Original Research

Video-Based Motion Analysis Use: C.P. Hensley, PT, DPT, Department of

Physical Therapy and Human
Movement Sciences, Northwestern
A National Survey of Orthopedic University Feinberg School of
Medicine, Chicago, Illinois.

Physical Therapists D. Millican, PT, DPT, Department of

Physical Therapy and Human
Movement Sciences, Northwestern
Craig P. Hensley, Devyn Millican, Nida Hamilton, Amy Yang, University Feinberg School of
Jungwha Lee, Alison H. Chang Medicine, Chicago, Illinois.
N. Hamilton, PT, DPT, Department of
Physical Therapy and Human
Objectives. Motion analysis is performed by physical therapists to assess and improve

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Movement Sciences, Northwestern
movement. Two-dimensional video-based motion analysis (VBMA) is available for smart- University Feinberg School of
phones/tablets and requires little to no equipment or cost. Research on VBMA use in Medicine, Chicago, Illinois.
clinical practice is limited. The purpose of this study was to examine the current use of
A. Yang, MSc, Department of
VBMA in orthopedic physical therapist practice. Preventive Medicine, Northwestern
University Feinberg School of
Methods. Members of the Academy of Orthopaedic Physical Therapy completed an Medicine, Chicago, Illinois.
online survey. Questions examined frequency of VBMA use, reasons for use, facilita- J. Lee, PhD, Department of Preventive
tors/barriers, device/apps used, practice patterns, other certificates/degrees, and demo- Medicine, Northwestern University
graphic information. Feinberg School of Medicine,
Chicago, Illinois.
Results. Among the final analysis sample of 477 respondents, 228 (47.8%) use VBMA. Of A.H. Chang, PT, DPT, Department of
228 VBMA users, 91.2% reported using it for ≤25% of their caseload, and 57.9% reported Physical Therapy and Human
using their personal device to capture movement. Reasons for using VBMA included visual Movement Sciences, Northwestern
feedback for patient education (91.7%), analysis of movement (91.2%), and assessment of University Feinberg School of
progress (51.8%). Barriers to use included lack of device/equipment (48.8%), lack of space Medicine, 645 N Michigan Avenue,
(48.6%), and time restraint (32.1%). Those with ≤20 years of clinical experience (odds ratio #1100, Chicago, IL 60611 (USA).
Address all correspondence to Dr
[OR] = 1.83, 95% CI = 1.21–2.76), residency training (OR = 2.49, 95% CI = 1.14–5.43),
Chang at: hsini@northwestern.edu.
and fellowship training (OR = 2.97, 95% CI = 1.32–6.66), and those from the West region
[Hensley CP, Millican D, Hamilton N,
of the United States (OR = 1.66, 95% CI = 1.07–2.56) were more likely to use VBMA.
Yang A, Lee J, Chang AH. Video-based
motion analysis use: a national survey
Conclusions. More than 50% of surveyed orthopedic physical therapists do not use of orthopedic physical therapists. Phys
VBMA in clinical practice. Future research should be directed toward assessing reliability Ther. 2020;100:1759–1770.]
and validity of VBMA use by smartphones, tablets, and apps and examining whether VBMA
© The Author(s) 2020. Published by
use enhances treatment outcomes. Data security, patient confidentiality, and integration
Oxford University Press on behalf of
into the electronic medical record should be addressed. the American Physical Therapy
Association. All rights reserved. For
Impact. This study is the first to our knowledge to describe the use of VBMA permissions, please e-mail:
in orthopedic physical therapist practice in the United States. It is the first step in journals.permissions@oup.com
understanding how VBMA is used and might be used to enhance clinical assessment and Published Ahead of Print:
treatment outcomes. July 31, 2020
Accepted: May 4, 2020
Submitted: November 1, 2019

Post a comment for this

article at:
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2020 Volume 100 Number 10 Physical Therapy 1759

Video-Based Motion Analysis
T
“ ransforming society by optimizing movement
to improve the human experience” is the vision
statement for the physical therapy profession put
forth by the American Physical Therapy Association.1
Physical therapists are experts in the movement system.
Interventions are designed to improve movement
effectiveness and safety based on examination and
evaluation findings.2,3 By identifying pathomechanics that
may drive nociceptive input or overload tissues and
monitoring movement pattern changes throughout the
episode of care, physical therapists address underlying
movement dysfunction to enhance treatment outcome and
performance. Motion analysis, when coupled with a robust
clinical reasoning process, is a useful tool for clinicians to
efficiently assess and improve movement. Traditionally,
movement has been analyzed using either simple visual
observation in the clinic or equipment-intensive,
quantitative motion capture systems in a laboratory.
Although providing reliable kinematic information, the
benchmark laboratory-based quantitative motion capture
system is neither always practical nor efficient for clinical
practice due to its high cost and space, equipment/
software, and time requirements. On the other end of the
spectrum, visual observation is easy, quick, and requires
little to no equipment. Movement analysis by direct visual
observation may be limited by the observer’s experience
and visual acuity and the speed of the analyzed
movement. As joint angular velocities increase, dynamic
visual acuity deteriorates.4,5 Patient fatigue or pain
exacerbation related to repetitive performance of the same
movement may also limit the use of direct visual
observation. Finally, the observation is transitory in nature
with no record to refer to or reflect on. Thus,
observational analysis without video may lack accuracy
and fail to detect pathological movement patterns.6,7
These limitations pose a need for a more consistent,
practical, and valid measurement tool.
With recent advances in smartphone/tablet video
recording capabilities (eg, capturing up to 240 frames per
second in slow-motion video mode) and developments of
numerous smartphone/tablet apps for 2-dimensional (2-D)
video-based motion analysis (VBMA), more nuanced
movement analysis can be performed requiring little to no
equipment at minimal to no cost.8 Recorded videos can be
reviewed with patients to achieve shared decision-making,
improve understanding and adherence, and motivate and
encourage self-management. Additionally, visual feedback
of impaired movement patterns through recorded videos
can potentially enhance patient motor learning. The
primary physical therapist can also consult with
colleagues across the globe using such technology.
Despite the emphasis on movement in the physical
therapy profession, recent development of
smartphones/tablets/apps for VBMA, and an accumulating
body of literature regarding VBMA application in
therapy, injury prevention, and sports performance,9–11
1760 Physical Therapy Volume 100 Number 10
research on VBMA use in clinical practice is currently
limited.
Given the importance of assessing and improving human
movement in physical therapist practice and the potential
benefits of VBMA, it is critical to know how and why
VBMA is used, what types of VBMA are used, and what
factors influence VBMA use. The objectives of this study
are to (1) examine patterns of VBMA use; (2) identify
barriers to and reasons for VBMA use; and (3) determine
demographic, clinical, and educational factors associated
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with VBMA use in orthopedic physical therapist practice.
Methods
This was a cross-sectional observational study using a
survey. The Northwestern University Institutional Review
Board approved the study.
Participants
An e-mail invitation was sent to members of the Academy
of Orthopaedic Physical Therapy (AOPT) at the study’s
onset. Inclusion criteria were licensed physical therapists
practicing at least 4 h/wk treating primarily
orthopedic-related injuries. Each participant gave
informed consent prior to taking the survey.
Survey Design
The survey questions underwent a series of iterations to
best capture respondents’ characteristics, behaviors, and
experience with VBMA use. The initial version was drafted
by 2 physical therapists, each with ≥10 years of
experience in musculoskeletal practice, and 4 Doctor of
Physical Therapy students. Next, a survey expert at
Northwestern University critically reviewed and revised
each question and corresponding response choices for
utility, specificity, clarity, and brevity; pruned immaterial
items; and structured question order and branching. To
further reduce response bias and improve relevance and
comprehensiveness, we empaneled a nationwide focus
group of 11 orthopedic physical therapists representing
different age groups, years of experience, and sexes. After
test-taking the survey, each focus group member provided
feedback during an online discussion. Questions were
further modified and arranged to improve the survey.
Finally, after evaluating questions and responses, an
experienced biostatistician built the data collection form
using Research Electronic Data Capture (REDCap) tools
hosted by Northwestern University. REDCap is a
web-based application designed to support data capture
and management for research.
The final survey contained a maximum of 18 questions
across 6 pages (Appendix). Each page covered 2 to 5
questions. Adaptive questioning was used to reduce
number and complexity depending on how participants
responded. Using closed-ended questions, the survey
queried VBMA use frequency, types, barriers, and reasons
2020

for use. The survey also contained questions examining
potential predictors of use, including age, years of
experience as a physical therapist, number of patients
seen per week, practice hours per week, practice setting,
time spent with patients, frequency of delegation to
physical therapist assistants and physical therapy aides,
and other certificates/degrees. A free-text box for write-in
answers was provided when respondents selected “other”;
for example, respondents could select “other” when their
certificates/degrees were not listed as options. Items were
presented in the same order for all respondents. Respon-
dents were allowed to review and change answers using a
“back” button. It took approximately 5 to 10 minutes to
complete the survey. Those completing the survey were
entered into a raffle for a $100 Amazon gift card.
Data Collection
The survey invitation, consisting of a recruitment letter
inviting participation, an informed consent statement, and
a short survey description, was sent electronically from
the AOPT to members in January 2018. The invitation
briefly described the study objectives and estimated time
to complete the survey. Interested participants clicked the
electronic link connecting them to more detailed study
instructions and eligibility criteria. Access to the survey
was granted after selecting “yes” to informed consent to
participate. No participant identifying information was
collected; thus, participation was completely anonymous.
Survey responses were collected on REDCap over
3 months, January to March 2018. Per AOPT policy, no
follow-up survey reminders were sent.
Data Analysis
Descriptive statistics, such as number (%) and mean (SD),
summarized the characteristics for the overall sample and
by VBMA use (yes vs no). To assess univariate associations
between individual factors and VBMA use, chi-squared
tests were conducted for categorical variables and
independent t tests for continuous variables. When the
expected cell count was <5, Fisher’s exact tests were used
instead. Factors with a P value ≤.20 in the univariate
comparisons were considered for inclusion in the final
multivariable logistic regression models. Results were
reported as odds ratios (ORs) and associated 95%
confidence intervals (CIs); a 95% CI that excludes 1.0 is
considered to be statistically significant. ORs > 1.0
indicated increased likelihood and <1.0 indicated
decreased likelihood. All analyses were performed using
SAS V9.4 (Cary, NC, USA).
Results
Survey Respondents
A total of 567 survey responses were recorded; 477
respondents met inclusion criteria. Demographics and
professional characteristics of respondents are
summarized in Table 1. Respondents were distributed
2020
Video-Based Motion Analysis
throughout the United States representing a range of age
groups, years of experience, practice settings, and
certifications/degrees. Respondents were predominantly
Doctors of Physical Therapy (340, 71.3%), practicing in
private practice (222, 46.5%) or outpatient hospital-based
(203, 42.6%) settings, and treating patients for 31 hours or
more per week (329, 69.0%). The majority of respondents
spent at least 45 minutes for new evaluations (329, 69.0%),
at least 30 minutes for return visits (354, 74.2%), and did
not delegate to physical therapist assistants (265, 55.6%)
or physical therapy aides (357, 74.8%). Additionally,
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respondents reported whether they had earned any other
certificates/degrees and were allowed to select more than
1 category. The Figure shows the number of respondents
in each certificate/degree category. For example, 210
(44.0%) were board-certified orthopedic clinical specialists
(OCS), and 143 (30.0%) did not have any
certificate/degree.
Frequency of VBMA Use
Of those who met the inclusion criteria (N = 477), 228
(47.8%) reported using VBMA to some extent. As shown
in Table 2, the majority of VBMA users (208/228, 91.2%)
reported VBMA use for only ≤25% of their caseload.
Device/Method Used to Capture VBMA
In VBMA users (N = 228), most (132, 57.9%) used their
personal device to capture VBMA (Tab. 3). One hundred
nineteen (52.2%) reported using a single video camera on
a tablet/phone as the primary method for capturing
VBMA, followed by 103 (45.2%) using an app, and 6
(2.6%) using 3-dimensional motion analysis. The top 2
apps for VBMA were Hudl Technique (47/103, 45.6%) and
Coach’s Eye (23/103, 22.3%) (Tab. 3).
Reasons for Use and Barriers
Among VBMA users (N = 228), the commonly cited
reasons for use included visual feedback (209, 91.7%),
analysis of movement (208, 91.2%), and assessment of
progress (118, 51.8%) (Tab. 4). Of 477 respondents, the
commonly reported barriers included lack of
device/equipment (233, 48.8%), lack of space (232,
48.6%), and time restraint (153, 32.1%) (Tab. 4).
Factors Associated With VBMA Use
Table 1 compares demographic and professional
factors between VBMA users and non-users. Because
age and years of experience as a physical therapist
were highly correlated, only years of experience were
included in the final logistic regression models. For
other certificates/degrees, respondents could select
more than 1 answer; we applied hierarchical grouping to
form 5 mutually exclusive subgroups.12 For example, the
OCS subgroup included those having only OCS (N = 163);
the manual therapy fellowship subgroup included those
earning fellowship with or without OCS or residency
training (N = 34); the orthopedic residency subgroup
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Video-Based Motion Analysis

Table 1.
Descriptive Summary of Factors Related to Use of VBMA (Univariate Comparisons)a

Factor Total N VBMA Use (N = 228) No VBMA Use (N = 249) Pb

Mean age in years (SD) 40.6 (11.2) 43.2 (12.4) .014
Years of physical therapist practice .003
≤20 y 326 171 (75.0%) 155 (62.2%)
>20 y 151 57 (25.0%) 94 (37.8%)
Certificates/degreesc .007

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OCS 163 79 (34.6%) 84 (33.7%)
Orthopedic residency graduate 36 24 (10.5%) 12 (4.8%)
Fellow (FAAOMPT) 34 23 (10.1%) 11 (4.4%)
Other 101 43 (18.9%) 58 (23.3%)
None 143 59 (25.9%) 84 (33.7%)
Time spent in direct patient care (h/wk) .556
4–10 29 16 (7.0%) 13 (5.2%)
11–20 45 18 (7.9%) 27 (10.8%)
21–30 74 33 (14.5%) 41 (16.5%)
31–39 184 86 (37.7%) 98 (39.4%)
≥40 145 75 (32.9%) 70 (28.1%)
Geographic region .183
Midwest 140 60 (26.3%) 80 (32.1%)
West 117 67 (29.4%) 50 (20.1%)
Northeast 100 48 (21.1%) 52 (20.9%)
Southeast 89 39 (17.1%) 50 (20.1%)
Southwest 31 14 (6.1%) 17 (6.8%)
Terminal physical therapy degree .218
DPT 340 170 (74.6%) 170 (68.3%)
MPT 72 33 (14.5%) 39 (15.7%)
PT 65 25 (11.0%) 40 (16.1%)
Practice setting .325
Private practice 222 114 (50.0%) 108 (43.4%)
Outpatient hospital-based 203 92 (40.4%) 111 (44.6%)
Otherd 52 22 (9.6%) 30 (12.0%)
Time spent with initial evaluations (min) .389
<30 25 9 (3.9%) 16 (6.4%)
30–44 123 60 (26.3%) 63 (25.3%)
45–59 244 113 (49.6%) 131 (52.6%)
≥60 85 46 (20.2%) 39 (15.7%)
Time spent with return patients (min) .300
<15 4 1 (0.4%) 3 (1.2%)
15–29 119 58 (25.4%) 61 (24.5%)
30–44 223 114 (50.0%) 109 (43.8%)
45–59 106 42 (18.4%) 64 (25.7%)
≥60 25 13 (5.7%) 12 (4.8%)

(Continued)

1762 Physical Therapy Volume 100 Number 10 2020

 Video-Based Motion Analysis

Table 1.
Continued

Factor Total N VBMA Use (N = 228) No VBMA Use (N = 249) Pb

Frequency of delegation to physical .879
therapist assistants (%)
0 265 131 (57.5%) 134 (53.8%)
1–25 116 54 (23.7%) 62 (24.9%)
26–50 75 35 (15.4%) 40 (16.1%)

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51–75 16 6 (2.6%) 10 (4.0%)
76–100 5 2 (0.9%) 3 (1.2%)
Frequency of delegation to physical .307
therapy aides (%)
0 357 162 (71.1%) 195 (78.3%)
1–25 94 51 (22.4%) 43 (17.3%)
26–50 20 12 (5.3%) 8 (3.2%)
>50 6 3 (1.3%) 3 (1.2%)
a
FAAOMPT = Fellow of American Academy of Orthopaedic Manual Physical Therapists; MPT = Master of Physical Therapy; OCS = board-certified orthopaedic
clinical specialist; DPT = Doctor of Physical Therapy; PT = Physical Therapy; VBMA = video-based motion analysis.
b
P values comparing VBMA use ≤ .20 are bolded.
c
Because respondents could select more than 1 answer, we applied hierarchical grouping to form 5 mutually exclusive subgroups. The OCS subgroup
included those having only OCS; the manual therapy fellowship subgroup included those earning fellowship with or without OCS or residency training;
the orthopedic residency subgroup included those completing residency training with or without OCS or fellowship; the “other” subgroup consisted of those
with certificates/degrees other than OCS, fellowship, or residency; and the “none” subgroup comprised those without any certificates/degrees.
d
“Other” included practice settings of state/federal government, workplace/occupational environment, wellness/prevention/sports/fitness, and research center.

Figure.
The number of respondents in each certificate/degree category (N = 477). Respondents may select ≥1 category. ATC = certified athletic
trainer; DSc = Doctor of Science; FAAOMPT = Fellow of American Academy of Orthopaedic Manual Physical Therapists; MDT = mechanical
diagnosis and therapy; OCS = board-certified orthopaedic clinical specialist; SCS = board-certified sports clinical specialist.

2020 Volume 100 Number 10 Physical Therapy 1763

Video-Based Motion Analysis

Table 2.
Percentage of Physical Therapist Caseload Using VBMAa

Caseload VBMA Used Respondents (N = 477)

0% 249 (52.2%)
1–25% 208 (43.6%)
26–50% 17 (3.6%)
51–75% 2 (0.004%)
76–100% 1 (0.002%)
a
VBMA = video-based motion analysis.

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Table 3.
Devices and Apps Used to Capture VBMAa

Device Used to Capture VBMA Respondents Who Use VBMA (N = 228)

Personal device 132 (57.9%)
Patient device 98 (43.0%)
Clinic-issued device 90 (39.5%)
Other 9 (4.0%)
App Used to Capture VBMA b
Respondents Who Use App (N = 103)
Hudl Technique 47 (45.6%)
Coach’s Eye 23 (22.3%)
Dartfish 15 (14.6%)
Slowmo 6 (5.8%)
KCapture 2 (1.9%)
CMV 2 (1.9%)
V1 Golf 1 (1.0%)
Runmatic 1 (1.0%)
Other 6 (5.8%)
a
Respondents were able to choose ≥1 answer. VBMA = video-based motion analysis.
b
Manufacturer information: Hudl Technique (Agile Sports Technologies Inc, Lincoln, NE, USA; Coach’s Eye (TechSmith Corporation, Okemos, MI, USA;
Dartfish (Alpharetta, GA, USA); KCapture (video-capturing app); CMV (CoachMyVideo, https://www.coachmyvideo.mobi); V1 Golf (V1 Sports, Novi, MI,
USA); Runmatic (https://apps.apple.com/us/app/runmatic/id1075902287).

included those completing residency training with or
without OCS or fellowship (N = 36); the “other” subgroup
consisted of those with certificates/degrees other than
OCS, fellowship, or residency (N = 101); and the “none”
subgroup comprised those without any certificates/degrees
(N = 143). As shown in Table 5, physical therapists with
≤20 years of experience, graduates from an orthopedic
residency program (vs physical therapists without
any other certificates/degrees), Fellows of the American
Academy of Orthopaedic Manual Physical Therapists (vs
physical therapists without any other certificates/degrees),
and those from the West geographic region were
each more likely to use VBMA. Other certificates/degrees,
weekly hours in patient care, patients seen per
week, time spent with patients for initial or return visits,
delegation to physical therapist assistants or physical
therapy aides, practice setting, or terminal physical
therapy degree were not associated with VBMA use.
Discussion
To our knowledge, this is the first study to examine
descriptive and predictive factors associated with VBMA
use in physical therapy practice. Results show that more
than 50% of orthopedic physical therapists do not use
VBMA. Among VBMA users, approximately 90% use it for
25% or less of their caseload. The limited use of VBMA
among orthopedic physical therapists may be attributed to
a number of factors. As highlighted in Table 4, lack of
equipment, lack of space, time restraint, cost, and patient
privacy were among the top 5 barriers to using VBMA in
orthopedic practice.

1764 Physical Therapy Volume 100 Number 10 2020

 Video-Based Motion Analysis

Table 4.
Reasons for and Barriers to Using VBMAa

Reasons for Using Respondents Who Use VBMA (N = 228)

Visual feedback for patient education 209 (91.7%)
Analysis of movement 208 (91.2%)
Assessment of progress 118 (51.8%)
Quantification of movement 82 (36.0%)

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Other 10 (2.1%)
Barriers to Using Respondents (N = 477)
Lack device/equipment 233 (48.8%)
Lack of space 232 (48.6%)
Time restraint 153 (32.1%)
Cost 137 (28.7%)
Other 104 (21.8%)
Patient privacy 93 (19.5%)
No barriers 62 (13.0%)
Difficult to use 29 (6.1%)
Do not find it benefits patients 24 (5.0%)
Unfamiliar 19 (4.0%)
Not allowed 18 (3.8%)
Lack internet access 11 (2.3%)
a
Respondents were able to choose ≥1 answer. VBMA = video-based motion analysis.

Table 5.
Factors Associated with Use of VBMA: Multivariate Logistic Regressiona

Factor Odds ratio 95% CI Pb

Physical therapist experience
≤20 vs >20 y as physical therapist 1.83 1.21–2.76 .004
Certificates or advanced degrees vs no certificates or advanced degrees
OCS 1.34 0.84–2.12 .217
Orthopedic residency graduate 2.49 1.14–5.43 .022
Fellow (FAAOMPT) 2.97 1.32–6.66 .008
Other certificates 1.19 0.70–2.02 .514
Geographic region
West vs other regions 1.66 1.07–2.56 .023
a
FAAOMPT = Fellow of American Academy of Orthopaedic Manual Physical Therapists; OCS = board-certified orthopedic clinical specialist; VBMA = video-based
motion analysis.
b
Factors with P ≤ .20 in the univariate comparisons (see Table 1) were included in the multivariate logistic regression models.

2020 Volume 100 Number 10 Physical Therapy 1765

Video-Based Motion Analysis
Barriers to Performing VBMA
Lack of equipment was the most common barrier to
performing VBMA. For those who do not want to use a
personal device, “lack of equipment” could be perceived
as a barrier. Some respondents may not have access to a
clinic-owned device (eg, phone or tablet) to capture video.
Finally, free text comments suggested that the inability to
upload video to Electronic Medical Record (EMR)
discourages VBMA use. This could be interpreted as “lack
of equipment.” Lack of space and time restraint were
frequently cited barriers. Tasks that require a larger area,
such as sprinting, may be difficult to capture in smaller
clinics. Recording long-distance running on a treadmill
could consume valuable patient encounter time. To
overcome these barriers, patients could share videos
captured outside clinic to maximize efficiency. Recording
and analyzing movement may initially require more time,
but it will enable clinicians to quickly identify key
pathomechanics and may save time and cost and reduce
patient visits. Nearly 30% of respondents selected cost as a
barrier. While most VBMA apps are free for basic
packages, some, as part of their premium packages,
require monthly subscription fees. Concerns over lack of
insurance reimbursement and uncertainty about
VBMA-related Current Procedural Terminology coding
may also be perceived as a cost-related barrier. Around
20% of physical therapists reported patient privacy as a
barrier. Capturing information by smartphones/tablets
poses a risk for confidentiality and Health Insurance
Portability and Accountability Act violations. In a survey of
dermatologists, 30% reported storing patient photographs
on personal smartphones; 48% of these were not secured
or encrypted.13 Unintentional privacy breaches could also
occur when other patients’ or staffs’ voices or images are
captured in the recording without knowledge or consent.
Care must be taken to document consent and record only
what is necessary. Future policies and guidelines relating
to patient consent; recording procedures; recording device
use; data storage, security, and encryption; and integration
with EMR should be developed to ensure confidentiality
and privacy protection. Approximately 6% reported
“difficult to use” and 4% reported “unfamiliar” as barriers
to VBMA use. It is unknown how motion analysis is
incorporated in physical therapy curriculum. If students
are not exposed to a framework of systematic analysis of
movement and VBMA, they may find it difficult to use in
clinical practice. Physical therapy educators may consider
integrating frameworks for structured movement analysis14
or VBMA application10,15,16 into their curriculum.
Facilitators to Performing VBMA
The top reasons for VBMA use were visual feedback for
patient education (91.7%) and analysis of movement
(91.2%). A recent systematic review concluded that visual
feedback, in conjunction with other methods of feedback
and intervention, should be incorporated when addressing
injury-contributing pathomechanics for runners.17 While
1766 Physical Therapy Volume 100 Number 10
some may argue that observation without technology
suffices to identify pathomechanics, it could be
challenging for clinicians to identify variables contributing
to the movement problem, especially during fast
movements. VBMA has the advantages of repeated
viewings, slowed motion analysis, zooming on a specific
region of interest, still frame at a particular movement
event, and side-by-side comparison with another
recording. Visual feedback of movement (real-time or
post-performance) provided to the patient may serve as
powerful immediate input to improve movement
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execution and performance and can be universally
applied to patients who move at all speeds.18 ,19 Over 50%
of respondents selected assessment of progress as a
reason to use VBMA. Anecdotally, we have found this to
be valuable in tracking movement pattern change over
time, from both the clinician’s and patient’s perspective.
Visual feedback of improvement may potentially further
facilitate a patient’s engagement and treatment adherence.
Device, Methods for Capturing VBMA
A single camera on a smartphone/tablet was more
commonly used than an app or 3-dimensional motion
analysis in clinical practice. This is expected given that
most smartphones/tablets come with preinstalled video
cameras. Although some of the VBMA apps are free, they
require extra steps to download and additional time to
learn. They also may occupy a large amount of storage on
devices. These drawbacks may discourage some physical
therapists from using apps. Hudl Technique and Coach’s
Eye were the 2 most frequently used VBMA apps. Both
are downloadable for Android and iOS and incorporate
features of video playback up to 240 frames per second;
slowed motion at one-half, one-quarter, and one-eighth
speeds; angle and line drawings; and side-by-side
comparison of pre- and post-videos. The basic version of
Hudl Technique is free, while a fee applies to Coach’s
Eye.8 ,15 ,20 ,21 Interestingly, the majority of our respondents
used their own personal devices to capture video, likely
due to familiarity with and access to one’s own device at
any time. In light of potential confidentiality and Health
Insurance Portability and Accountability Act violations,
physical therapists are advised to obtain consent prior to
capturing patient information on their personal devices.
Alternatively, recording on patients’ devices could
potentially mitigate this risk but at the expense of limited
access for the clinician.
Factors Associated With VBMA Use
Those with 20 years or less experience as a physical
therapist were more likely to use VBMA. One possible
explanation is that younger individuals are more familiar
with recent advances in digital technology and
smartphone use. This is consistent with what has been
reported in medicine. Medical students (85%) and
residents (95%) used their smartphones for
communicating with other medical staff and for quick
2020

access to information more frequently than their faculty
mentors (65%).22 Additionally, less experienced physical
therapists may be more inclined to rely on
smart/electronic technologies for accuracy given their
limited experience and confidence in movement
analysis.6,23,24 Additional training in orthopedic residency
or fellowship in orthopaedic manual physical therapy
each increased the likelihood of use. These individuals
may have been introduced to VBMA during their
structured advanced training. In theory, pursuing
post-graduate training may signal interest and
commitment to expert practice, in part characterized by a
central focus on movement assessment linked to patient
function and by a clinical reasoning process that is
embedded in a collaborative, problem-solving venture
with the patient.25 This focus on patient-centered
movement analysis and use of technology to engage
patients may have explained why those with advanced
training were more likely to use VBMA.
Compared with the rest of the United States, those from
the West region were more likely to use VBMA. Regional
variance in health care practice is frequently observed.26
Given that western states have statistically higher
smartphone and tablet usage rates than the national
average,27 it is plausible that clinicians in this region are
more attuned and open to adopting available technology
that may enhance clinical practice.
Recent advances in smartphone/tablet video recording
capabilities and relative ease of capturing movement
kinematics using automated apps/software have motivated
renewed interest in examining the reliability and validity
of using 2-D video analysis to assess functional tasks.
Moderate to excellent intra- and inter-rater reliability has
been reported when analyzing lower extremity kinematics
during functional tasks, such as walking, running,
squatting, and landing tasks.9,28– 30 Investigations into the
validity of 2-D video analysis have shown mixed results in
two recent systematic reviews9,29 reporting very low to
low article quality.9 Both reviews, nonetheless,
emphasized that 2-D analysis could be informative in
identifying those with pathomechanics at risk for injury.
Several limitations to this study should be recognized. We
made every attempt to ensure clarity and accurate
interpretation of survey items by iterative survey
development/refinement that involved experts and
stakeholders (eg, 11 nationwide practicing orthopedic
physical therapists). However, the final survey
questionnaire was not further pilot tested; varied
individual interpretation of questions/answers may exist.
All survey respondents were AOPT members; among
them, 44% were OCSs. This may limit generalizability of
our results to other non-AOPT members and/or those
without clinical specialization that provide care for
patients with musculoskeletal dysfunction. It is possible
that these findings may overestimate the use of VBMA in
2020
Video-Based Motion Analysis
orthopedic clinical practice. Recall bias could have
occurred when responding to survey items. At the time of
survey distribution in January 2018, there were
approximately 19,000 AOPT members. Due to the
electronic distribution methods and anonymous nature of
the survey, we are unable to account for e-mails that were
undelivered, unopened, or received in duplicate by
members. Further, we were unable to account for
members who opted out of e-mail communications. Thus,
a true response rate is undetermined. However, the
number of recorded returns and sample characteristics in
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our study are comparable with those in a recent survey
that employed the same method of e-mail invitation to
AOPT members.31 No identifying information was
collected regarding each respondent, which may have
allowed some to access and respond to the survey more
than once if they wished to do so.
This survey is, to our knowledge, the first to describe the
use of VBMA in orthopedic physical therapist practice in
the United States. Results indicate that the majority of
orthopedic physical therapists do not use VBMA in clinical
practice. In VBMA users, approximately 90% utilize it for
25% or less of their caseload. Those practicing for 20 years
or less or those from the West region are more likely to
use VBMA. Being Fellows of the American Academy of
Orthopaedic Manual Physical Therapy or orthopedic
residency graduates each predicted VBMA use. Future
research should be directed toward better assessing
reliability and validity of VBMA use through
smartphones/tablets/apps; investigating whether VBMA is
superior to commonly used clinical assessment tools (eg,
goniometry); developing educational programs of VBMA
application for clinicians; and examining whether the use
of VBMA enhances treatment outcomes. Data security,
patient confidentiality, and integration into EMR should
also be addressed.
Author Contributions and Acknowledgments
Concept/idea/research design: C.P. Hensley, D. Millican,
N. Hamilton, J. Lee, A.H. Chang
Writing: C.P. Hensley, D. Millican, N. Hamilton, J. Lee, A.H. Chang
Data collection: C.P. Hensley, D. Millican, N. Hamilton, A. Yang,
A.H. Chang
Data analysis: D. Millican, A. Yang, J. Lee, A.H. Chang
Project management: C.P. Hensley, A.H. Chang
Consultation (including review of manuscript before submitting):
A. Yang
The authors thank the survey respondents and Dr Stephen Reischl
for providing feedback to improve the manuscript.
Ethics Approval
This study was approved by the Institutional Review Board at
Northwestern University.
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Video-Based Motion Analysis
Funding
There are no funders for this study.
Disclosures
The authors completed the ICMJE Form for Disclosure of Potential
Conflicts of Interest and reported no conflicts of interest.
DOI: 10.1093/ptj/pzaa125
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Appendix.
Survey
Thank you for agreeing to take part in this important survey
regarding physical therapist use of video-based motion analysis
in clinical practice. This survey should take 5–10 minutes to
complete. All the answers you provide will be completely
anonymous.
Section 1
1) Do you currently see patients at least 4 hours per
week?
• Yes
• No
2) Are you a licensed physical therapist?
• Yes
• No
2020
 Video-Based Motion Analysis

3) Do most of your patients have orthopedic and/or • Lack of space availability

sports-related injury? • Time restraint
• Unfamiliar with the use of video-based motion
• Yes
• No analysis
• Other (please specify)

Section 2
8) What is the primary method you use to perform
4) Approximately how many patients do you see per video-based motion analysis in your clinical practice?
week? (Check all that apply)
• Between 1–10
• • Single video camera, smartphone, tablet, other video

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Between 11–25
• Between 26–40 method
• • App on smartphone/tablet
Between 41–59
• • 3d motion analysis cameras
More than 60

8b) (If answered B to 8) What video-based motion analysis app

5) How many hours per week do you provide direct
do you use most frequently?
patient care?
• Between 4–10
• Video-based Motion Analysis Applications (Apps): Apps available
Between 11–20
• for android, iPhone, and iPad that record video and still frames to
Between 21–30
• assist with movement analysis using various features of
Between 31–39
• frequency, timing, angles, posture grids, Borg scales, and slow
40 or more
motion. Examples include Hudl/Technique, Coach’s Eye, Dartfish
6) What percentage of your patient caseload do you use Express, and PostureScreen.
video-based motion analysis in clinical practice?
• Hudl/Technique
• 0% • Sports Motion Analyzer HD
• 1%–25% • Coach’s Eye—Video Analysis
• 26%–50% • Dartfish Express
• 51%–75% • PostureScreen
• 76%–100% • VStrator
• KCapture
6b) (If response to 6 was other than 0%) Which of the following • SKLZ Cam
devices do you use to capture video-based motion analysis in • Slowmo
clinical practice? (Select all that apply) • CMV—Slow Frame Video Analysis
• Simi Move
• • Coach Video Analyzer
Your own personal device
• • V1 Golf—2D video
A hospital/clinic-issued device
• • Runmatic
Patient device
• • Other (please list)
Other (free text)

9) What barriers, if any, keep you from using

7) What barriers, if any, keep you from using video-based motion ANALYSIS APPS in your clinical
video-based motion ANALYSIS in your clinical practice? (Choose all that apply).
practice? (Select all that apply).

• No barriers to use • No barriers to use

• Cost • Cost
• Difficult to use • Difficult to use
• Discouraged/not allowed in clinic by • Discouraged/not allowed in clinic by
supervisor/manager/boss/institution supervisor/manager/boss/institution
• Do not find that it benefits me or my patients • Do not find that it benefits me or my patients
• Lack internet access • Lack internet access
• Lack of equipment/device to use video-based • Lack of equipment/device to use video-based
motion analysis motion analysis
• Patient privacy/lack of patient consent/data security • Patient privacy/private room

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Video-Based Motion Analysis
• Lack of patient consent or others in the clinic • 0%
• Time restraint • 1–25%
• Unfamiliar with the use of video-based motion • 26–50%
analysis • 51–75%
• Other (please specify) • 76–100%

10) How do you use video-based motion-analysis in your 13b) What percentage of your patient caseload do you delegate to
practice? Select all that apply. physical therapy AIDES?

• Analysis/evaluation of movement • 0%
• Assessment of progress • 1–25%

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• Visual feedback for patient education in clinic • 26–50%
and/or at home • 51–75%
• Quantification of movement patterns (ie, knee • 76–100%
flexion ROM during a squat)
• Other (please specify)
14) What is your current age?
15) What is the primary state you practice in?
11) What is your primary practice setting? 16) How many years have you been working as a
licensed physical therapist?
• Outpatient hospital-based clinic
• Private practice • Under 5 years
• Wellness/Prevention/Sports/Fitness • 5–10 years
• Workplace, or Other Occupational Environments • 11–15 years
• State/Federal Government • 16–20 years
• Research Center • Over 20 years
• Other

17) Please list any additional certifications/education you

12) During an initial evaluation, how much time (on currently hold (ie, board certification, fellow, manual
average) do you spend with a patient? therapy, aquatics, myofascial release, kinesiotape,
etc.) Select all that apply.
• Less than 30 minutes • None
• 30–44 minutes • OCS
• 45–59 minutes • SCS
• 60 minutes or more • FAAOMPT
• Other APTA board certification
13) During return visits, how much time (on average) do • Graduated from APTA orthopedic residency program
you spend one-on-one (not including time with • Graduated from APTA sports residency program
physical therapy assistant or aide) with a • PhD
patient? • DHS
• DsC
• • ATC
15 minutes or less •
• 16–29 minutes MDT
• • Other free text
30–44 minutes
• 45–59 minutes
• 60 minutes or more 18) What is your terminal physical therapy degree?

13a) What percentage of your patient caseload do you delegate to

• PT
physical therapy ASSISTANTS?
• MPT
• DPT

1770 Physical Therapy Volume 100 Number 10 2020