title: A technical support tool for joint range of motion determination in functional diagnostics - an inter-rater study.
abstract: BACKGROUND
  The examination of joint range of motion (RoM) is part of musculo-skeletal functional diagnostics, used, for example, in occupational examinations. Various examination methodologies exist that have been optimized for occupational medical practice, which means they were reduced to the most necessary and feasible measures and examinations for efficiency and usability reasons. Because of time constraints in medical examinations in occupational settings, visual inspection is commonly used to quantify joint RoM. To support medical examiners, an inertial sensor-based measurement system (CUELA) was adapted for joint RoM examination in these settings. The objective of the present study was to evaluate the measurement tool in functional diagnostics under conditions close to clinical practice.
  
  
  METHODS
  The joint RoM of twenty healthy subjects were examined by three physicians, who were simultaneously using the measurement tool. Physicians were blinded to the measurement results and the other physicians. Active RoM was examined on the cervical, thoracic and lumbar spine while passive RoM was examined on the shoulder, elbow, wrist, hip, and knee, resulting in a total of 40 joint examination angles. The means, standard deviations, intraclass correlation coefficients (I C C 3,k ), and Bland-Altman-Plots were calculated using MatLab for statistical analysis.
  
  
  RESULTS
  Most measurement results were in accordance with expected joint RoMs. All examinations showed an acceptable repeatability. In active RoM examinations, the ICC of inter-rater reliability varied between 0.79 and 0.95. In passive RoM examination the ICC varied between 0.71 and 0.96, except examination angles at the elbow and knee extension (ICC: 0.0-0.77).
  
  
  CONCLUSIONS
  The reliability and objectivity of active RoM examinations were improved by the measurement tool compared with examiners. In passive RoM examinations of upper and lower extremities, the increase of objectivity by the measurements was limited for some examination angles by external factors such as the individual examiner impact on motion execution or the given joint examination conditions. Especially the elbow joint examination requires further development to achieve acceptable reliability. A modification in the examination method to reduce the examiner impact on measurement and the implementation of a more complex calibration procedure could improve the objectivity and reliability of the measurement tool in passive joint RoM examination to be applicable on nearly the whole body.
authors.affiliation: Institute of Occupational and Social Medicine, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, Aachen, 52074 Germany ; Institute for Occupational Safety and Health of the German Social Accident Insurance, Alte Heerstrasse 11153757, Sankt Augustin, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schiefer
authors.affiliation: Institute of Occupational and Social Medicine, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, Aachen, 52074 Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kraus
authors.affiliation: Institute for Occupational Safety and Health of the German Social Accident Insurance, Alte Heerstrasse 11153757, Sankt Augustin, Germany.
authors.forename: Rolf P
authors.initials: RP
authors.lastname: Ellegast
authors.affiliation: Institute of Occupational and Social Medicine, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, Aachen, 52074 Germany ; West Saxon University of Applied Sciences, Zwickau, Germany.
authors.forename: Elke
authors.initials: E
authors.lastname: Ochsmann
keywords: Ambulatory field measurement; Functional diagnostics; Human motion capture; Inertial measurement units; Joint range of motion