Research Consultant, Nicholas Institute of Sports Medicine & Athletic Trauma, Lenox Hill Hospital, New York, NY 10021, USA.
Physiother Theory Pract. 2010 Jul;26(5):327-33. doi: 10.3109/09593980903094230.
The clinical use of digital levels, for joint measurement, may be a viable alternative to standard goniometry. The purpose of this study was to determine the intra- and intertester reliability of a construction grade digital level compared to the standard universal goniometer for measurements for active assisted shoulder range of motion (ROM). Two experienced physical therapists measured shoulder flexion, external rotation (ER), and internal rotation (IR) ROM bilaterally, on two different occasions, in 20 patients (9 males, 11 females, 18-79 years old) with unilateral shoulder pathology, using a goniometer and a digital level. Relative reliability was assessed by using intraclass correlation coefficients (ICC), and absolute reliability was assessed by using 95% limits of agreement (LOA). Intratester ICCs ranged from 0.91 to 0.99, and LOA ranged from 3 degrees to 9 degrees for measurements made with the goniometer and digital level. Intertester ICCs ranged from 0.31 to 0.95, and LOA ranged from 6 degrees to 25 degrees . For the comparison of goniometric vs. digital level ROM, ICCs ranged from 0.71 to 0.98. ER and IR ROM were 3-5 degrees greater for the digital level than the goniometer (p < 0.01). Goniometric vs. digital level LOA ranged from 6 degrees to 11 degrees for shoulder flexion. Both measurement techniques had excellent intratester reliability, but for intertester reliability ICCs were 20% lower and LOA were 2.3 times higher than intratester values. Reliability estimates were similar between the digital level and the goniometer. However, because glenohumeral rotation was 3-5 degrees greater for the digital level than the goniometer (systematic error), the two methods cannot be used interchangeably. On the basis of the average intratester LOA for the goniometer and the digital level, a change of 6-11 degrees is needed to be certain that true change has occurred. For comparison of measures made by two different therapists, a change is of 15 degrees is required to be certain a true change has occurred. A digital level can be used to reliably measure shoulder ROM but should not be used interchangeably with a standard goniometer.
数字水平仪在关节测量中的临床应用可能是一种替代标准量角器的可行方法。本研究的目的是确定一种建筑级数字水平仪与标准通用量角器在测量主动辅助肩部活动范围（ROM）时的内和间测试者可靠性。两名经验丰富的物理治疗师在 20 名单侧肩部病变患者（9 名男性，11 名女性，年龄 18-79 岁）的两次不同场合下，使用量角器和数字水平仪测量了双侧肩部的屈曲、外展（ER）和内旋（IR）ROM。相对可靠性通过使用组内相关系数（ICC）进行评估，绝对可靠性通过使用 95%的一致性界限（LOA）进行评估。内测试者 ICC 范围为 0.91 至 0.99，使用量角器和数字水平仪测量时 LOA 范围为 3 度至 9 度。间测试者 ICC 范围为 0.31 至 0.95，LOA 范围为 6 度至 25 度。对于量角器与数字水平仪 ROM 的比较，ICC 范围为 0.71 至 0.98。与量角器相比，数字水平仪的 ER 和 IR ROM 大 3-5 度（p < 0.01）。量角器与数字水平仪 LOA 范围为肩部屈曲 6 度至 11 度。两种测量技术的内测试者可靠性均极佳，但间测试者可靠性的 ICC 比内测试者低 20%，LOA 则比内测试者高 2.3 倍。数字水平仪和量角器的可靠性估计值相似。然而，由于数字水平仪比量角器的盂肱旋转大 3-5 度（系统误差），因此这两种方法不能互换使用。基于量角器和数字水平仪的平均内测试者 LOA，需要 6-11 度的变化才能确定确实发生了变化。为了比较两位不同治疗师的测量结果，需要 15 度的变化才能确定确实发生了变化。数字水平仪可用于可靠地测量肩部 ROM，但不应与标准量角器互换使用。
