title: Accuracy and Validity of Goniometer and Visual Assessments of Angular Joint Positions of the Hand and Wrist.
abstract: OBJECTIVE
  To compare goniometric and visual assessments of angular hand joint and wrist joint positions measured by board-certified hand surgeons and certified hand therapists. We hypothesized that visual estimation would be similar to the goniometric measurement accuracy of digital and wrist joint positions.
  
  
  METHODS
  The wrist, index finger metacarpophalangeal (MCP) joint, and index finger proximal interphalangeal (PIP) joint were evaluated in different positions by 40 observers: 20 board-certified hand surgeons and 20 certified hand therapists. Each observer estimated the position of the wrist, index MCP joint, and index PIP joint of the same volunteer, who was positioned in low-profile orthoses to reproduce predetermined positions. Following visual estimation, the participants measured the same joint positions using a goniometer. The control measurement was digitally determined by a radiologist who obtained radiographs of the hand and wrist positions in each orthosis. Observers were blinded to the results of control measurements.
  
  
  RESULTS
  When considering all joints at all positions, neither visual assessments nor goniometer assessments were consistently within ± 5° of the measurements obtained on control radiographs. When considering individual joints, goniometer measurements were significantly closer to control radiograph measurements than the visual assessments for all 3 PIP joint positions. There was no difference for the measurements at the wrist or for 2 of the 3 MCP joint positions. Significant differences between surgeon and therapist joint angle measurements were not observed when comparing visual and goniometer assessments to radiograph controls.
  
  
  CONCLUSIONS
  Compared with radiograph measurements, neither visual nor goniometer assessment displayed high levels of accuracy. On average, visual assessment of the angular positions of the index MCP and wrist joint were as accurate as the goniometer assessment, whereas goniometer assessment of the angular position of the PIP joint was more accurate than visual assessment. There was a relatively high degree of between-observer variability in measurements, and therefore, no one person's measurements could be consistently relied upon to be accurate.
  
  
  METHODS
  Diagnostic II.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Mayo Clinic, Jacksonville, FL.
authors.forename: Kimberly H
authors.initials: KH
authors.lastname: McVeigh
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL. Electronic address: murray.peter@mayo.edu.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Murray
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Heckman
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL.
authors.forename: Bhupendra
authors.initials: B
authors.lastname: Rawal
authors.affiliation: Department of Radiology, Mayo Clinic, Jacksonville, FL.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Peterson
mesh_terms: D053587:Arthrometry, Articular; D050823:Hand Joints / Q000502:physiology*; D006801:Humans; D015588:Observer Variation; D016059:Range of Motion, Articular / Q000502:physiology*; D015203:Reproducibility of Results
keywords: Goniometer; hand; metacarpophalangeal joint; proximal interphalangeal joints; wrist