Virtual goniometric measurement in patients with hand and forearm injuries: a double-blind psychometric study

Accurate assessment of joint range of motion (ROM) is essential for hand and wrist disorders, and virtual tools need validation as telehealth use rises. This study evaluated the validity and reliability of virtual goniometry versus manual goniometry for wrist and finger ROM in 42 adults with hand or wrist injuries.

In a double-blind, cross-sectional study, 42 patients (32.2 ± 14.2 years) were recruited. ROM of the wrist and fingers was measured using a standard manual goniometer and a web-based virtual goniometer (Protractor v3.1.2). Criterion validity was assessed with Spearman's correlation and Bland-Altman analysis; intra- and inter-rater reliability with ICCs; measurement error with SEM and MDC₉₅.

Manual goniometry was followed by virtual assessment of 298 joints, 240 analyzed. Virtual goniometry showed high validity (ρ = 0.956, p < 0.001) with minimal bias (-0.47°). Intra- and inter-rater reliability were excellent for MCP, PIP, and DIP flexion (ICC = 0.93-0.99), but lower for wrist (ICC = 0.34) and thumb IP flexion (ICC = 0.29). Most MDC₉₅ values were acceptable (<16.5°), except for wrist and thumb joints.

Virtual goniometry is valid and reliable for most hand and finger joints, particularly MCP and PIP flexion. Limitations remain for wrist and thumb assessments, emphasizing the need for image quality and standardized conditions.