Validity and reliability of inertial sensors for elbow and wrist range of motion assessment

Abstract

Background: Elbow and wrist chronic conditions are very common among musculoskeletal problems. These painful conditions affect muscle function, which ultimately leads to a decrease in the joint's Range Of Motion (ROM). Due to their portability and ease of use, goniometers are still the most widespread tool for measuring ROM. Inertial sensors are emerging as a digital, low-cost and accurate alternative. However, whereas inertial sensors are commonly used in research studies, due to the lack of information about their validity and reliability, they are not widely used in the clinical practice. The goal of this study is to assess the validity and intra-inter-rater reliability of inertial sensors for measuring active ROM of the elbow and wrist.

Materials and methods: Measures were taken simultaneously with inertial sensors (Werium^™ system) and a universal goniometer. The process involved two physiotherapists ("rater A" and "rater B") and an engineer responsible for the technical issues. Twenty-nine asymptomatic subjects were assessed individually in two sessions separated by 48 h. The procedure was repeated by rater A followed by rater B with random order. Three repetitions of each active movement (elbow flexion, pronation, and supination; and wrist flexion, extension, radial deviation and ulnar deviation) were executed starting from the neutral position until the ROM end-feel; that is, until ROM reached its maximum due to be stopped by the anatomy. The coefficient of determination (r ²) and the Intraclass Correlation Coefficient (ICC) were calculated to assess the intra-rater and inter-rater reliability. The Standard Error of the Measurement and the Minimum Detectable Change and a Bland-Altman plots were also calculated.

Results: Similar ROM values when measured with both instruments were obtained for the elbow (maximum difference of 3° for all the movements) and wrist (maximum difference of 1° for all the movements). These values were within the normal range when compared to literature studies. The concurrent validity analysis for all the movements yielded ICC values ≥0.78 for the elbow and ≥0.95 for the wrist. Concerning reliability, the ICC values denoted a high reliability of inertial sensors for all the different movements. In the case of the elbow, intra-rater and inter-rater reliability ICC values range from 0.83 to 0.96 and from 0.94 to 0.97, respectively. Intra-rater analysis of the wrist yielded ICC values between 0.81 and 0.93, while the ICC values for the inter-rater analysis range from 0.93 to 0.99.

Conclusions: Inertial sensors are a valid and reliable tool for measuring elbow and wrist active ROM. Particularly noteworthy is their high inter-rater reliability, often questioned in measurement tools. The lowest reliability is observed in elbow prono-supination, probably due to skin artifacts. Based on these results and their advantages, inertial sensors can be considered a valid assessment tool for wrist and elbow ROM.

Keywords: Elbow joint; Goniometer; Inertial sensors; Joint assessment; Range of motion; Reliability; Wrist joint.

Figure 1. Werium™ inertial sensor.

Figure 2. Screen of the software Pro Motion Capture™ during a wrist asessment.

Virtual human models display real-time movements while equivalent ROM values are simultaneously reflected in (A) sagittal, (B) transverse and (C) frontal planes.

Figure 3. Anatomical landmarks for goniometer alignment before measuring of elbow and wrist.

(A) Bony landmarks on the longitudinal axis of the humerus, the forearm (radius) and the lateral epicondyle. (B) Bony landmarks on the ulnar styloid and the lateral midline of the fifth metacarpal. (C) Bony landmarks on the capitate and the third metacarpal.

Figure 4. Measurement of elbow flexion ROM using the goniometer and inertial sensors.

(A) Starting position for flexion-extension ROM assessment. (B) Measuring of maximum flexion ROM.

Figure 5. Measurement of elbow prono-supination ROM using the goniometer and inertial sensors.

(A) Starting position for prono-supination ROM assessment. (B) Measuring of maximum pronation ROM. (C) Measuring of maximum supination ROM.

Figure 6. Measurement of wrist ROM using the goniometer and inertial sensors.

(A) Starting position for flexion-extension ROM assessment. (B) Measuring of maximum flexion ROM. (C) Measuring of maximum extension ROM. (D) Starting position for ulnar-deviation ROM assessment. (E) Measuring of maximum radial deviation ROM. (F) Measuring of maximum ulnar deviation ROM.

Figure 7. Bland–Altman plots for both instruments in elbow assessment.

The figure shows the dispersion graphs comparing the goniometer and inertial sensors for (A) elbow flexion, (B) elbow supination and (C) elbow pronation. The means of both instruments are presented on the X axis, while the difference between them is presented on the Y axis. It can be noted that the majority of the values represented are distributed within the limits of agreement.

Figure 8. Bland–Altman plots for both instruments in wrist assessment.

The figure shows the dispersion graphs comparing the goniometer and inertial sensors for (A) wrist flexion, (B) wrist extension, (C) wrist radial deviation and (D) wrist ulnar deviation. The means of both instruments are presented on the X axis, while the difference between them is presented on the Y axis. It can be noted that the majority of the values represented are distributed within the limits of agreement.