Low Inter-rater Reliability of Active Hand Joint Range of Motion Measurements When Assessing Hand Function in a Clinical Setting

Author(s): Margarida Vieira, Alexander Kögel, Marie Stroetmann, Robert Wendlandt, Arndt-Peter Schulz

Background: Hand physiotherapists typically rely on goniometers for manual joint angle assessments, a process that is not only time-consuming but also susceptible to significant variability between therapists, which can lead to inconsistent evaluations, complicating the accurate tracking of a patient’s progress. Inter-rater reliability tests are crucial in determining whether these standard assessment tools need to be improved or replaced, to achieve more accurate assessments and ultimately enhance the quality of patient care.
Methods: Participants in the study included five patients hospitalized in the hand department due to movement restrictions and five experienced hand physiotherapists. Following a standardized protocol, flexion and extension of all finger joints were measured, along with other thumb and wrist movements, using identical goniometers and a finger ruler to assess fingernail palm distance (FPD) and fingernail table distance (FNTD). Each joint measurement was performed once by each of the five therapists to evaluate inter-rater reliability.
Results: Results indicate varied inter-rater reliability, with 37.2% of measurements showing poor agreement (ICC < 0.5), 30.2% moderate agreement (0.5 ≤ ICC < 0.75), and 4.7% excellent agreement (ICC ≥ 0.9).
Conclusions: Findings underscore the need for improved measurement instruments in clinical settings, suggesting potential benefits from sensor gloves or other electrically based devices to enhance reliability and accuracy in ROM assessments.