LaStayo P C, Wheeler D L
Department of Physical Therapy, College of Health Related Professions, University of Florida, Gainesville 32610.
Phys Ther. 1994 Feb;74(2):162-74; discussion 174-6. doi: 10.1093/ptj/74.2.162.
The purpose of this study was twofold: (1) to determine whether passive wrist flexion and extension goniometric measurements using ulnar alignment, radial alignment, and volar/dorsal alignment were similar or dissimilar and (2) to examine which of these three techniques had the greatest intratester and intertester reliability.
One hundred forty patients (141 wrists) were measured. The testers were 32 therapists from eight different hand/upper-extremity clinical sites around the United States.
Randomly paired testers measured passive wrist flexion and extension. The intraclass correlation coefficient (ICC) was used as an estimate of agreement for both intratherapist (model 3.1) and intertherapist (model 2.1) reliability.
Six of the eight clinics showed significant differences among the various goniometric techniques. Flexion intratherapist mean ICCs for the radial, ulnar, and dorsal alignment techniques were .86, .87, and .92, respectively. Extension intratherapist mean ICCs were .80, .80, and .84 for the three techniques. Intertherapist flexion mean ICCs were .88, .89, and .93 for the radial, ulnar, and volar alignment techniques, respectively. Extension intertherapist mean ICCs were .80, .80, and .84 for the three techniques. The standard error of measurement was also used to quantify reliability, with the volar/dorsal alignment technique consistently producing less error than the ulnar and radial alignment techniques. The generalizability theory statistical model was utilized to identify the sources of error. The patient contributed to variance the most, although inherent error within the study, diagnostic category, therapeutic approach, and goniometric technique also contributed.
The overall results indicated there were differences among the three goniometric techniques. The volar/dorsal alignment technique is the goniometric technique of choice, as it consistently had the greatest reliability.
本研究的目的有两个：（1）确定使用尺侧对线、桡侧对线和掌侧/背侧对线进行被动腕关节屈伸角度测量是否相似；（2）检验这三种技术中哪一种具有最高的测试者内和测试者间可靠性。
对140名患者（141个腕关节）进行了测量。测试者为来自美国八个不同手部/上肢临床机构的32名治疗师。
测试者随机配对，测量被动腕关节屈伸。组内相关系数（ICC）用于评估测试者内（模型3.1）和测试者间（模型2.1）可靠性的一致性。
八个诊所中的六个显示不同角度测量技术之间存在显著差异。桡侧、尺侧和背侧对线技术的测试者内屈曲平均ICC分别为0.86、0.87和0.92。三种技术的测试者内伸展平均ICC分别为0.80、0.80和0.84。桡侧、尺侧和掌侧对线技术的测试者间屈曲平均ICC分别为0.88、0.89和0.93。三种技术的测试者间伸展平均ICC分别为0.80、0.80和0.84。测量标准误也用于量化可靠性，掌侧/背侧对线技术始终比尺侧和桡侧对线技术产生的误差更小。使用概化理论统计模型来识别误差来源。患者对变异的贡献最大，尽管研究中的固有误差、诊断类别、治疗方法和角度测量技术也有贡献。
总体结果表明三种角度测量技术之间存在差异。掌侧/背侧对线技术是首选的角度测量技术，因为它始终具有最高的可靠性。
