VALIDATION OF VIRTUAL WRIST RANGE OF MOTION MEASUREMENTS USING VIDEO COACHING

Wrist range of motion (ROM) is an important assessment in patients with wrist pathology. It is most commonly assessed using a manual long-arm goniometer. In-person intra-rater reliability of this has been found to be high. Studies evaluating the ability to assess wrist ROM virtually are less conclusive. The purpose of this study was to determine the validity, intra-rater, and inter-rater reliability of virtual wrist ROM measurements using a video coaching method developed by the authors. We performed a prospective cohort study assessing wrist flexion, wrist extension, pronation, and supination in healthy volunteers. Three assessors - medical student, research assistant, and upper extremity surgeon - measured participant wrist ROM at an in-person, same-day virtual, and repeat virtual visits with a one to six -week washout period. Measurements were made with a long arm goniometer. Virtual assessments were done over zoom so that the assessor could coach the volunteer on correct wrist positioning for accurate measurement based on a series of alignment checks. An a priori power analysis was performed to determine the sample size. Inter-class correlations (ICC) were used to assess reliability using 95% confidence intervals. Fifty-three wrists were enrolled with complete data available on 45. For all raters and for 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. Intra-rater 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 intra-rater reliability, with all raters having ICC values graded as excellent (ICC>0.9). Virtual wrist ROM assessments showed good inter-rater and intra-rater reliability, with ICC scores that were comparable to in-person measures using a video coaching method. This was true for raters of all levels of experience. Virtual wrist ROM assessment by this method offer a reliable alternative to in-person assessment.