patients send in digital photography of their elbow range of motion in clinical and research follow-up.

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