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Aims The aim of this study was to assess and compare active rotation of the forearm in normal subjects after the application of a short-arm cast (SAC) in the semisupination position and a long-arm cast (LAC) in the neutral position. A clinical study was also conducted to compare the functional outcomes of using a SAC in the semisupination position with those of using a LAC in the neutral position in patients who underwent arthroscopic triangular fibrocartilage complex (TFCC) foveal repair. Methods A total of 40 healthy right-handed volunteers were recruited. Active pronation and supination of the forearm were measured in each subject using a goniometer. In the retrospective clinical study, 40 patients who underwent arthroscopic foveal repair were included. The wrist was immobilized postoperatively using a SAC in the semisupination position (approximately 45°) in 16 patients and a LAC in 24. Clinical outcomes were assessed using grip strength and patient-reported outcomes. The degree of disability caused by cast immobilization was also evaluated when the cast was removed. Results Supination was significantly more restricted with LACs than with SACs in the semisupination position in male and female patients (p < 0.001 for both). However, pronation was significantly more restricted with SACs in the semisupination position than with LACs in female patients (p = 0.003) and was not significantly different in male patients (p = 0.090). In the clinical study, both groups showed improvement in all parameters with significant differences in grip strength, visual analogue scale scores for pain, modified Mayo Wrist Score, the Disability of the Arm, Shoulder, and Hand (DASH) score, and the Patient-Rated Wrist Evaluation (PRWE) score. No significant postoperative differences were noted between LACs and SACs in the semisupination position. However, the disability caused by immobilization in a cast was significantly higher in patients who had a LAC on the dominant hand (p < 0.001). Conclusion We found that a SAC in the semisupination position is as effective as a LAC in restricting pronation of the forearm. In addition, postoperative immobilization with a SAC in the semisupination position resulted in comparable pain scores and functional outcomes to immobilization with a LAC after TFCC foveal repair, with less restriction of daily activities. Therefore, we recommend that surgeons consider using a SAC in the semisupination position for postoperative immobilization following TFCC foveal repair for dorsal instability of the distal radioulnar joint. Cite this article: Bone Joint J 2022;104-B(2):249–256.

Context: Deficits in the hip range of motion are associated with hip and groin injuries. Accurate and reliable goniometric measurements are important in identifying those at risk of injury and determining the efficacy of treatment interventions. Smartphone goniometric applications are regularly used to assess joint ranges of motion; however, there is limited knowledge on the reliability of this method in relation to the hip, particularly between clinicians with different levels of experience. Objective: To determine the intratester and intertester reliability of a smartphone clinometer application for the assessment of hip goniometric measurements in healthy volunteers by an experienced and novice clinician. Design: Reliability study. Setting: University Athletic Therapy facility. Participants: Physically active, university students. Main Outcome Measures: The study determined the intra- and intertester (experienced vs novice clinician) reliability of goniometric measurements of the hip joint (modified Thomas test and seated hip internal and external rotation) using a smartphone goniometric application. Intraclass correlation coefficients (ICCs), standard error of measurement, and minimal detectable change at a 95% confidence interval were used to assess reliability. Results: Goniometric measurements demonstrated good to excellent relative intratester reliability for the modified Thomas test (ICC = .94), external rotation (ICC = .93–.95), and internal rotation (ICC = .80–.81). Intertester reliability for expert and novice clinicians was also excellent for the modified Thomas test (ICC = .98), external rotation (ICC = .95), and internal rotation (ICC = .92). Intratester and intertester standard error of measurement and minimal detectable change at 95% confidence interval values were similar for both testers and ranged from 1.9° to 3.6° and 5° to 10.1° and from 1.1° to 2.3° and 2.9° to 6.5°, respectively. Conclusion: Smartphone-based goniometric measurements of hip range of motion have high intratester and intertester reliability for novice and expert clinicians. It may be a useful, simple, and inexpensive resource for clinicians.

ObjectiveTo investigate repetitive movements and the use of hand force as causes of treatment for distal upper extremities musculoskeletal disordersMethodsA cohort of 202 747 workers in a pension health scheme from 2005 to 2017 in one of 17 jobs (eg, office work, carpentry, cleaning) was formed. Representative electro-goniometric measurements of wrist angular velocity as a measure for repetition and expert-rated use of hand force were used in a job exposure matrix (JEM). Job titles were retrieved from the Danish registers. Outcome was first treatment in the distal upper extremities. In a Poisson regression model, incidence rate ratios (IRRs) of treatment were adjusted for age, calendar-year, diagnosis of rheumatoid arthritis and arm fractures. In further analyses, wrist velocity or hand force was added.ResultsIn men, wrist velocity had an IRR of 1.48 (95% CI 1.15 to 1.91) when the highest exposure level was compared with the lowest but with no clear exposure-response pattern. The effect became insignificant when adjusted for hand force. Hand force had an IRR of 2.65 (95% CI 2.13 to 3.29) for the highest versus the lowest exposure with an exposure-response pattern, which remained after adjustment for wrist velocity. Among women, no increased risk was found for hand force, while wrist velocity showed a significantly protective association with treatment.ConclusionsIn men, occupational exposure to hand force more than doubled the risk of seeking treatment. The results for exposure to repetition were less clear. In women, we could not find any indications of an increased risk neither for force nor for repetition.

Context: Limited dorsiflexion (DF) range of motion (ROM) is commonly observed in both the athletic and general populations and is a predisposing factor for lower extremity injury. Graston Technique® (GT) is a form of instrument-assisted soft tissue mobilization (IASTM), used commonly to increase ROM. Evidence of the long-term effects of GT on ROM is lacking, particularly comparing the full GT protocol versus IASTM alone. Objective: To evaluate the effectiveness of 6 sessions of the GT or IASTM compared with a control (CON) group for increasing closed-chain DF ROM. Design: Cohort design with randomization. Setting: Athletic training clinic. Patients or Other Participants: A total of 23 physically active participants (37 limbs) with Intervention: Participants’ closed-chain DF ROM (standing and kneeling) were assessed at baseline and 24–48 hours following their sixth treatment. Participants in the CON group were measured at baseline and 3 weeks later. The intervention groups received 6 treatments during a 3-week period, whereas the CON group received no treatment. The GT group received a warm-up, instrument application, stretching, and strengthening of the triceps surae. The IASTM group received a warm-up and instrument application. Main Outcome Measures: Closed-chain DF was assessed with a digital inclinometer in standing and kneeling. Results: A significant difference between groups was found in the standing position (P = .03) but not in kneeling (P = .15). Post hoc testing showed significant improvements in DF in standing following the GT compared with the control (P = .02). Conclusions: The GT significantly increases ankle DF following 6 treatments in participants with DF ROM deficits; however, no differences were found between GT and IASTM. The GT may be an effective intervention for clinicians to consider when treating patients with DF deficits.

Context: Technological advances have given smartphones the capabilities of sensitive clinical measurement equipment at lesser cost and higher availability. The Clinometer is a smartphone application that can be used to measure the joint range of motion in a clinical setting, but psychometric properties of the tool’s use measuring cervical range of motion (CROM) are not established. Objectives: The purpose of this study was to examine the validity and intrarater reliability of the Clinometer application for the measurement of CROM (ie, flexion, extension, rotation, lateral flexion) and to determine the minimal detectable change and SEM. Design: A blinded, repeated-measures correlational design was employed. Setting: The study was conducted collaboratively between 2 athletic training clinics. Participants: A convenience sample of healthy adults ages 18–30 years were recruited. Participants with any history in the last 3 months of cervical or thoracic pathology, pain, or any musculoskeletal injury were excluded. Main Outcome Measures: Three repetitions of each motion were measured by a primary researcher with a goniometer. The same researcher then conducted 3 blinded measurements with the Clinometer application following the same procedure. A second researcher, blinded to the goniometer measurements, recorded the results. Thirty minutes later, testing was repeated with the application. The Pearson correlation was calculated to determine validity of the application compared with goniometry. Results: The measurements between devices had moderate to excellent concurrent validity, with the coefficients ranging between 0.544 and 0.888, P Conclusion: The Clinometer application is a valid and reliable instrument for measuring active CROM. Level of evidence: clinical measurement, level 1b.

Context: Joint mobilizations have been studied extensively in the literature for the glenohumeral joint and talocrural joint (ankle). Consequently, joint mobilizations have been established as an effective means of improving range of motion (ROM) within these joints. However, there is a lack of extant research to suggest these effects may apply within another critical joint in the body, the hip. Objective: To examine the immediate effects of hip joint mobilizations on hip ROM and functional outcomes. Secondarily, this study sought to examine the efficacy of a novel hip mobilization protocol. Design: A prospective exploratory study. Setting: Two research labs. Patients or Other Participants: The study included 19 active male (n = 8) and female (n = 11) college students (20.56 [1.5] y, 171.70 [8.6] cm, 72.23 [12.9] kg). Interventions: Bilateral hip mobilizations were administered with the use of a mobilization belt. Each participant received hip joint mobilization treatments once during 3 weekly sessions followed immediately by preintervention and postintervention testing/measurements. Testing for each participant occurred once per week, at the same time of day, for 3 consecutive weeks. Hip ROM was the first week, followed by modified Star Excursion Balance Test the second week and agility T test during the third week. Main Outcomes Measures: Pretest and posttest measurements included hip ROM for hip flexion, extension, abduction, adduction, internal and external rotation, as well as scores on the modified Star Excursion Balance Test (anterior, posterolateral, and posteromedial directions) and agility T test. Results: A significant effect for time was found for hip adduction, internal and external rotation ROM, as well as the posterolateral and posteromedial directions of the modified Star Excursion Balance Test. A separate main effect for both limbs was found for adduction and internal rotation ROM. Conclusion: Isolated immediate changes in ROM and functional outcomes were evident. Further evaluation is needed.

Objectives The clinical parameter of morning stiffness is widely used to assess the status of RA, but its accurate quantitative assessment in a clinical setting has not yet been successful. This lack of individual quantification limits both personalized medication and efficacy evaluation in the treatment of RA. Methods We developed a novel technology to assess passive resistance of the MCP III joint (stiffness) and its passive range of motion (PRoM). Within this pilot study, 19 female postmenopausal RA patients and 9 healthy controls were examined in the evening as well as the morning of the following day. To verify the specificity of the biomechanical quantification, 11 patients with RA were assessed both prior to and ∼3 h after glucocorticoid therapy. Results While the healthy controls showed only minor changes between afternoon and morning, in RA patients the mean PRoM decreased significantly by 18% (s.d. 22) and stiffness increased significantly by 20% (s.d. 18) in the morning compared with the previous afternoon. We found a significant positive correlation between RA activity and biomechanical measures. Glucocorticoids significantly increased the mean PRoM by 16% (s.d. 11) and reduced the mean stiffness by 23% (s.d. 22). Conclusion This technology allowed mechanical stiffness to be quantified in MCP joints and demonstrated high sensitivity with respect to disease status as well as medication effect in RA patients. Such non-invasive, low-risk and rapid assessment of biomechanical joint stiffness opens a novel avenue for judging therapy efficacy in patients with RA and potentially also in other non-RA inflammatory joint diseases.

OBJECTIVE This study aims to investigate compensatory rotational movements of the wrist joint in patients with proximal congenital radioulnar synostosis (CRUS), using a valid and reliable three-dimensional (3D) motion analysis technique. METHODS A total of 26 patients (6 females, 14 males; mean age=15.3 years; and age range=6-32 years) who were diagnosed with unilateral proximal CRUS but were not operated were enrolled in this study. Patients were then categorized into 2 groups: Group I included 5 patients younger than 10 years, and Group II included 15 patients older than 10 years. Eighteen light-reflective skin markers were placed on the bony landmarks of both upper limbs, and both distal forearms were fixed using a U-shaped device to minimize forearm rotation. Each patient grasped the handle of an instrument that used a goniometer to measure wrist rotation; maximal passive pronation and supination angles of the wrist were measured in this manner and also using 3D motion analysis. RESULTS There was a significant correlation between measurements by the goniometer and 3D motion analysis (r=0.985, p

Objective This study aimed to determine the intra- and interrater reliability of active and passive range of motion in the shoulders of individuals with subacromial impingement syndrome using a digital inclinometer. Methods The raters evaluated active and passive range of motion in the shoulder of 50 individuals with unilateral subacromial impingement syndrome in movements including flexion, abduction, extension, external rotation in a neutral position, external rotation with the arm at 90° of abduction, and internal rotation with the arm at 90° of abduction. The tests were performed by 2 examiners on the same day, with a 10-minute interval, and were repeated by 1 examiner after a 2- to 4-day interval. Reliability was analyzed using the intraclass correlation coefficient (ICC2,3). Results There was moderate to excellent interrater (ICC2,3 = 0.50-0.95) and intrarater (ICC2,3 = 0.74-0.94) reliability. In the interrater analysis, the standard error of measurement (SEM) ranged from 4.1° to 10°, the percentage SEM (%SEM) ranged from 2% to 17%, and the minimum detectable change ranged from 9.5° to 23.4°. In the intrarater analysis, the SEM ranged from 4° to 9.2°, %SEM ranged from 3% to 14%, and the minimum detectable change ranged from 9.3° to 21.4°. Conclusion The digital inclinometer showed moderate to excellent reliability for measuring active and passive range of motion in shoulders with unilateral subacromial impingement syndrome.

Aim The aim of this study was to establish the validity of an external measurement system (the Hawk goniometer). This is a digital device which measures joint ranges compared to the universal goniometer for the measurement of shoulder range of motion in healthy adults. Material and methods a correlational study with 157 healthy volunteers completed six shoulder movements (forward flexion, abduction, extension, adduction and internal and external rotation) with each shoulder. The degree of agreement between each goniometer and Hawk measurement was assessed using Intra-class Correlation Coefficients (ICC) and Bland-Altman 95% limits of agreement (LOA). Results the tests showed a very strong relationship between the readings of both devices (CI between 0.81 and 0.99) and there were no significant differences between the mean readings of both devices. An intraclass correlation coefficient (ICC) of above 0.9 was obtained, indicating a high intra-evaluator reliability of the Hawk goniometer in repeated measurements of shoulder range of motion. Conclusions the Hawk goniometer is a valid and reliable element for the objective measurement of the range of motion at the shoulder joint.

The purpose of our study was to determine whether smartphone photography is as reliable and valid as clinical goniometry for measuring interphalangeal joint range of motion. We conducted a retrospective review of 37 fingers in 33 patients after flexor tendon repair. The measurements on photographs taken with a smartphone by a surgeon were compared with manual measurements with goniometry by the same surgeon. Pearson coefficients and interclass correlation coefficients were all above 0.85, and Bland–Altman analysis demonstrated that at least 35 of 37 measurements were within the 95% confidence interval in all variables. According to the Tang criteria, the total number of excellent and good results were equivalent according to both methods. There was high interobserver reliability between measurements by surgeons and a therapist. We conclude that if the pictures are properly taken, the measurement of the angles in the smartphone pictures are as reliable as measuring the angles with goniometry and that grading of the results according to the two methods gives identical results.

Introduction Smartphone app-based goniometer (SG) are emerging as an alternative to Universal Goniometers (UG) in assessing joint range of motion (ROM). This study examined whether the experience level of examiner affected the reliability of assessing knee flexion (KF) and knee extension (KE) ROM using UG and SG. Methods Participants with osteoarthritis of the knee or following total knee replacement were recruited. KF and KE ROM using UG and SG were assessed twice by an experienced physical therapist (PT) and a student PT (SPT). Intraclass correlation coefficients (ICC) examined the interrater (experienced PT vs SPT) and intrarater reliabilities (for experienced PT and SPT) in assessing KF and KE ROM for UG and SG. Concurrent relationships were examined between the knee ROM with pain and physical function using Pearson Correlation Coefficient (r). Results The interrater reliability in assessing KF and KE ROM was excellent (ICC>0.90) between novice and experienced examiners. The standard error of measurement (SEM) for novice examiner in assessing KF was 1° and 2° while using UG and SG respectively; whereas the SEM for experienced examiner in assessing KF was 1° irrespective of which device was used. The concurrent relationships between KF and KE ROM with measures of pain and function were divergent (moderate to low correlations; r 0.05). Conclusion Both UG and SG have smaller measurement error in assessing KF and KE ROM irrespective of experience level of examiner and therefore no one tool is superior than the other for assessing knee ROM in clinical practice.

Background There has been increased usage of virtual telerehabilitation approach during the COVID-19 pandemic. It is crucial to establish reliability of conducting virtual assessments for musculoskeletal conditions. Objectives This research determined the intra- and interrater reliability of measuring knee and wrist range of motion (ROM) assessed virtually and obtained face-to-face (F2F) using a goniometer (UG) for a student and an experienced examiner. Method Knee and wrist joint ROM for 54 healthy participants was assessed virtually and F2F by a student examiner and an experienced physical therapist. Intra- (virtual vs. UG assessment) and inter-rater (virtual or UG assessment between examiners) reliabilities were examined for all ROM using Intraclass correlation coefficient (ICC). The ICC values were considered good (>0.75) or excellent (>0.90). Bland and Altman plots determined the limits of agreement (LOA) in assessing joint ROM. Results/findings Student examiner had good reliability in virtually estimating knee extension (ICC = 0.79), wrist flexion (ICC = 0.82) and wrist extension (ICC = 0.78), whereas the experienced examiner had excellent reliability in virtually estimating all knee and wrist ROM (ICC > 0.90). The LOA in assessing knee and wrist ROM for the student examiner were wider indicating higher disagreement between virtual and UG-obtained ROM in some cases. Conclusions Virtual estimation of knee and wrist ROM is a reliable technique, however experience level impacts the precision of measurement. It is suggested that the same examiner conducts all the ROM assessments throughout the clinical course of a patient receiving virtual interventions for knee or wrist pathologies.

OBJECTIVE: The aim of this systematic review was to evaluate the available published evidence on the intra- and inter-rater reliabilities of assessment methods used for identifying and measuring scapular dyskinesis (SD) in asymptomatic subjects. METHODS: A systematic electronic literature search was performed in PubMed, Physiotherapy Evidence Database, Scopus, and the Cochrane Library, and studies on the intra- and inter-rater reliabilities of physical examination tests used for identifying SD in asymptomatic people were identified. Methodological quality of the studies meeting the inclusion criteria was assessed using the Quality Appraisal of Reliability Studies (QAREL) checklist by two reviewers. The overall level of evidence of this systematic review was determined by the Modified Cochrane Back Pain Criteria based on previous research which was modified for reliability studies of the shoulder complex. RESULTS: The literature search generated 388 results, and only 14 articles met the inclusion criteria. In these studies, reliabilities of two qualitative and five quantitative methods for the assessment of SD were analyzed. The QAREL checklist revealed that 12 studies had moderate risk of bias and 2 had high risk of bias. Additionally, none of the studies were of high quality. On the basis of the Modified Cochrane Back Pain Criteria, the overall level of evidence was moderate. Most of the studies including quantitative measurement methods found good to excellent inter- and intra-rater reliability values. Most of the studies including qualitative methods found low-to-moderate intra- and inter-rater reliability values. CONCLUSION: Considering the available published evidence, there is lack of high-quality studies evaluating the inter- and intra-rater reliabilities of qualitative or quantitative methods used for the assessment of SD. There are no qualitative methods with high reliability that are fit for clinical applications. Some quantitative methods with higher reliability are present, but clinicians should be aware of the methodological flaws that studies evaluating these methods suffer from. LEVEL OF EVIDENCE: Level II, Diagnostic study

No one has validated measuring the wrist's active range of motion (ROM) using smartphone images in patients. It is not known whether pathological factors affect the accuracy of this measurement technique. The purpose of this study was to assess if smartphone photography is as reliable and valid as manual goniometry for measuring wrist joint ROM. We reviewed 38 wrists in 38 patients (21 women and 17 men) with a mean age of 45 years (range, 26-60). Smartphones were used to take digital photos of injured wrists at extremes of wrist motion, including flexion, extension, radial and ulnar deviation. The mean difference in measured ROM between the two measurement methods (digital photos and handheld goniometer) was compared using Student's t test and the relationship determined using Pearson correlation coefficients. Bland-Altman analysis was used to define the limits of agreement (LOA). No significant difference was found when comparing the wrist ROM in the four positions using manual goniometry and digital measurements from photos taken by a surgeon. Between the goniometer measurements and digital photos taken by a surgeon, the Pearson coefficients were high, with most being above 0.8 for the four positions. The Pearson coefficients also show the smartphone measurements were highly precise. There was high reliability between the photographs taken by surgeons and by patients, as well as high interobserver reliability. Smartphone photography is a reliable and valid method to measure wrist joint ROM in patients. This measurement method can be used to measure outcomes.

Ankle injuries are highly prevalent in ballet, with strength highlighted as a primary risk factor. To profile ankle strength, fourteen female ballet dancers (age: 19.29 ± 1.59 years) completed an isokinetic testing protocol comprising concentric eversion (CON

To evaluate the effect of sedation or general anesthesia (GA) on elbow goniometry and thoracic limb circumference (TLC) measurements in dogs with elbow osteoarthritis (OA).Prospective study.Twenty-four client-owned dogs with radiographically confirmed elbow OA.Elbow goniometry and TLC measurements were made before and after either sedation or GA by using a hand-held goniometer and spring tension measuring tape, respectively. Observers were not allowed to review their pre-sedation or pre-GA measurements at the time of obtaining measurements on dogs under sedation or GA. Mixed analysis of variance models were used to compare elbow goniometry and TLC measurements before and after sedation or GA.Eleven and thirteen dogs were included in the sedation and GA groups, respectively. Mean elbow flexion decreased by 5° and 3° and mean elbow extension increased by 6° and 2° under sedation and GA, respectively. Total range of motion increased by 11° under sedation and by 5° under GA. Each of these changes was statistically significant (P .05) except elbow extension under GA (P = .129). Sedation and GA did not influence TLC measurements (P .05).Sedation or GA led to slight and similar increase in elbow flexion and extension but did not influence TLC measurements in dogs with elbow OA.Sedation or GA can cause slight alterations to goniometric measurements in canine elbows with OA. The protocols used in this study for sedation and GA seem interchangeably acceptable for goniometry and TLC measurements in dogs with elbow OA.

The purpose of this study was to compare clinical outcomes and graft healing after anterior cruciate ligament (ACL) reconstruction with anteromedial and central femoral tunnel placement. During 2016 and 2018, 110 consecutive patients underwent single bundle ACL reconstruction; 85 patients met the inclusion criteria, and each patient underwent 3D-CT within 1 week and MRI 1.5 years after the operation. The central point of the femoral tunnel and signal/noise quotient (SNQ) of three regions of interest (ROI) in the intra-articular graft were measured to analyse the tunnel position and graft healing extent. Clinical assessments, including functional scores, KT-2000 arthrometer measurements and pivot-shift tests, were evaluated at the 2-year follow-up. Patients were divided into two groups depending on the femoral tunnel position: the anteromedial position group (Group A) and the centre position group (Group B). Seventy-one patients were available for the 2-year follow-up and MRI examination: 34 patients in Group A and 35 patients in Group B, and 2 patients were excluded for an eccentric tunnel position. No graft failure occurred, and compared with the preoperative assessment outcomes, the outcomes of both groups improved at the final follow-up. Group A was significantly better than Group B regarding the KT-2000 arthrometer measurements (P = 0.031). No significant differences were observed in terms of functional scores, pivot-shift test results, or the SNQ between groups. No differences in clinical outcomes or graft healing were found between AM and central femoral tunnel placements in single bundle ACL reconstruction. Therefore, satisfactory clinical outcomes, knee stability and graft healing can be obtained for both femoral tunnel placements. II.

To compare the outcomes of anterior cruciate ligament (ACL) reconstruction with those of combined ACL and anterolateral ligament (ALL) reconstruction in ACL-deficient knees. The objective of this study was to improve knowledge regarding the treatment of ACL-deficient knees with combined ACL and ALL reconstruction. Combined ACL and ALL reconstruction has been hypothesized to result in better clinical and functional outcomes than isolated ACL reconstruction (ACLR). One-hundred and seven adult male athletes with ACL tears and high-grade pivot shifts were randomized into two groups. Those in group A (n = 54) underwent ACLR, while those in group B (n = 53) underwent combined ACL and ALL reconstruction. The median age was 26 (18–40) and 24 (18–33) years in groups A and B, respectively, and the median follow-up was 60 (55–65) months. Physical examination findings, instrumented knee laxity tested using a KT-1000 arthrometer, and International Knee Documentation Committee Scale (IKDC) scores were used to evaluate the outcomes. One-hundred and two patients were available for follow-up: 52 in group A and 50 in group B. Postoperatively, the pivot shift was normal in 43 (82.7%) and 48 (96%) patients in groups A and B, respectively (p

Background Survival rates in cancer are increasing exponentially, with a corresponding increase/influence in disability-adjusted life-years. Efforts should be made to explore the optimal balance between unsupervised/distance-based and supervised/onsite approaches to cancer care. Objective This study aimed to compare the clinical efficacy of the BENECA mobile Health (mHealth) lifestyle application combined with a supervised rehabilitation program (BENECA and supervised rehabilitation) versus the BENECA mHealth lifestyle application alone on quality of life (QoL) and functional outcomes of breast cancer survivors. Methods This randomized controlled trial included 80 survivors of breast cancer diagnosed at stage I–IIIA, who completed adjuvant therapy and were overweight or obese at diagnosis. Participants were randomly allocated (ratio 1:1, 3 waves) to BENECA mHealth and rehabilitation for 2 months (n = 40) or BENECA mHealth and usual care (BENECA mHealth alone; n = 40). Participants completed a questionnaire at baseline (T1), 8-weeks post-intervention (T2) and 6-month follow-up (T3). The primary outcome was QoL assessed with the EORT QLQ-C30. Secondary outcomes included upper-limb functionality and body composition. Statistical (between-group analyses of covariance) and clinical effects were analyzed by intention to treat. Results Both groups showed improved outcomes, but global QoL was significantly better with BENECA mHealth and rehabilitation than BENECA mHealth alone (mean difference, 12.76; 95% confidence interval 4.85; 20.67; P = 0.004), with a moderate-to-large effect size (d = 72). The proportion of participants reporting reliable clinical improvement on global QoL at T2 was higher with BENECA mHealth and rehabilitation than BENECA mHealth alone (57.5% vs 26.3%, P = 0.008). Improvement in subjective and objective upper-limb functionality was also higher with BENECA mHealth and rehabilitation. Conclusions The BENECA mHealth lifestyle application with a supervised rehabilitation program had a statistically and clinically significant effect on QoL and upper-limb functionality in breast cancer survivors and is a unique and important promising new approach.

Purpose. The current study was designed to assess interrater and intrarater validity of cervical range of motion measurements performed with a CROM goniometer. Material and Methods. The study involved 95 healthy university students (31 males and 64 females) aged 20-24 years. Two examiners performed measurements of cervical range of motion using a CROM goniometer. The same subjects were examined again after two weeks, in the same conditions. The results acquired by one rater during the first and the second examination were compared for reproducibility, while the results obtained by the two examiners were compared to assess validity and reliability of the tool. Cronbach’s alpha was applied to determine intrarater reliability, and the values of correlations were used to assess the interrater agreement. Results. Analysis of the results showed both intrarater and interrater agreement in all the measures of cervical range of motion. The highest intrarater and interrater concordance was observed in the measure of extension. Intrarater agreement for Examiner 1 was reflected by Cronbach’s alpha=0.85, and for Examiner 2 by Cronbach’s alpha=0.89. As for the interrater agreement in the measure of extension, the value of correlation in both the first and the second measurement amounted to r=0.89. Conclusions. Measurements performed with the CROM goniometer show interrater and intrarater agreement in assessments of cervical range of motion. The CROM goniometer can be recommended for use in daily clinical practice.

Occupational Abstract The aim of this project was to develop and test an application capable of quickly and repeatedly measuring trunk flexion angles during sagittal plane lifting tasks. The developed application uses the built-in accelerometer in mobile devices to approximate trunk flexion angle, as the user follows an operator as they perform a lift. A black line is superimposed over the camera feed, allowing the user to approximate the angle of inclination of a line connecting the operator's seventh cervical and first sacral vertebrae-thereby estimating the trunk flexion angle. The magnitude of this angle and its velocity have been linked to the development of occupational low back pain; thus the application provides ergonomists a more refined means of screening tasks beyond currently available survey tools.

To assess the convergent validity and reliability of joint angle measurements from a new video goniometer iPhone/iPad application separately in adults, older and young children.Cross-sectional.Child care and university environments.Fifty-four adults (mean ± SD=22.5±4.5y), 20 older children (mean ± SD=10.9±2.2y), 20 younger children (mean ± SD=1.6±0.8y) (N=94).Adults and older children performed both standardized static positions and functional activities. Younger children performed only a functional activity protocol.Joint angle measurements using the app were validated against a commercially validated two-dimensional goniometric software program. In addition, validity of the app was compared to a standard mechanical goniometer for the measurement of angles drawn on a white board. Intra- and interrater reliability were assessed through independent rescoring of videos.Correlations between joint angle estimates obtained from the app and goniometer software or a mechanical goniometer were positive and very strong (r.900; P.0001). The intraclass correlation coefficient (ICC) for repeated scoring from the app indicated excellent intra- and interrater reliability (ICC.900).High correlations for repeated measures and comparison to gold standard angle measurement instruments suggest that the new app is a valid and reliable tool for assessing joint angles during functional activity. This tool may provide clinicians an inexpensive yet accurate method for quantification of movements and immediate feedback on range of motion during tasks in a natural environment.

BACKGROUND: Mobile applications which are designed to assess the range of motion (ROM) are widely used. OBJECTIVE: The aim of this cross-sectional observational study was to determine the inter-observer and intra-observer reliability of a smartphone application “PT Goniometer” (PTG) and determine the correlation between PTG and universal goniometer (UG) regarding active ROMs of the hip in healthy participants. METHODS: Thirty-four healthy young participants were included in the study. Two physiotherapists performed active hip flexion, abduction, internal rotation and external rotation ROM measurements of dominant legs of the participants by using PTG and UG. Intraclass correlation coefficients (ICC) were calculated to determine the intra-observer and inter-observer reliability. Level of correlations between PTG and UG were used to establish concurrent validity of PTG. RESULTS: The PTG demonstrated excellent inter-observer and intra-observer reliability (ICC > 0.90) for all measured hip movements. The minimum detectable change (MDC95) was ranged from 3.29° to 5.1° for the intra-observer reliability, and from 2.55° to 3.21° for the inter-observer reliability. Additionally, the concurrent validity was found excellent (r = 0.91–0.93). CONCLUSION: The results of the present study suggest that PTG is a valid and reliable mobile technology for measuring hip ROMs.

Background Range of motion (ROM) measurements are essential for diagnosing and evaluating upper extremity conditions. Clinical goniometry is the most commonly used methods but it is time-consuming and skill-demanding. Recent advances in human tracking algorithm suggest potential for automatic angle measuring from RGB images. It provides an attractive alternative for at-distance measuring. However, the reliability of this method has not been fully established. The purpose of this study is to evaluate if the results of algorithm are as reliable as human raters in upper limb movements. Methods Thirty healthy young adults (20 males, 10 females) participated in this study. Participants were asked to performed a 6-motion task including movement of shoulder, elbow and wrist. Images of movements were captured by commercial digital cameras. Each movement was measured by a pose tracking algorithm (OpenPose) and compared with the surgeon-measurement results. The mean differences between the two measurements were compared. Pearson correlation coefficients were used to determine the relationship. Reliability was investigated by the intra-class correlation coefficients. Results Comparing this algorithm-based method with manual measurement, the mean differences were less than 3 degrees in 5 motions (shoulder abduction: 0.51; shoulder elevation: 2.87; elbow flexion:0.38; elbow extension:0.65; wrist extension: 0.78) except wrist flexion. All the intra-class correlation coefficients were larger than 0.60. The Pearson coefficients also showed high correlations between the two measurements (p Conclusions Our results indicated that pose estimation is a reliable method to measure the shoulder and elbow angles, supporting RGB images for measuring joint ROM. Our results presented the possibility that patients can assess their ROM by photos taken by a digital camera. Trial registration This study was registered in the Clinical Trials Center of The First Affiliated Hospital, Sun Yat-sen University (2021–387).

Background Changes in postural stability may be a reason for injuries in individuals who have altered musculoskeletal alignment. Q angle (QA) has shown to be a predictor for lower extremity injuries. However, the relationship between balance and QA has not been investigated in young adults. Objective The aim of the study was to investigate the relationship between QA and balance in young adults. Methods Ninety participants performed the single leg stance test (SLST) and Star Excursion Balance Test (SEBT) to assess static and dynamic balance, respectively. QA was measured using a manual goniometer. Participants were divided into low, normal and high QA groups. Results The relationship between SLST and QA was not statistically significant in both eyes opened and closed condition (r=-0.030, p= 0.782; r= 0.031, p= 0.774; respectively). SLST scores did not differ among the three groups in both eyes opened and closed condition (p= 0.781, p= 0.790; respectively). QA significantly correlated with lateral, posterolateral directions and sum score of SEBT (r= 0.240, p= 0.023; r= 0.269, p= 0.010; r= 0.210, p= 0.047). The comparisons among the low, normal and high Q angle groups' SEBT scores showed that balance performance in lateral direction was poorer in low QA group (p= 0.027). Conclusions The results of the study showed that QA and dynamic balance have a significant relationship. To reduce musculoskeletal injury risk, the dynamic balance should be assessed in young adults who have lower QA.

Study Design Cross-sectional cohort. Introduction Smartphone gyroscope and goniometer applications have been shown to be a reliable way to measure wrist ROM when used by researchers or trained staff. If wrist-injured patients could reliably measure their own ROM, rehabilitation efforts could be more effectively tailored. Purpose of the Study To assess agreement of self-measured ROM by wrist-injured and wrist-healthy study participants using a built-in iPhone 5 level feature as compared to researcher-measured ROM using a universal goniometer (UG). Methods Thirty wrist-healthy and 30 wrist-injured subjects self-measured wrist flexion, extension, supination, and pronation ROM using the built-in preinstalled digital level feature on an iPhone 5. Simultaneously a researcher measured ROM with a UG. Results Average absolute deviation between the self-measured iPhone 5 level feature and researcher-measured UG ROM was less than 2° for all 4 movements individually and combined was found to be 1.6° for both populations. Intraclass correlation coefficient showed high correlation with values over 0.94 and Bland-Altman plots showed very strong agreement. There was no statistical difference in the ability of wrist-injured and healthy patients to self-measure wrist ROM. Discussion Both populations showed very high agreement between their self-measured ROM using the built-in level feature on an iPhone 5 and the researcher-measured ROM using the UG. Both populations were able to use the iPhone self-measurement equally well and the injury status of the subject did not affect the agreement results. Conclusion Wrist-healthy and wrist-injured subjects were able to reliably and independently measure ROM using a smartphone level feature.

Context Ankle plantarflexion is thought to play an important role in swimming performance; thus, coaches and swimmers often seek ways to increase range of motion (ROM) in the ankles. Objective To assess whether osteopathic manipulative treatment (OMT), specifically applying the muscle energy technique (MET) principle of post–isometric relaxation, increases ankle plantarflexion and therefore improves swimming performance. Methods Healthy young male and female competitive swimmers were randomly assigned to either a control, sham, or MET group. At baseline, ankle plantarflexion was measured via goniometer, and a 25-yard flutter kick swim with a kickboard was timed. After receiving the ascribed intervention, the ankle plantarflexion measurements and timed flutter kick were repeated. The initial plantarflexion measurement was retrospectively used to determine the presence of somatic dysfunction, by way of restricted motion, with reference to expected normal ranges based on age and gender. Paired t tests were used to analyze the pre- to postintervention changes in ROM and flutter kick speed within each group. Results Fifty-five swimmers (32 girls and 23 boys; mean age, 12 years) participated in this study. Sixteen participants were in the control group, 17 in the sham group, and 22 in the MET intervention group. Among participants with restricted ROM, those in the MET group showed a statistically significant increase in ankle plantarflexion for the left and right ankles (P=.041 and P=.011, respectively). There was no significant difference in ROM of the control or sham groups. For flutter kick speed, there was no significant pre- to postintervention difference in any group. Conclusion Although a single application of MET, using post–isometric relaxation, on participants with restricted ROM immediately significantly increased swimmers’ ROM for bilateral ankle plantarflexion, it did not immediately improve their swimming performance.

Although soft tissue tension during total knee arthroplasty (TKA) has been targeted to achieve equal flexion and extension gaps, such a perfect gap is not always obtained. This study was performed to investigate the impact of difference between flexion and extension gaps on postoperative knee flexion angle. We reviewed 107 consecutive TKAs using a J-curve design posterior-stabilized prosthesis. Soft tissue tension was measured intraoperatively using an offset-type tensor under 30 lb force of joint distraction with the patella reduced. All TKAs were performed in a uniform manner including the subvastus approach and without use of a pneumatic tourniquet. We assessed the association between knee flexion angle 1 year after TKA and the difference between flexion and extension gaps using Pearson’s product-moment correlation and multiple regression analysis with age, sex, body mass index, diagnosis, history of diabetes mellitus, preoperative flexion angle, and gap difference as explanatory variables. The difference between flexion and extension gaps showed a slight negative correlation with postoperative knee flexion angle in univariate analysis (r = − 0.20, 95% CI, − 0.38 to − 0.01, p = 0.04). Multiple regression analysis showed that the gap difference was an independent factor associated with postoperative knee flexion angle (β = − 0.89, 95% CI, − 1.60 to − 0.18, p = 0.01). The difference between flexion and extension gaps was negatively correlated with postoperative knee flexion angle. Looser flexion gap compared with extension gap should be avoided in J-curve design posterior-stabilized TKA.

Background Traditional clinical shoulder range-of-motion (ROM) measurement methods (ie, goniometry) have limitations assessing ROM in total shoulder arthroplasty (TSA) patients. Inertial measurement units (IMUs) are superior; however, further work is needed using IMUs to longitudinally assess shoulder ROM before TSA and throughout post-TSA rehabilitation. Accordingly, the study aims were to prospectively capture shoulder elevation in TSA patients and to compare the results with healthy controls. We hypothesized that patients would have reduced maximum elevation before TSA compared with controls but would have improved ROM after TSA. Methods A validated IMU-based shoulder elevation quantification method was used to continuously monitor 10 healthy individuals (4 men and 6 women; mean age, 69 ± 20 years) without shoulder pathology and 10 TSA patients (6 men and 4 women; mean age, 70 ± 8 years). Controls wore IMUs for 1 week. Patients wore IMUs for 1 week before TSA, for 6 weeks at 3 months after TSA, and for 1 week at 1 year after TSA. Shoulder elevation was calculated continuously, broken into 5° angle “bins” (0°-5°, 5°-10°, and so on), and converted to percentages. The main outcome measures were binned movement percentage, maximum elevation, and average elevation. Patient-reported outcome measures and goniometric ROM were also captured. Results No demographic differences were noted between the cohorts. Average elevation was not different between the cohorts at any time. Control maximum elevation was greater than pre-TSA and post-TSA week 1 and week 2 values. Time under 30° and time above 90° were equal between the cohorts before TSA. After TSA, patients showed decreased time under 30° and increased time above 90°. Discussion This study demonstrates that acute and chronic recovery after TSA can be assessed via maximum elevation and time above 90°, respectively. These results inform how healthy individuals and patients use their shoulders before and after TSA.

Background Cervical pain is the biggest musculoskeletal health problem in industrialised countries. There is an important association between this and decrease in range of motion. Objective Estimate the validity and reliability intra and inter examiner of two Smartphone apps regarding the measurement of lower and upper cervical spine range of motion in subjects with chronic cervical pain. Methods A cross-sectional study was conducted. The sample consisted of 25 subjects with chronic cervical pain. An examiner made a measurement of the range of motion using the CROM device as a gold standard, afterwards, another examiner did the same using a Smartphone, in order to establish validity. After this, the Smartphone examiner and a new examiner simultaneously conducted the intra and inter examiner reliability. Results Measurement of the lower and upper cervical spine range show an excellent validity (> 0.75), with an excellent intra and inter reliability (> 0.75) in all movements except flexion of upper cervical spine (0.75-0.65). Conclusion The two Smartphone applications used in this study showed an excellent validity compared to the CROM. The intra and inter reliability is excellent for all movements, except for the upper cervical spine flexion.

Patients with severe osteoarthritis (OA) of the knee have changes in bone mineral density (BMD) of the distal femur and proximal tibia. Correlations between the medial-to-lateral BMD (M/L-BMD) ratio (which normalizes the potentially confounding effects of body size and sex on BMD) and radiographic parameters that indicate OA progression have not been adequately studied. The purpose of this study was to evaluate correlations between radiographic indicators of OA progression and femoral and tibial M/L-BMD ratios.A consecutive series of 182 knees in 156 patients with advanced medial knee OA who underwent total knee arthroplasty were included. We evaluated correlations between the femoral and tibial M/L-BMD ratios and various radiographic parameters, including tibiofemoral angle (TFA), mechanical axis angle (MAA), tibial coronal angle, tibiofemoral subluxation (%), load-bearing axis deviation at the tibial plateau (%), and medial and lateral laxity.Univariate analyses using Spearman's correlation coefficient revealed significant positive correlations between femoral and tibial M/L-BMD ratios and both TFA and MAA and negative correlations with tibial coronal angle and load-bearing axis deviation. Multivariate analyses showed significant associations between TFA and the femoral M/L-BMD ratio (β = 0.434, p 0.001) and between MAA and the tibial M/L-BMD ratio (β = 0.384, p 0.001).BMD distribution around the knee might be predictable with radiographic parameters such as the TFA for the femur and MAA for the tibia. The findings of this study provide in vivo data on the evaluation of preoperative femoral and tibial M/L-BMD ratios without dual-energy X-ray absorptiometry.

Despite various approaches to measuring ballet dancers' turnout, no standardized method for doing so has yet been estab- lished. Here a newly designed rotational goniometer (RGM) for assessing ballet dancers' functional turnout is evaluated. Twenty experienced female ballet dancers participated in the study. Measurements of the dancers' turnout were taken three times in each of the following conditions: 1. while standing on the RGM device (RGMT); 2. as if the participant was in a ballet class (CT); and 3. performing an active external rotation of the lower extremities in the supine position (AT). The angles obtained in the three trials in each condition were averaged and the results of the three conditions were compared. The mean angle of RGMT (RGMTangle: 103.89° ± 15.2°) was significantly smaller than those of the CT (CTangle: 128.7° ± 15.1°) and AT (ATangle: 110.09° ± 17.6°) conditions (p < 0.05 and p < 0.01, respectively). The greatest angle (i.e., the CTangle) is influenced by both friction and weightbearing. The ATangle is released from weightbearing, unlike the RGMTangle. Positive correlations were revealed between the RGMTangle and the ATangle (r = 0.78, p < 0.01) and between the RGMTangle and the CTangle (r = 0.57, p = 0.05). These findings demonstrate that the novel RGM device, characterized by elimination of friction and full weightbearing, is useful for assessing ballet dancers' functional turnout.

Aims: This study evaluated, for youth with cerebral palsy (CP), the reliability of passive range of motion (PROM) measures taken with an inclinometer, a device that may be simpler to use th...

Reduced stability while standing typically decreases the soleus muscle Hoffmann (H-) reflex amplitude, purportedly to prevent the Ia afferent signal from excessively activating spinal motor neurons during the unstable stance. H-reflex measures, however, by excluding the spindle do not reflect the actual effect of the Ia pathway (i.e. the combined effects of spindle sensitivity and Ia presynaptic inhibition) on motor neuron activation, as tendon tap reflex measures can. But the effect of stance stability on soleus muscle tendon tap reflex amplitude is largely unknown. This study examined 30 young adults (mean(s), 21(2) years) as they stood in a wide stable stance position and an unstable tandem stance with a reduced base of support. Standing body sway, the amplitude of the soleus muscle tendon tap reflex, background EMG and tap force were measured in both stances. A repeated measured design t-test was calculated for each variable. Most subjects (69%) decreased tendon tap reflex amplitude when in the tandem stance position (mean decrease 11.6%), compared to the wide stance (wide stance 0.248(0.124) mV, tandem stance 0.219(0.119) mV, p 0.05, Cohen's d = 0.24 small) with no significant differences in background soleus and tibialis anterior EMG, and tap force across the stances. There was no relationship between the modulation of the tendon tap reflex amplitude across the stances and standing body sway in the tandem stance. Results support the idea that for most subjects examined, during a less stable stance the Ia excitation of motor neurons is decreased, likely by presynaptic inhibition, thereby avoiding potential instability in the reflex loop or saturating the reflex pathway and possibly interfering with descending control of the involved spinal motor neurons.