Reliability and Clinical Utility of Telehealth-Based Goniometry to Measure Digit Range of Motion

Background
Telehealth usage surged as consumers and clinicians sought to safely access and deliver hand therapy services during the COVID-19 pandemic. To date, there is no reliable method to measure digit range of motion during a teleconsultation. This study aims to investigate the reliability and clinical utility of manual goniometry for measuring digit range of motion during a teleconsultation.
Methods
Following a test-retest protocol, twelve independent raters (who currently provide hand therapy services) each obtained twelve screen-based goniometric range of motion measurements of the fifth digit. Four pre-recorded videos of an unaffected fifth digit were distributed at two-time points via a web-based survey. Raters evaluated the clinical utility of the method using a Likert-scale and free-text format. Analysis of test-retest and inter-rater reliability involved statistical measures of relative and absolute reliability. Free-text responses were analysed using content analysis.
Results
Inter-rater reliability was excellent for all flexion and extension measures (ICC ≥ 0.888) but poor for arc of motion (ICC ≤ 0.667). Test-retest reliability was poor (ICC ≤ 0.433). No statistically significant differences between test and retest measurements were observed (p ≥ 0.24). The overall Coefficient of Variation indicated good precision (14.69%). Measurement error (≤ 6.07º) and Limits of Agreement (≤ 6.33) had acceptable levels to support clinical use. Content analysis revealed several practical considerations.
Conclusion
This study suggests that manual goniometry is unreliable for measuring digit range of motion during a teleconsultation. Patient-reported and functional outcome measures should be used in conjunction with range of motion assessment in virtual hand therapy practice for a true indication of client outcomes.