Annals of International Occupational Therapy

Original Research 

Intrarater and Interrater Reliability of Goniometric and Trigonometric-Ruler Measurements of Metacarpophalangeal Hyperextension

Siaw Chui Chai, PhD; Grace Z. Chen, MS, OTR/L; Natasha F. Milard, MS, OTR/L; Jane Bear-Lehman, PhD, OTR/L, FAOTA

Abstract

Introduction:

This study evaluated the intrarater and interrater reliability of three methods for measuring metacarpophalangeal hyperextension: the goniometric-volar (G-Volar) approach, goniometric-lateral (G-Lateral) approach, and trigonometric-ruler (T-Ruler) method.

Methods:

Two occupational therapy graduate students measured hyperextension of the second and fifth metacarpophalangeal joints of 32 participants with all three methods: G-Volar, G-Lateral, and T-Ruler.

Results:

The respective findings for intrarater and interrater reliability for the T-Ruler method were moderate to good (intraclass correlation coefficient [ICC] = 0.57 to 0.80, 0.51 to 0.77). For the G-Volar approach, they were moderate to good (ICC = 0.63 to 0.89) and poor to good (ICC = 0.46 to 0.75). For the G-Lateral approach, they were poor to good (ICC = 0.07 to 0.76, −0.01 to 0.59).

Conclusion:

The T-Ruler method had more consistent findings for intrarater and interrater reliability. We recommend further study of this method to determine its potential clinical use for measuring metacarpophalangeal hyperextension. [Annals of International Occupational Therapy. 2018; 1(3):147–156.]

Abstract

Introduction:

This study evaluated the intrarater and interrater reliability of three methods for measuring metacarpophalangeal hyperextension: the goniometric-volar (G-Volar) approach, goniometric-lateral (G-Lateral) approach, and trigonometric-ruler (T-Ruler) method.

Methods:

Two occupational therapy graduate students measured hyperextension of the second and fifth metacarpophalangeal joints of 32 participants with all three methods: G-Volar, G-Lateral, and T-Ruler.

Results:

The respective findings for intrarater and interrater reliability for the T-Ruler method were moderate to good (intraclass correlation coefficient [ICC] = 0.57 to 0.80, 0.51 to 0.77). For the G-Volar approach, they were moderate to good (ICC = 0.63 to 0.89) and poor to good (ICC = 0.46 to 0.75). For the G-Lateral approach, they were poor to good (ICC = 0.07 to 0.76, −0.01 to 0.59).

Conclusion:

The T-Ruler method had more consistent findings for intrarater and interrater reliability. We recommend further study of this method to determine its potential clinical use for measuring metacarpophalangeal hyperextension. [Annals of International Occupational Therapy. 2018; 1(3):147–156.]

Measuring joint range of motion is an important component of the evaluation process in occupational therapy practice. Assessment of range of motion is used to determine which joints have a limitation that impairs day-to-day hand use. This assessment also allows the occupational therapist to set intervention goals that reflect the probable cause of the observed limitations and design an effective restorative or compensatory plan for identifying appropriate adaptive devices. For a restorative plan, it is important to establish baseline measurements that can be obtained serially to reflect changes in joint capacity over time and evaluate the effectiveness of therapeutic interventions (Ellis, Bruton, & Goddard, 1997; Killingsworth, Pedretti, & Pendleton, 2013; Metcalf & Notley, 2011; Norkin & White, 2009; Rose, Nduka, Pereira, Pickford, & Belcher, 2002). The metacarpophalangeal (MCP) joints allow the hand to fully open and fully close for effective functional hand positioning and precision (Rath, 2011). Articulating between the head of the metacarpal and the base of the proximal phalanx, the MCP has a condyloid configuration that allows for both flexion-extension and abduction-adduction movements, and accurate measurement is essential (Moore, Dalley, & Agur, 2010). For extension-flexion, the methods for measuring the MCP are well documented and indicate an expected range from 0° extension to 90° flexion, with greater expected MCP flexion in the two ulnar digits to achieve complete hand grasp. There is little documentation of effective methods to measure MCP hyperextension goniometrically. Hyperextension of the MCP is required to bear weight on the hand and to open the hand to reach and begin to execute the needed grasp to hold on to an object. Clinical experience suggests that the average range of MCP hyperextension is 15° to 45° (Killingsworth et al., 2013). Most activities of daily living require and can be completed within 11° to 14° of MCP hyperextension (Hayashi & Shimizu, 2013). Measuring MCP hyperextension serially is important for setting and monitoring occupational therapy intervention strategies for skin, soft tissue, joint, or muscle changes that can lead to significant functional limitations or even deformity of the hand. Examples include occupational therapy management of thermal hand burns to restore hand use and prevent claw hand deformity (Sabapathy, Bajantri, & Bharathi, 2010) and potential progression of untreated boutonnière deformity associated with rheumatoid arthritis that could result in fixed MCP hyperextension (Williams & Terrono, 2008). Measuring MCP hyperextension is also important in diagnosing hypermobility syndrome, and a key criterion for diagnosis is the ability to hyperextend the MCP with the digits parallel to the dorsum of the forearm (Biro, Gewanter, & Baum, 1983).

Goniometry, visual estimation, wire tracing, composite finger flexion, and motion analysis systems are methods used to assess digital range of motion (Bruton, Ellis, & Goddard, 1999; Chiu, Lin, Su, Wang, & Hsu, 2000; Rose et al., 2002). For measurement of MCP hyperextension, goniometry is the conventionally used method, with the goniometer placed either on the volar aspect of the joint (volar approach) (Adams, Greene, & Topoozian, 1992; Clarkson, 2006; Norkin & White, 2009) or the lateral aspect of the joint (lateral approach) (Killingsworth et al., 2013; Klein, 2014). The lateral approach is often used when the volar approach is difficult, typically when the finger has a long, curved fingernail that prevents the goniometer from contacting the volar surface or when the hand has edema, scar tissue, or other malformations (Adams et al., 1992; Norkin & White, 2009). Use of the lateral approach is limited by allowing direct measurement of only the second and fifth digits with the goniometer, requiring visual estimation for the third and fourth digits (Killingsworth et al., 2013). We proposed the use of the trigonometric-ruler (T-Ruler) method to address limitations of the volar and lateral approaches to goniometry for measuring MCP hyperextension. In current clinical practice, the ruler is used to measure digital extension deficit (Salter & Cheshire, 2000), thumb opposition to each digit, MCP abduction-adduction, and digital flexion to the distal palmar crease or composite finger flexion (Adams et al., 1992). The T-Ruler method uses two linear (distance) measurements to obtain an angular measurement of MCP hyperextension: (a) the distance between the midpoint of the proximal interphalangeal crease and the proximal palmar crease of the second digit or the distal palmar crease of the third, fourth, and fifth digits and (b) the vertical distance achieved between the proximal interphalangeal crease as the digit lifts into MCP hyperextension from its palmar resting position on a flat surface, such as a table (Figure 1). Trigonometric calculation is performed with these two measured distance values to obtain the degree of MCP hyperextension. The T-Ruler method minimizes problems with goniometry because there is no direct contact with or pressure on the digit; in addition, it directly measures every digit instead of using visual estimation for the third and fourth digits.

Trigonometric-ruler measurement of metacarpophalangeal hyperextension of the second and fifth digits.

Figure 1:

Trigonometric-ruler measurement of metacarpophalangeal hyperextension of the second and fifth digits.

According to psychometric theory, a measurement instrument must have good instrument reliability to have strong validity and support the interpretation of measurements (Cook & Beckman, 2006). Validity is the ability of an instrument to measure what it is intended to measure, and reliability is the ability of an instrument to produce consistent measurements of a given attribute (DeVon et al., 2007). Because measurements of range of motion are typically taken several times and often by different clinicians, having instruments with strong intrarater and interrater reliability is important for informing clinical decisions. Intrarater reliability is the consistency of measurements performed by a single clinician serially, and interrater reliability is the consistency of measurements performed by multiple clinicians (Marx, Bombardier, & Wright, 1999). Studies have found goniometry to be a more reliable method than wire tracing, which is a process of tracing a bent solder wire (i.e., after placing it along the dorsal aspect of the hand and bending it to conform to the angle of each joint) on a piece of paper (Ellis et al., 1997); visual estimation (Bruton et al., 1999); and composite finger flexion obtained repeatedly with a ruler by the same clinician (Ellis & Bruton, 2002). Goniometry also has shown stronger intrarater reliability than interrater reliability (Brand & Hollister, 1993; Lewis, Fors, & Tharion, 2010; Michels, 1982).

Although both the volar and lateral approaches to hand-based goniometry are recommended in standard practice guidelines and classic textbooks (Adams et al., 1992; Clarkson, 2006; Killingsworth et al., 2013; Klein, 2014; Norkin & White, 2009), it is well known that, when examining the effect of placement of the goniometer or the type of tool used, intrarater reliability is the strongest type of reliability in serial measurements (Brand & Hollister, 1993). Studies of the reliability of hand-based goniometry for measuring the MCP (Bruton et al., 1999; Lewis et al., 2010) did not focus on MCP hyperextension. Reliability studies of the ruler method have considered measurement of composite finger flexion and handspan (Edgar, Finlay, Wu, & Wood, 2009; Ellis & Bruton, 2002). When comparing the reliability of the ruler as used in composite finger flexion with that of goniometry in measuring digital range of motion, Ellis and Bruton (2002) noted that both methods yielded the same interrater reliability, although goniometry had slightly higher intrarater reliability. The clinical significance of those findings is that using the ruler for composite finger flexion was as reliable as using a goniometer for range of motion when measurements were taken by several clinicians. When only one clinician is taking measurements and the measurements are focused on one joint, then goniometry should be used. The ruler method showed excellent intrarater and interrater reliability when used for composite finger flexion and handspan measurements (Edgar et al., 2009).

The goal of our study was to establish a method to measure MCP hyperextension effectively. There is little evidence to guide therapists as to how to measure MCP hyperextension effectively with a goniometer or ruler. However, given the capacity of the MCP to achieve hyperextension in day-to-day hand use, it is important to establish the psychometric soundness of the instruments used to measure MCP status (DeVon et al., 2007). This study was conducted to determine the intrarater and interrater reliability of MCP hyperextension as measured with the goniometric-volar (G-Volar) approach, the goniometric-lateral (G-Lateral) approach, and the T-Ruler method.

Methods

Participants

We recruited a convenience sample of 32 adult volunteers. To recruit participants, we set up a table on a university campus in an area with high walking traffic. As curious individuals approached the table, the raters described the purpose of the study and asked those who agreed to participate for consent. Participants read and signed the New York University Institutional Review Board informed consent document before participating in the study. We included healthy volunteers who did not report hand injuries or conditions that would impair hand use (e.g., arthritis, cumulative trauma disorders). The volunteer participants were 19 to 65 years (M = 27.9, SD = 8.99), predominantly female (n = 22, 68.8%), and right hand dominant (n = 30, 93.8%).

Raters

Two full-time occupational therapy graduate students served as raters (rater A and rater B) and were not blinded to the goal of the study. Both raters completed measurement training given by an occupational therapist with expertise in hand assessment before data were collected.

Instruments

We used two types of goniometers. For the G-Lateral and T-Ruler measurements, we used the Baseline plastic pocket goniometer with a 180° head and 6-inch arms. This goniometer measures angular motion in 5° increments, and its linear scale measures distance in both inches and centimeters. According to the American Society of Hand Therapists guidelines (Adams et al., 1992), distance was recorded in centimeters. For G-Volar measurements, we used the Baseline 6-inch stainless steel finger/small joint goniometer, which has two opposing 180° scales marked in 5° increments (Figure 2).

Goniometric-volar and goniometric-lateral measurement of metacarpophalangeal hyperextension of the second and fifth digits.

Figure 2:

Goniometric-volar and goniometric-lateral measurement of metacarpophalangeal hyperextension of the second and fifth digits.

Procedure

We developed the protocol for the T-Ruler method ourselves and referenced the American Society of Hand Therapists guidelines (Adams et al., 1992) and textbooks (Clarkson, 2006; Killingsworth et al., 2013; Norkin & White, 2009) for the G-Volar and G-Lateral approaches. The raters received equal training in taking each measurement and were given procedural guidelines to use for reference for the study by an occupational therapist with expertise in hand assessment. To further familiarize the raters with the protocol and ascertain their ability to follow procedural guidelines, they practiced the measuring procedures on two students 1 week before formal data collection occurred.

Formal data collection took place over the course of 7 nonconsecutive days. The two raters sat 4 feet apart on the same side of a long table. Raters demonstrated each hand position to each participant and then asked the participant to actively position the hands for each measurement. Participants were asked to support their elbows on the table. The forearm was kept in neutral position for G-Volar and G-Lateral measurements. For the T-Ruler measurement, the forearm was fully supinated for measurement of the distance between the midpoint of the proximal interphalangeal crease and the proximal palmar crease or distal palmar crease. The forearm was pronated for the height measurement. Only the second and fifth digits were measured, fundamentally because the third and fourth digits are not accessible with the G-Lateral approach (Killingsworth et al., 2013). Raters took approximately 20 minutes to measure the second and fifth digits of both hands of each participant. Participants had brief rest breaks between measurements and raters.

Goniometric-volar measurements. Raters took G-Volar measurements (in degrees) of the second and fifth digits, respectively, by aligning the axis of the goniometer volarly over the MCP, with the stationary arm over the volar midline of the second and fifth metacarpal bones and the movable arm over the volar midline of the second and fifth proximal phalanges (Figure 2).

Goniometric-lateral measurements. Raters took G-Lateral measurements (in degrees) of the second and fifth digits, respectively, by aligning the axis of the goniometer laterally at the MCP, with the stationary arm over the lateral midline of the second and fifth metacarpal bones and the movable arm over the lateral midline of the second and fifth proximal phalanges (Figure 2).

Trigonometric-ruler measurements. Raters palpated the volar surface of the proximal phalanges of the second and fifth digits to locate landmarks for placing the ruler. The linear measurement (in centimeters) of the second digit was taken by aligning the ruler (i.e., the linear scale of the 180° plastic goniometer) over the midline of the second proximal phalanx, from the proximal palmar crease to the midpoint of the proximal interphalangeal crease of the second proximal phalanx. For height measurement (in centimeters), raters obtained the perpendicular height from the table surface to the middle of the second proximal interphalangeal joint at its radial aspect by instructing, “Please place your hand palm down on the table and raise all fingers off the table. Make sure to keep your palm fully on the table,” as shown in Figure 1. A similar measuring procedure was used for the fifth digit except that the proximal palmar crease was replaced with the distal palmar crease and the height was measured at the ulnar aspect of the fifth digit. We selected the proximal palmar crease as the landmark for the second digit and the distal palmar crease as the landmark for the fifth digit by referencing Terminology for Hand Surgery by the International Federation for Societies of the Hand (2001), which states that MCP flexion-extension takes place in a transverse line between the origin of the distal palmar crease on the ulnar aspect and the origin of the proximal palmar crease on the radial aspect. Because the base of the proximal phalanx is the articulating surface of the MCP, it is anatomically explainable to use the proximal palmar crease and the distal palmar crease as landmarks when the respective second and fifth digits perform MCP hyperextension. The final step was to convert the linear measure (in centimeters) of both distances of the second and fifth digits to an angular measure (in degrees) by trigonometric calculation (Figure 3).

Trigonometric calculation for metacarpophalangeal hyperextension.

Figure 3:

Trigonometric calculation for metacarpophalangeal hyperextension.

We designed the order of data collection by having each rater repeat the same measurements on the same participant until each participant was measured twice by each of the two raters, alternating between rater A and rater B. The typical order of measurements was rater A ➧ rater B ➧ rater A ➧ rater B. In a few cases, measurement started with rater B (i.e., rater B ➧ rater A ➧ rater B ➧ rater A) to allow measurement of two participants simultaneously. Raters encouraged participants to attain consistent hyperextension for each measurement by asking, “Is this as far as you can go?” They also asked participants to relax between measurements to avoid fatigue.

Data Analysis

Data were analyzed with SPSS Statistics, version 21. Descriptive statistics performed on range of motion are expressed as mean ± standard deviation (SD) and range. We used intraclass correlation coefficient (ICC) values (3, 1) for both intrarater reliability and interrater reliability analyses and interpreted the values according to the recommendations of Portney and Watkins (2009): greater than or equal to 0.90 = excellent; 0.75 to 0.89 = good; 0.50 to 0.74 = moderate; less than 0.50 = poor. By using the SD and ICC values obtained, we also calculated the standard error of measurement (SEM) for all measurements, based on the equation SD × √ (1 − ICC).

Results

The raters took a total of 48 MCP hyperextension measurements (i.e., obtaining G-Volar, G-Lateral, and T-Ruler measurements twice for the second and fifth digits of both hands, respectively, by rater A and rater B) for each participant. Summary of these measurements is shown in Table 1. By summing all of the measurements taken by both raters using all three methods and then averaging them, we obtained MCP hyperextension of 26.68° ± 5.71° for the right second digit; 26.08° ± 7.06° for the right fifth digit; 29.03° ± 6.09° for the left second digit; and 28.81° ± 6.74° for the left fifth digit.

Metacarpophalangeal Hyperextension as Measured by the Goniometric-Volar Approach, Goniometric-Lateral Approach, and Trigonometric-Ruler Method

Table 1:

Metacarpophalangeal Hyperextension as Measured by the Goniometric-Volar Approach, Goniometric-Lateral Approach, and Trigonometric-Ruler Method

Both G-Volar (ICC = 0.63 to 0.89; SEM = 5.98 to 9.95) and T-Ruler (ICC = 0.57 to 0.80; SEM = 6.79 to 11.19) measurements showed moderate to good intrarater reliability. In contrast, G-Lateral measurements had poor to good intrarater reliability (ICC = 0.07 to 0.76; SEM = 7.99 to 10.31) (Table 2).

Intrarater Reliability of the Goniometric-Volar Approach, Goniometric-Lateral Approach, and Trigonometric-Ruler Method for Measuring Metacarpophalangeal Hyperextension

Table 2:

Intrarater Reliability of the Goniometric-Volar Approach, Goniometric-Lateral Approach, and Trigonometric-Ruler Method for Measuring Metacarpophalangeal Hyperextension

Only T-Ruler measurements showed moderate to good interrater reliability (ICC = 0.51 to 0.77; SEM = 7.60 to 13.39). Both G-Volar (ICC = 0.46 to 0.75; SEM = 8.74 to 11.71) and G-Lateral (ICC = −0.01 to 0.59; SEM = 8.67 to 11.72) measurements had poor to good interrater reliability (Table 3).

Interrater Reliability of the Goniometric-Lateral Approach, Goniometric-Volar Approach, and Trigonometric-Ruler Method for Measuring Metacarpophalangeal Hyperextension

Table 3:

Interrater Reliability of the Goniometric-Lateral Approach, Goniometric-Volar Approach, and Trigonometric-Ruler Method for Measuring Metacarpophalangeal Hyperextension

Discussion

Our healthy adult volunteer participants averaged MCP hyperextension of 26.08° to 29.03°, as determined by the G-Volar, G-Lateral, and T-Ruler measurements (Killingsworth et al., 2013). All three measuring methods had higher intrarater reliability compared with interrater reliability, which is in agreement with published studies (Edgar et al., 2009; Gajdosik & Bohannan, 1987; Goodwin, Clark, Deakes, Burdon, & Lawrence, 1992; Lewis et al., 2010; Michels, 1982).

Although the G-Volar and G-Lateral approaches are recommended for measuring MCP hyperextension (Adams et al., 1992; Clarkson, 2006; Killingsworth et al., 2013; Klein, 2014; Norkin & White, 2009), G-Lateral measurements had the lowest findings for intrarater and interrater reliability. The G-Lateral approach showed broad inconsistency, with two very low ICC values (0.07 and −0.01 for the right second digit). This finding may be related to inability to align the stationary arm of the goniometer precisely over the lateral midline of the second metacarpal bone. In comparison, the G-Volar approach had higher findings for intrarater and interrater reliability. Groth, VanDeven, Phillips, and Ehretsman (2001) reported that the lateral approach had lower reliability than the dorsal approach for measurement of interphalangeal joints.

The T-Ruler method had more consistent findings for intrarater and interrater reliability, with values comparable to those for the G-Volar approach. We believe that the T-Ruler method may provide a good alternative technique for measuring MCP hyperextension. The T-Ruler method has several advantages over both goniometric methods. First, by palpating the phalanx and using skin creases as landmarks, this method allows more precise ruler placement. Second, trigonometric calculation gives a more accurate angular measure than both 180° plastic and stainless steel finger goniometers, which allow only 5° increments. Third, unlike the G-Lateral approach, which is limited to the second and fifth digits, the T-Ruler method allows the same access to all MCP joints. However, the T-Ruler method may take longer to perform because it requires two sets of measurements and trigonometric conversion. In addition, a flat surface is required for measuring height. Clinically, we speculate that the T-Ruler method may be useful for measuring MCP hyperextension when the goniometer arms can rest flat on the volar surface. This may be difficult in the acute stage of injury, but possible later, when healing has begun and conditions such as burns with severe dorsal contractures and disorders that cause severe edema have begun to resolve. The T-Ruler method also may be suitable for measuring fingers with long, curved fingernails and locations where the goniometer is not easily accessible.

Although there is no literature on the reliability of the T-Ruler method for measuring MCP hyperextension, in our study, the interrater reliability of the T-Ruler method was comparable to that of goniometry when used for composite finger flexion measurement (Ellis & Bruton, 2002). Edgar et al. (2009) compared the reliability of goniometry with that of the ruler as used in composite finger flexion and handspan for burn injuries, and both methods had excellent findings for intrarater and interrater reliability. Similar to other studies (Goodwin et al., 1992; Lewis et al., 2010), in our study, intrarater reliability was slightly higher than interrater reliability for both measuring tools. Edgar et al. (2009) attributed these reliability results to the use of a standardized measurement protocol and training of the observers that emphasized technique and identification of bony landmarks. Our findings are comparable to the conclusions of Ellis and Bruton (2002) and Edgar et al. (2009). That is, the T-Ruler method had intrarater and interrater reliability values that were comparable to those for angular goniometric measures, although both studies obtained linear measures directly (i.e., composite finger flexion and handspan; in contrast, our study used trigonometric calculation to obtain the angular measurement of the digit).

Generalizability theory states that error in measurement is attributed to several sources, and certain sources can be controlled to produce more accurate measurements (Brennan, 2001). Although this study controlled rater variance by training both raters to follow a strict measuring protocol for all three methods, there appear to be some inconsistencies and disagreements for both raters because SEM of 5.98 to 11.19 was found for intrarater reliability and SEM of 7.60 to 13.39 was found for interrater reliability. The large range of SEM values may affect the actual reliability, and this finding needs further investigation. Our findings also may be affected by soft tissue fatigue because each participant was measured 48 times within 20 minutes. We did not perform power analysis before the study was conducted, and the small sample size and inadequate statistical power also may have limited the generalizability of the findings.

This study focused on intrarater and interrater reliability for the three measures obtained from a healthy population. We recommend further study of the T-Ruler method to determine its potential clinical use for measuring MCP hyperextension and determining how the values obtained can contribute to safe and comfortable planning for effective hand use in daily tasks. All three methods of measurement were examined for participants with uninjured MCP joints. Clinically, for hands with open wounds, edema, and other physical problems that occur in the trajectory of recovery, best practice requires the clinician to use measurement tools that correspond to the patient's clinical status. The same method should be used for the series of measurements so that true change is determined based on movement capacity rather than the influence of a different method of measurement. If the T-Ruler method cannot be used for initial measurements, once the MCP and surrounding tissues have healed, the best approach is to use G-Volar and T-Ruler measurements at the time when the MCP will be measured with the T-Ruler method for the duration of care.

Conclusion

We evaluated three methods for measuring MCP hyperextension: G-Volar, G-Lateral, and T-Ruler. The T-Ruler method had more consistent findings for intrarater and interrater reliability than the goniometric approaches. Further studies are needed to validate our results and confirm the appropriateness of our suggestion of using the T-Ruler method to measure MCP hyperextension when soft tissue status permits. For the treating occupational therapist, the values obtained from T-Ruler measurement of MCP hyperextension can provide an outcome value that will allow testing of treatment goals to improve day-to-day use of the hand and determine whether there is a need to protect the limited range of hyperextension of the MCP joints or to identify a corresponding adaptive device that will comfortably allow for improved hand use.

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Metacarpophalangeal Hyperextension as Measured by the Goniometric-Volar Approach, Goniometric-Lateral Approach, and Trigonometric-Ruler Method

DigitMeasurementMean ± SD (range)
A1A2B1B2
Right secondG-Volar25.63° ± 7.59° (15.00°–50.00°)25.94° ± 9.54° (10.00°–55.00°)22.03° ± 7.50° (10.00°–40.00°)22.50° ± 8.90° (10.00°–50.00°)
G-Lateral28.28° ± 6.79° (15.00°–45.00°)28.91° ± 7.80° (15.00°–45.00°)20.31° ± 6.59° (10.00°–35.00°)21.41° ± 8.25°(5.00°–35.00°)
T-Ruler29.04° ± 8.50° (10.48°–51.06°)32.23° ± 9.84°(10.48°–53.13°)31.54° ± 8.71° (14.75°–58.33°)32.32° ± 8.05° (13.67°–48.59°)
Right fifthG-Volar28.75° ± 8.80° (10.00°–55.00°)29.38° ± 9.73° (15.00°–55.00°)27.34° ± 10.16° (10.00°–50.00°)27.19° ± 11.14° (10.00°–60.00°)
G-Lateral22.81° ± 7.40° (10.00°–40.00°)27.19° ± 8.13° (15.00°–45.00°)20.47° ± 8.65°(5.00°–45.00°)21.41° ± 8.73°(5.00°–45.00°)
T-Ruler27.17° ± 9.81° (12.29°–51.06°)26.88° ± 7.81° (12.29°–38.69°)27.40° ± 8.07°(12.84°–44.08°)26.93° ± 7.94° (15.96°–42.37°)
Left secondG-Volar28.59° ± 9.27° (15.00°–55.00°)28.75° ± 8.90° (10.00°–55.00°)25.78° ± 7.84° (15.00°–45.00°)25.16° ± 7.78° (10.00°–40.00°)
G-Lateral28.28° ± 7.80° (15.00°–45.00°)30.47° ± 8.27° (15.00°–55.00°)25.94° ± 7.01° (15.00°–40.00°)27.34° ± 7.93° (10.00°–50.00°)
T-Ruler30.46° ± 9.35° (15.83°–53.13°)30.38° ± 9.67° (12.84°–51.06°)32.39° ± 7.60° (16.44°–51.06°)34.80° ± 11.99° (12.37°–73.05°)
Left fifthG-Volar29.69° ± 10.39° (20.00°–60.00°)30.16° ± 7.98° (20.00°–55.00°)31.56° ± 10.51° (15.00°–55.00°)32.03° ± 9.99° (20.00°–50.00°)
G-Lateral25.63° ± 7.16° (15.00°–45.00°)27.81° ± 7.61° (15.00°–45.00°)25.47° ± 8.07° (15.00°–45.00°)26.88° ± 9.22° (15.00°–45.00°)
T-Ruler27.79° ± 10.04° (11.78°–48.59°)29.47° ± 9.08° (14.48°–43.99°)29.20° ± 7.84° (18.03°–48.04°)30.00° ± 9.28° (16.06°–48.59°)

Intrarater Reliability of the Goniometric-Volar Approach, Goniometric-Lateral Approach, and Trigonometric-Ruler Method for Measuring Metacarpophalangeal Hyperextension

DigitMethodA1–A2B1–B2
Intraclass correlation95% confidence intervalSEMIntraclass correlation95% confidence intervalSEM
Right secondG-Volar0.65a0.39, 0.819.250.80a0.62, 0.906.96
G-Lateral0.07−0.29, 0.4110.310.59a0.31, 0.778.51
T-Ruler0.57a0.28, 0.7610.760.69a0.45, 0.838.57
Right fifthG-Volar0.89a0.79, 0.955.980.80a0.63, 0.909.04
G-Lateral0.57a0.18, 0.799.270.76a0.57, 0.887.99
T-Ruler0.69a0.44, 0.839.050.80a0.64, 0.906.79
Left secondG-Volar0.63a0.36, 0.809.950.79a0.62, 0.896.77
G-Lateral0.48b0.17, 0.7010.120.63a0.37, 0.808.23
T-Ruler0.62a0.34, 0.7910.520.62a0.36, 0.8011.19
Left fifthG-Volar0.77a0.57, 0.888.340.88a0.76, 0.946.88
G-Lateral0.50b0.20, 0.729.090.67a0.43, 0.839.11
T-Ruler0.72a0.50, 0.859.410.78a0.60, 0.897.60

Interrater Reliability of the Goniometric-Lateral Approach, Goniometric-Volar Approach, and Trigonometric-Ruler Method for Measuring Metacarpophalangeal Hyperextension

DigitMethodA1-B1A2-B2
Intraclass correlation95% confidence intervalSEMIntraclass correlation95% confidence intervalSEM
Right secondG-Volar0.46b0.14, 0.699.610.75a0.46, 0.888.74
G-Lateral−0.01−0.18, 0.249.450.31b−0.05, 0.6011.31
T-Ruler0.60a0.32, 0.789.780.77a0.58, 0.888.10
Right fifthG-Volar0.71a0.49, 0.859.470.75a0.55, 0.879.83
G-Lateral0.55a0.26, 0.759.550.28b−0.03, 0.5611.72
T-Ruler0.72a0.50, 0.858.800.73a0.52, 0.867.60
Left secondG-Volar0.56a0.28, 0.7610.140.46b0.15, 0.7010.63
G-Lateral0.32b−0.01, 0.5910.110.51b0.20, 0.729.94
T-Ruler0.54a0.25, 0.7510.170.51b0.20, 0.7313.39
Left fifthG-Volar0.61a0.34, 0.7911.710.72a0.50, 0.858.89
G-Lateral0.59a0.30, 0.778.670.46b0.13, 0.6910.60
T-Ruler0.72a0.50, 0.858.840.57a0.28, 0.7610.64
Authors

Dr. Chai is Senior Lecturer, Occupational Therapy Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia. Ms. Chen is Occupational Therapist, New York City Department of Education, New York, New York. Ms. Milard is Occupational Therapist, Rehabilitation Department, Long Island Jewish Medical Center, New Hyde Park, New York. Dr. Bear-Lehman is Professor and Director, Health Science Program, College of Health Professions, Pace University, Pleasantville, and Adjunct Associate Professor, College of Dentistry, New York University, New York, New York.

The authors have no relevant financial relationships to disclose.

The authors thank Rebecca Lipton and Rivka Bachrach for their initial contribution to this work and the study participants for their time and cooperation.

Address correspondence to Siaw Chui Chai, PhD, Occupational Therapy Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia; e-mail: sc.chai@ukm.edu.my.

Received: October 27, 2017
Accepted: May 02, 2018
Posted Online: June 26, 2018

10.3928/24761222-20180620-02

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