Validation of Virtual Wrist Range of Motion Measurements Using Video Coaching.

PURPOSE: Wrist range of motion (ROM) is an important assessment in wrist pathology. It is most commonly assessed using a long-arm goniometer. In-person intrarater reliability has been found to be high. Studies evaluating the assessment of wrist ROM virtually are less conclusive. The purpose of this study was to determine the validity and intrarater and inter-rater reliability of virtual wrist ROM measurements using a video coaching method.

METHODS

We performed a prospective cohort study assessing wrist flexion, extension, pronation, and supination in healthy volunteers. Three assessors-medical student, research assistant, and upper-extremity surgeon-measured participant wrist ROM at in-person, same-day virtual, and repeat virtual time points, with a 1-week washout period. Measurements were made with a long-arm goniometer. Virtual assessments were performed over Zoom, allowing the assessor to coach volunteers on correct wrist positioning for accurate measurement, using a predefined protocol. Interclass correlation (ICC; 95% confidence intervals) was used to assess intra- and inter-rater reliability between each time point.

RESULTS

Fifty-three wrists were enrolled, with complete data available for 45 of them. For all raters and all ROM measures, ICC values for in-person measurements were >0.75, suggesting good inter-rater reliability. This was also seen for same-day and repeat virtual measures for all ROM measurements and raters (ICC >0.75), suggesting similar inter-rater reliability to in-person measurements. Intrarater reliability for in-person, same-day virtual, and repeat virtual was at least good (ICC > 0.75) for all raters and all ROM measurements. Supination had the highest intrarater reliability, with all raters having ICC values graded as excellent (ICC > 0.9).

CONCLUSIONS

Virtual wrist ROM assessments showed good inter-rater and intrarater reliability, with ICC scores comparable with in-person measures. This was true for raters of all levels of experience. Virtual wrist ROM assessment by this method offers a reliable alternative to in-person assessment.

TYPE OF STUDY AND LEVEL OF EVIDENCE: Diagnostic IIb.