Journal of Orthopaedic & Sports Physical Therapy

Official Publication of the Orthopaedic and Sports Physical Therapy Sections of the American Physical Therapy Association
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Christos Karagiannopoulos, MPT, MEd, ATC 1 Michael Sitler, EdD, ATC 2 Shipping/Billing Information 3 Susan Michlovitz, PT, PhD, CHT

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Reliability of 2 Functional Goniometric Methods for Measuring Forearm Pronation And Supination Active Range of Motion
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Name _______________________________________________________________________________________________ Address _____________________________________________________________________________________________ Address Design: Test-retest reliability study. Study _____________________________________________________________________________________________ important for clinical identificaObjectives: To determine intra- and intertester reliability of the hand-held pencil (HHP) and the tion City _______________________________State/Province __________________Zip/Postal of impairments, functional Code _____________________ plumbline goniometer (PLG) methods for measuring active forearm pronation and supination limitations, and monitoring effimotions in individuals with and without injuries. cacy of interventions during the Phone _____________________________Fax____________________________Email _____________________________ Background: The distal forearm method has been considered the gold standard for measuring rehabilitation process.6 forearm pronation receive JOSPT email updates and renewal notices? Would you like to and supination motion. The HHP and PLG, however, are 2 more functional I No I Yes The distal forearm method is methods for measuring forearm motions, though limited information on the psychometric the most common measurement properties of these tests is currently available. Methods and Measures: Intra- and intertester reliability of the HHP and PLG methods were technique used and is considered Payment Information convenience (20 injured and 20 noninjured). Two testers performed 3 the gold standard for measuring determined in 40 subjects of repeated measurements for each motion and method on all subjects. Intraclass correlation pronation and supination AROM.5 I coefficients (ICC for intratester reliability, ICC for intertester reliability) and standard error of Check enclosed (made payable to the JOSPT). 3,1 2,3 This method consists of aligning a measurements (SEMs) were determined. I Credit Card (circle one) MasterCardpronation and supination using the HHP and PLG goniometer’s stationary arm paralVISA American Express Results: The ICCs for the measurements of lel to the humerus anterior methods were high (range, 0.86-0.98) for individuals with and without injuries, with the reliability midline while the moving arm is Card Number ___________________________________Expiration for the _________________________________________ for the PLG method being equal or slightly greater than the HHP method Date majority of placed on the volar or dorsal distal pronation and supination measurements. Intratester ICCs were higher (SEMs were conversely 14 A limitation of the Signature ______________________________________Date __________________________________________________ lower) than intertester ICCs for nearly all measurements. The ICC values were generally the same forearm. distal forearm method is that it or higher for individuals with injuries compared to individuals without injuries. Conclusions: The HHP and PLG are highly reliable methods for measuring functional forearm requires measuring pronation and pronation and supination. Because plumbline To order are not commercially available and the supination AROM in a nonfuncgoniometers call, fax, email or mail to: instrumentation for the HHP method is readily accessible, clinicians should consider the latter as tional manner,5 as it does not 1111 North forearm Street, and supination. J Orthop Sports simulate their method of choice for measuring functional Fairfax pronationSuite 100, Alexandria, VA 22314-1436 many manual activities of Phys Ther 2003;33:523-531. Phone 877-766-3450 • Fax 703-836-2210 • Email: subscriptions@jospt.org daily living that combine forearm rotation and hand use. Current Key Words: goniometry, radioulnar joints, upper extremity Thank you for subscribing! clinical standards stress the use of functional methods for measuring he amount of active range of motion (AROM) for forearm and restoring physical capacity. Aspronation and supination can be altered by disruption of sessment of functional pronation the radioulnar and radiocarpal joints’ biomechanics result- (eg, pronation combined with ing from trauma and inflammatory processes.8 Reliable gripping) and supination AROM methods for assessing pronation and supination AROM are should include methods that measure concurrent radioulnar joint ro1 Senior Physical Therapist, Temple University Physical Therapy, Temple University Hospital, Philadel- tation (proximal and distal) and phia, PA. accessory wrist motion4,10 at the 2 Chair, Department of Kinesiology, Temple University, College of Education, Philadelphia, PA. 5 3 Professor, School of Physical Therapy, Temple University, College of Health Professions, Philadelphia, radiocarpal and midcarpal joints. The hand-held pencil (HHP) PA. Work for this study was done in partial fulfillment of the requirements for the degree Master of Education. and plumbline goniometer (PLG) The research protocol was approved by the Institutional Review Board of Temple University. Send correspondence to Christos Karagiannopoulos, Temple University Hospital, Outpatient Building, 5th are the only 2 reported assessment methods that present the potential Floor, 3401 North Broad Street, Philadelphia, PA 19140. E-mail: karagianopou@netcarrier.com

RESEARCH REPORT

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Intratester reliability for the measurement of passive pronation and supination range of motion has been reported (ICC = 0. The first group consisted of a sample of convenience of 20 subjects with recent injuries (10 males. left. Sex F M M M F M F M F F M M M F M F M F F F Age (y) 49 36 39 33 56 44 38 71 80 37 31 57 38 65 60 50 54 59 77 46 Diagnosis R elbow epicondylectomy L distal humerus fracture R radial head fracture L proximal ulnar fracture L radial head fracture R lateral epicondyle release L distal radius fracture L scapholunate ligament repair R distal radius fracture L radial head fracture R scaphoid fracture R distal radius fracture R distal radius fracture L metacarpal fracture L scaphoid fracture R lateral epicondyle fracture L distal radius fracture L metacarpal fracture L distal radius fracture L distal radius fracture 524 J Orthop Sports Phys Ther • Volume 33 • Number 9 • September 2003 . Subject Number 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Abbreviations: M.5 Neither intra. forearm. The dependent variable was AROM. The outcome of this study is intended to improve clinical examination technique by determining the reliability of 2 functional methods for assessing forearm motion.5 The purpose of this study was to determine the intra. R. forearm. or elbow trauma (Table 1). pain or deformity secondary to rheumatoid disease. right.and intertester reliability for measurements using the distal forearm method in subjects with injuries range from 0. The independent variables were measurement method (HHP and PLG). hand.87 and 0.3 consists of measuring pronation and supination with the goniometer aligned with a pencil held in the hand of the person being measured.5 consists of measuring pronation and supination with a plumb line attached to a hand-held single-arm goniometer. The subjects in this group were patients at Temple University Department of Orthopaedic Surgery and Sports Medicine at Northeastern Hospital and were seen within 1 to 10 weeks following forearm immobilization due to hand. Diagnoses and demographics of subjects with injuries. The PLG method.and intertester reliability of the HHP and PLG methods for measuring active forearm pronation and supination in individuals with and without injuries. tester (1 and 2). wrist.95) for the PLG method but for subjects with injuries only. METHODS Research Design Two testers performed 3 measurements of pronation and supination with both methods within a single testing session.and intertester reliability of the HHP and PLG methods in a population with injuries. and inability to touch the distal palmar crease with the tips of the second through the fifth digits TABLE 1.98. or elbow musculoskeletal injuries not treated via immobilization. female. which was first described by McRae13 and later modified by Clarkson and Gilewich.79 to 0.nor intertester reliability has been reported for the HHP method. motion (pronation and supination).for measuring functional pronation and supination. 10 females) who were on average (± SD) 51 ± 14. F. male.1. Exclusion criteria were: neurological pathologies resulting in paralysis or paresis of the arm. The HHP method. L. which was first described by Flowers et al. and group (injured and noninjured). wrist. This group was used to determine the intra.5 years of age (range. Limited psychometric testing has been conducted on the 3 aforementioned methods of measuring active and passive range of motion of the forearm in pronation and supination. Intra. Subjects Two independent groups of subjects participated in the study. 31-80 years).

hand dominance. palmar aspect of the hand facing medially with the thumb directed upwards) (Figure 2). Instrumentation Data Recording Forms A demographic data form was used to collect subject age. ipsilateral arm fully adducted to the side. The exclusion criteria were limited to the neurological pathologies. and upperextremity musculoskeletal injuries as identified for the subjects with injuries. 12 females). the tester turned the goniometer and read the exposed side of its central scale. rheumatoid disease complications. 10°.5-cm-long arms were used for the HHP method. and toothbrush use. the tester aligned the goniometer’s movement arm parallel to the pencil while the axis and stationary arms remained at their initial positions (Figure 3). A separate form was used to record the pronation and supination AROM values measured for the HHP and PLG methods. The string of the plumbline was free to move about its axis of rotation at the center of the goniometer’s central scale. Then. All subjects were employees or patients at the aforementioned medical facility. and movement arm parallel to the pencil (Figure 2). scissor use. The same goniometer was used for all HHP measurements for both testers.54-cm-diameter tubular handle was attached at the goniometer’s midpoint at a 90° angle.2 a 5-item questionnaire based on writing. The pencil extended from the radial aspect of the subject’s hand. The forearm was unsupported and placed in a neutral position (ie. The goniometer was positioned as follows: axis aligned with the head of the third metacarpal. Plumbline goniometer.12 Plumbline Goniometer A 14. Data were recorded for each subject and each tester on a separate form to minimize tester bias. sex. All pronation and supination AROM measurements were taken with reference to the neutral. The second group consisted of a sample of convenience of 20 subjects without injuries (8 males.11 The goniometer was repositioned to 0° prior to each measurement. The study was approved by the Temple University Institutional Review Board. For this method. position. One side of the goniometer’s central scale was covered with white adhesive paper to minimize tester bias during each measurement. who were on average (± SD) 41 ± 13 years of age (range. and elbow flexed to 90°. drawing. A 5° increment goniometer was selected due to its common use in the clinical setting and the fact that measurement fluctuation of up to ± 5° is usually expected and attributed to instrument error. MA) with a central 360° scale in FIGURE 1. 20-74 years). This angle allowed the plumbline goniometer to be positioned horizontally over the radial aspect of the hand while the subject held the tubular handle. feet flat on the floor. forearm horizontal to the floor. 5° increments. The goniometer’s central scale was positioned with its covered side facing the tester. Goniometric measurements were repeated 3 times each for pronation and supination. When the patient reached maximum active pronation or supination. throwing.5-cm-long single-arm plastic goniometer with a plumbline attached to the center of its 360° central scale5 was used for the PLG method (Figure 1). This group was used to determine the intra. HHP Goniometric Measurement Method Pronation and supination AROM using the HHP method were measured via a standardized testing protocol as described by Clarkson and Gilewich. The central scale of the plumbline goniometer had identical degree increments as the central scale of the HHP goniometer. stationary arm perpendicular to the floor. A 2. Subjects read and signed an informed consent prior to participating in the study. Hand-Held Universal Goniometer A plastic goniometer (AliMed. Measurements were rounded to the closest 5° increment (eg. The full-fist criterion was required for testing for both measurement methods. and two 14. 5°. The same plumbline goniometer was used for all PLG measurements for both testers. Dedham. each subject held a 15-cm-long pencil in a tight full fist. Hand dominance was determined via the modified Edinburgh Handedness Inventory.3 Measurements were conducted with each subject seated in an armless chair in a comfortable erect position with hips and knees flexed to 90°. 15°). or 0°. and presence of inclusion and exclusion criteria information.when making a full fist.and intertester reliability of the HHP and PLG methods in a population without injuries. Dominance was defined as the hand with the highest number of positive responses. 525 RESEARCH REPORT J Orthop Sports Phys Ther • Volume 33 • Number 9 • September 2003 .

measurements were taken on the injured arm. Neutral forearm position for the hand-held pencil method. A measurement was taken when the subject reached maximum active pronation or supination with the plumbline lying flush on the surface of the goniometer’s central scale without oscillating (Figure 5). Measurement of active range of motion in supination with the hand-held pencil method. or 0°. The tester rotated the goniometer handle in the subject’s hand to a horizontal position. Each subject held the plumbline goniometer by its tubular handle in a tight full fist (Figure 4).5 Measurements were conducted with each subject seated in the same position as for the HHP method. Order of testing for measurement method (HHP and PLG) and motion (supination and pronation) were randomized by coin flip within each group for each subject. Three repeat measures were completed on each FIGURE 2. The testers were 2 male physical therapists with 2 and 4 years of professional experience and no prior clinical exposure to the HHP and PLG methods. The tester manually stopped any oscillatory movements of the plumbline prior to reading the value. Testers used the same instrument for each method to complete all measurements. allowing the plumbline to make full contact with the goniometer’s central scale. For subjects without injuries. The plumbline was placed medial to the hand for the measurement of pronation and lateral to the hand for supination. J Orthop Sports Phys Ther • Volume 33 • Number 9 • September 2003 . For the subjects with injuries. 526 FIGURE 3. Privacy of each tester’s recording form was ensured during measurements to prevent tester bias. and the order of testing for the testers was also randomized. Testers were formally trained on each method and practiced each method on 10 subjects without injuries prior to the study. and turn their palms towards the ceiling as far as possible prior to each supination measurement. position (Figure 4). All pronation and supination AROM measurements were taken with reference to the neutral. subjects were stratified into 1 of 2 groups (noninjured or injured). Subjects were positioned as aforementioned and asked to turn their palms towards the floor as far as possible prior to each pronation measurement. Goniometric measurements were repeated 3 times each for pronation and supination. All subjects were measured by 2 testers.Procedures After completion of the demographic data form. measurements were taken on the dominant arm. PLG Goniometric Measurement Method Pronation and supination AROM using the PLG method were measured via a standardized testing protocol as described by Flowers et al. Each tester read and recorded his own goniometric measurements in separate recording forms.

hand-held pencil. injured group (n = 20).3 was used to calculate the intertester reliability.9. subject by both testers within the same test session. The mean value from the 3 trials of each tester was used in the intertester reliability analysis for each method.92 to 0. which had FIGURE 4. and ICC2.16 the lowest ICC value (highest SEM value).90 50-110 90-128 55-108 88-125 Mean ± SD 76 ± 15 78 ± 11 75 ± 11 78 ± 9 82 ± 16 104 ± 12 80 ± 14 101 ± 11 PLG Range 43-100 53-100 48. ICC values were interpreted as follows: equal to or greater than 0. Neutral forearm position for the plumbline method. 0.40 were classified as poor.and intertester reliability of the HHP and PLG methods. SEM values ranged from 1.98 60. 527 J Orthop Sports Phys Ther • Volume 33 • Number 9 • September 2003 . ICC values for the 2 methods ranged from 0. NIG. IL) was used to analyze the data. Chicago.95 55. The PLG had the same or lower SEM values than the HHP within testers but higher between testers. Data Analysis Intraclass correlation coefficients (ICC) and standard error of measurements (SEM) were used to determine the intra. Descriptive statistics for measurement of active range of motion (in degrees) of the forearm with the hand-held pencil and plumbline goniometer techniques. Intratester ICCs were higher (SEMs were conversely lower) than intertester ICCs (SEMs were conversely higher) for both goniometric measurement methods except HHP pronation measurement for tester 2. PLG.75 were classified as high. These values are based on the average of trial 2 and 3 made by each tester. The PLG method had the same or higher ICC values than the HHP method except for intertester pronation. Subjects With Injuries The intra. HHP Motion Pronation Tester 1 2 Supination 1 2 Group IG NIG IG NIG IG NIG IG NIG Mean ± SD 76 ± 12 79 ± 10 78 ± 10 79 ± 8 81 ± 16 103 ± 10 80 ± 14 101 ± 11 Range 48-100 55..16 ICC calculations were based on the 20 subjects for each reliability measure.90 50-115 90-130 55-115 88-125 Abbreviations: HHP. RESEARCH REPORT RESULTS Descriptive statistics for pronation and supination AROM using the HHP and PLG methods for each tester are reported in Table 2. respectively. The testers visually inspected the subjects’ body positions prior to and during each trial to ensure proper body and arm alignment.98.4° to 3. The Statistical Package for Social Sciences for Windows 10.1.TABLE 2.6°. and below 0. From the 3 trials for each motion. The same type of chair was utilized for all measurements. IG. Inc. the second and third trials of both testers were used to calculate the intratester reliability for each method. ICC3.1 (SPSS.95 55.75 were classified as moderate. plumbline goniometer.and intertester ICC and SEM values for pronation and supination AROM for the HHP and PLG methods for the subjects with injuries are reported in Tables 3 and 4.40 to 0. Values are based on the average of trial 2 and 3 made by each tester.1 was used to calculate the intratester reliability for each tester. noninjured group (n = 20).

4.8 ICC 0. A variety of assessment instruments to measure forearm pronation and supination have been used in the clinical setting. Pronation Tester 1 Group Injured Noninjured Method HHP PLG HHP PLG ICC 0.86-0.96 0.97 0.and intertester ICC values were the same or higher for the individuals with injuries compared to individuals without injuries.and intertester measurements.1 2. No consistent pattern of differences existed in the ICC and SEM values of the PLG and HHP methods for intra.0 ICC 0. SEM.15 The HHP3 and PLG5 methods allow for functional measurement of forearm pronation and supination AROM but have not been thoroughly assessed for psychometric properties. Measurement of active range of motion in pronation for the plumbline method.and intertester ICC values (range. The same was not true for SEM values. standard error of measurements.2 2. For individuals with and without injuries alike. 528 J Orthop Sports Phys Ther • Volume 33 • Number 9 • September 2003 .98 0. A comparison of the 2 methods revealed that the PLG had the same or slightly higher ICC values than the HHP method for all measurements except for intertester pronation FIGURE 5.1 2. DISCUSSION The forearm and wrist constitute a multi-joint system which primary function is to position the hand in space during pronation and supination.2 2.13.96 0.98 0. plumbline goniometer.4° to 3.86 0.98 0.0 1. except for HHP pronation for tester 1. intraclass correlation coefficients.98 Tester 1 SEM 2.97 SEM 2. hand-held pencil. which did not display a consistent relationship between the 2 groups.94 Supination Tester 2 SEM 1.values ranged from 1.9°.86 to 0.8 1. The highest SEM value existed in the HHP intertester supination measurement.1 2.and intertester ICC and SEM values for pronation and supination AROM for the HHP and PLG methods for the subjects without injuries are reported in Tables 3 and 4.1 1. HHP.9 1. There is no previous reliability study that has presented such a comparison in measuring active range of motion for pronation and supination. Comparison Between Subjects With and Without Injuries Intra.6 Abbreviations: ICC. respectively.98 0.98 0.98 0.5 ICC 0.8 1. Establishing psychometric properties of these methods for individuals with and without injuries provides important information useful for clinical practice and future research. Intratester pronation and supination intraclass correlation coefficients and standard error of measurements (in degrees) of each tester for subjects with and without injuries. PLG.95 Tester 2 SEM 2.98. SEM TABLE 3. the HHP and PLG methods produced high16 pronation and supination intra.95 0. Intratester ICCs were higher (SEMs were conversely lower) than intertester ICCs (SEMs were conversely higher) for both goniometric measurement methods except for the HHP pronation and PLG supination measurements for tester 2.96 0.7. 0.4 2.4 2.98). Subjects Without Injuries The intra. ICC values for the 2 methods ranged from 0.

9 2. and radial and ulnar deviations when using a universal goniometer. plumbline goniometer. except for the intratester HHP pronation and PLG supination measurements (tester 2) for subjects without injuries. This result was not anticipated as greater measurement variability and error was expected in subjects with injuries.95 0. potential sources of experimental error included lack of standardization for pain and assessment time postimmobilization.4 3.than intertester reliability for active pronation and supination AROM measurements using the distal forearm method. whereas the PLG method did not.and intertester supination measurements for the subjects with injuries. The slightly higher PLG ICCs could be attributed to instrument and methodology differences between the 2 methods. in both groups.and intertester ICC values with the HHP method for forearm pronation and supination in both groups is not clear. Horger9 also reported higher intra. except for measurements of pronation for tester 1. These findings were anticipated because a lower error of measurement is typically associated with repeated measurements conducted by a single rather than multiple testers. using a goniometer with 5° scale increment. standard error of measurements. which was not calibrated prior to measurements. In our study. SEM.or lower-extremity goniometric assessment.9 3.96 0. It would be expected that the aforementioned instrumentation differences would lead to higher ICC values for all conditions. No study to date has determined reliability differences between subjects with and without injuries for any upper. SEM values for subjects without injuries were the same or higher than for the subjects with injuries for all HHP measurements. Armstrong et al1 reported higher intra. This result was not anticipated because measurement error would be more difficult to control for subjects with injuries than for subjects without injuries. PLG. The HHP required tester identification of bony landmarks and goniometer alignment.4 3.and intertester reliabilities for assessing functional pronation and supination AROM. but did not include subjects without injuries in their study. except for the measurement of HHP pronation for tester 1. lack of control of subjects’ clothing. Because the gravitational force line is always perpendicular to the ground. Such an inverse relationship between ICC and SEM values is expected.0 3. Intratester ICCs were higher (SEMs were conversely lower) than intertester ICCs (SEMs were conversely higher) for both measurement methods among all subjects. Because ROM measurement reliability depends on factors such as patient population and type of injury. In contrast to the ICC findings. the higher the ICC value the lower the SEM value. hand-held pencil. This inverse relationship between ICC and SEM values was consistently seen among all subjects except for intra. the PLG method negated the tester’s dual responsibility of aligning and reading the goniometer during a measurement. 0. the SEM values followed an inconsistent relationship between subjects with and without injuries.96) for elbow flexion and extension AROM in subjects with injuries.91 SEM 2. Therefore. the reason for the same or higher intra. AROM measurements with a 1° scale increment goniometer eliminate the need for estima529 RESEARCH REPORT J Orthop Sports Phys Ther • Volume 33 • Number 9 • September 2003 . extension.6 The ICC values obtained on the measurements made on the subjects with injuries were the same or higher than the ICC values obtained on the subjects without injuries.than intertester reliability for measurements of range of motion for active wrist flexion.96 Supination SEM 2. SEM values for subjects with injuries were higher than for the subjects without injuries for all PLG measurements. Such findings may be attributed to the greater range of motion variability among the subjects with injuries.96 0. and for intratester pronation (tester 1) and intratester supination (tester 2) in subjects without injuries.90-0. as indicated by the larger standard deviation values. The PLG method consisted of rotation of the hand-held instrument by the subject and tester assessment of joint motion via the constant gravitational force line of the plumbline.6 2. ICC. Typically.2 Abbreviations: HHP. except for the measurement of pronation for tester 1 and supination for tester 2. Rothstein et al17 reported high ICC values (range. as measurements of greater reliability are associated with lower experimental error. Pronation Group Injured Noninjured Method HHP PLG HHP PLG ICC 0. Accordingly. Intertester pronation and supination intraclass correlation coefficients and standard error of measurements (in degrees) for subjects with and without injuries.0 ICC 0. greater measurement error was expected among the subjects with injuries regardless of measurement method. In general. intraclass correlation coefficients.92 0.94 0. No study to date has reported on the differences between intra.TABLE 4.6 comparisons between noninjured and injured populations should be joint or injury specific prior to making generalizations for clinical practice.92 0.

and intertester reliability for measuring forearm pronation and supination AROM in subjects with and without injuries. respectively. Not covering the dial of the plumbline goniometer was not considered a threat to intratester reliability of the PLG method in this study because AROM was controlled by the subject and measurement simply consisted of only reading without aligning the goniometer by the tester. Measuring handedness with questionnaires. Graham TJ. Armstrong AD. subjects were not allowed to look at the goniometer and verbal instructions to each subject were standardized to avoid coaching the subject to the previous angle during PLG measurements. Hotchkiss RN. Current clinical standards require the use of functional methods for measuring and restoring patients’ physical capacities. MPT. J Anat. Glanville AD.5-7. the latter should be considered the method of choice by clinicians for measuring functional forearm pronation and supination. These values were similar to those reported by both Glanville and Kreezer7 (99° ± 11°) and Darcus and Salter4 (102° ± 11°) for subjects without injuries. Flowers KR. 1937.14:30-35. Darcus HD. Variability in functional pronation AROM among these studies is attributed to differences in instrumentation (eg. LaStayo P. Gilewich GB. 2. REFERENCES 1. 9.7:573-580. The maximum amplitude and velocity of joint movements in normal male human adults. Am J Occup Ther. Fischer TJ. Glanville and Kreezer7 and Darcus and Salter4 reported functional pronation values of 91° ± 26° and 63° ± 10°. age. A future multicenter reliability study that compares today’s gold standard distal forearm method to either the HHP or PLG method on a larger sample of subjects with injuries using multiple measurement sessions may offer a greater external validity of results and finally answer. 5. Clinical measurement of range of motion. Although we believe that masking the HHP method goniometer and recording AROM values in separate forms for each tester during measurements provided adequate blinding in this study. King GJ. In an attempt to improve the clinical examination technique of functional forearm motion. 1987. subjects of convenience. ACKNOWLEDGMENTS Thanks to Matthew Spiegler. Interestingly. 2001. Bryden MP. random. Although both methods seem to be reliable.4-3. In the current study. The values for forearm supination obtained with the HHP and PLG methods in the current study were 103° ± 10° and 104° ± 12°.0) than the SEM values reported by Horgen9 (range. a doubleblind study design would have offered lower threat to intratester reliability.0) for wrist AROM measurements obtained via a 1° scale increment goniometer in subjects with injuries. The quality of this study’s intertester reliability values was protected by having testers blinded to each other’s results by using separate recording forms and ensuring the privacy of these forms during measurements. Galante BL. Kreezer G. the question of which method (nonfunctional versus functional) is the most reliable for measuring forearm pronation and supination.87:169-184. Disorders of the forearm axis.14:305316. MD: Williams and Wilkins. grip force). 8. 1989. this study’s outcome supports the clinical use of both the HHP and PLG methods. Salter N. Neuropsychologia.67:1867-1872. Musculoskeletal Assessment: Joint Range of Motion and Manual Muscle Strength. once and for all. Review of goniometry emphasizing reliability and validity. 4. Hand Clin. 3. Hum Biol. our study’s forearm AROM measurements obtained with a 5° scale increment goniometer resulted in lower SEM values (range.15:617-624. Such a limitation may have decreased the anticipated higher measurement variability and experimental error among subjects with injuries. J Hand Ther. 7. 6. at present. who so diligently offered his substantial participation in the data collection process of this study. Kleinman WB.tion of readings over a 5° interval and are expected to have lower SEM values than measurements with a 5° scale increment goniometer. sex). Because plumbline goniometers are not commercially available and the instrumentation for the HHP is readily accessible in the clinical setting. pronation values (mean ± SD) obtained with the HHP and PLG methods for subjects without injuries were 79° ± 8° and 78° ± 9°. 1998. 1990. A final limitation of this study was the lack of significant AROM restriction found among the individuals with injuries. Gajdosik RL. The reliability of goniometric measurements of active and passive wrist motions. The amplitude of pronation and supination with the elbow flexed to a right angle. 1998. The slightly higher reliability of the PLG method is offset by the simplicity and availability of the instrumentation needed for the HHP method.44:342-348. 1953. Phys Ther. the HHP method is a more accessible and cost-effective instru530 mentation for today’s clinical settings. Stevens RS. 1977. for subjects without injuries. J Shoulder Elbow Surg. Reliability of range-of-motion measurement in the elbow and forearm. J Orthop Sports Phys Ther • Volume 33 • Number 9 • September 2003 . Chinchalkar S. Horger MM. respectively. MacDermid JC. In addition. Bohannon RW.9:197-211. respectively. CONCLUSIONS Results of this study demonstrated that the HHP and PLG methods have both high intra. Baltimore. Intrarater reliability of a new method and instrumentation for measuring passive supination and pronation: a preliminary study. Clarkson HM. 1. Stephens-Chisar J. 2. and subject sampling (eg. handle size.

Watkins MP. J Bone Joint Surg Am. UK: Churchill and Livingstone. 12. CT: Appleton and Lange. Goniometric reliability in a clinical setting. A study of supination and pronation with especial reference of the treatment of forearm fractures. Measurement of Joint Motion: A Guide to Goniometry. Norwalk.27-39. 1986.28:737-748.62:227-229. 11.65:92-94.10. Norkin CC. 1993. 1984. Patrick J. Clin Orthop. Roettger RF. Foundations of Clinical Research: Applications to Practice. 1985. Mayerson NH. Portney LG. 1981. McRae R. 1946. RESEARCH REPORT J Orthop Sports Phys Ther • Volume 33 • Number 9 • September 2003 531 . 17. Elbow and knee measurements. The reliability of joint measurement. 13. Rothstein JM. 14. 1983. Phys Ther. PA: FA Davis. 1976.63:1611-1615. Linscheid RL. Milano RA. Goniometric measurement reliability in physical medicine. Miller PJ. Clinical Orthopaedic Examination. Philadelphia. Kinematic considerations of the wrist. Low JL. Arch Phys Med Rehabil. Edinburgh. White DJ. 15. Physiotherapy. 16.