Koong Denis P, Lee Jillian, Cheng Tegan L, Little David G
Department of Orthopaedic Surgery, The Children's Hospital at Westmead, Sydney, NSW, Australia.
The University of Sydney, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, Sydney, NSW, Australia.
J Child Orthop. 2020 Oct 1;14(5):488-494. doi: 10.1302/1863-2548.14.200123.
Precise measurement of elbow range of motion (ROM) post-injury or surgery forms an important part of determining prognosis and the need for further intervention. Clinicians are increasingly incorporating smartphone use in our medical practice; we sought to determine if a smartphone goniometer application is a valid and reliable tool for assessment of elbow ROM in the paediatric patient, compared to visual and goniometer assessment.
In total, 20 paediatric patients (40 elbows) between six and 15 years of age with an elbow or forearm injury were included in this prospective series. Elbow flexion, extension, pronation and supination were measured independently by two orthopaedic clinicians. Measurements were taken from injured as well as unaffected side using a standardized technique, first with visual estimation and then using a universal goniometer (UG) and smartphone goniometer application Angle Meter via Google Play store (Smart Tool Factory, Istanbul, Turkey).
There was excellent interobserver reliability for all three modalities, with average intraclass correlation coefficient (ICC) values greater than 0.90. Visual estimation had the lowest average ICC of 0.92, compared to 0.97 for UG and smartphone. Overall, there was excellent intraobserver reliability between the smartphone application and the gold standard UG for all elbow movements with ICCs ranging between 0.98 to 0.99 and mean absolute difference ranging from 1.1 ± 1.0° to 2.6 ± 1.9°. The smartphone application showed superior agreement over visual estimation when compared to the gold standard UG with lower mean differences and 95% limits of agreement (LOA) falling within 10°.
Our study demonstrates that a smartphone application is a valid and reliable assessment tool for measurement of elbow ROM in paediatric patients, and better than visualization alone.
III.
精确测量损伤或手术后的肘关节活动范围（ROM）是确定预后和是否需要进一步干预的重要组成部分。临床医生在医疗实践中越来越多地使用智能手机；我们试图确定与视觉评估和角度计评估相比，智能手机测角仪应用程序是否是评估小儿患者肘关节ROM的有效且可靠的工具。
本前瞻性研究共纳入20例6至15岁患有肘部或前臂损伤的小儿患者（40个肘关节）。两名骨科医生独立测量肘关节的屈曲、伸展、旋前和旋后。使用标准化技术从受伤侧和未受伤侧进行测量，首先进行视觉估计，然后使用通用角度计（UG）和通过谷歌应用商店（土耳其伊斯坦布尔智能工具工厂）下载的智能手机测角仪应用程序Angle Meter。
所有三种测量方法的观察者间信度都非常好，平均组内相关系数（ICC）值大于0.90。视觉估计的平均ICC最低，为0.92，而UG和智能手机应用程序的ICC为0.97。总体而言，智能手机应用程序与金标准UG在所有肘关节运动中的观察者内信度都非常好，ICC在0.98至0.99之间，平均绝对差在1.1±1.0°至2.6±1.9°之间。与金标准UG相比，智能手机应用程序与视觉估计相比显示出更好的一致性，平均差异更低，95%一致性界限（LOA）在10°以内。
我们的研究表明，智能手机应用程序是测量小儿患者肘关节ROM的有效且可靠的评估工具，且优于单独的视觉评估。
III级。
