Reliability of Range of Motion Assessment Using Universal Goniometer and Video Goniometer Application: A Comparative Study

Duane Tristan Jayubo; Phoebe  Demegillo; Anthony Joy Ramas; Neo Eljan Apolonio; Kaizhi Makabenta; Meg Evicelle Aznar; Dianne Mae Legion; Erl John Manalo; Ma. Le Ann Canono; Jacob Rosales; Gwynth Kaye Sudario; Faivy Kristine Alcalde; Julienne Daffon

Authors

Duane Tristan Jayubo Department of Physical Therapy, College of Biomedical Sciences, Doña Remedios Trinidad Romualdez Educational Foundation Inc., Tacloban City, Leyte Philippines
Phoebe Demegillo Department of Physical Therapy, College of Biomedical Sciences, Doña Remedios Trinidad Romualdez Educational Foundation Inc., Tacloban City, Leyte Philippines
Anthony Joy Ramas Department of Physical Therapy, College of Biomedical Sciences, Doña Remedios Trinidad Romualdez Educational Foundation Inc., Tacloban City, Leyte Philippines
Neo Eljan Apolonio Department of Physical Therapy, College of Biomedical Sciences, Doña Remedios Trinidad Romualdez Educational Foundation Inc., Tacloban City, Leyte Philippines
Kaizhi Makabenta Department of Physical Therapy, College of Biomedical Sciences, Doña Remedios Trinidad Romualdez Educational Foundation Inc., Tacloban City, Leyte Philippines
Meg Evicelle Aznar Department of Physical Therapy, College of Biomedical Sciences, Doña Remedios Trinidad Romualdez Educational Foundation Inc., Tacloban City, Leyte Philippines
Dianne Mae Legion Department of Physical Therapy, College of Biomedical Sciences, Doña Remedios Trinidad Romualdez Educational Foundation Inc., Tacloban City, Leyte Philippines
Erl John Manalo Department of Physical Therapy, College of Biomedical Sciences, Doña Remedios Trinidad Romualdez Educational Foundation Inc., Tacloban City, Leyte Philippines
Ma. Le Ann Canono Department of Physical Therapy, College of Biomedical Sciences, Doña Remedios Trinidad Romualdez Educational Foundation Inc., Tacloban City, Leyte Philippines
Jacob Rosales Department of Physical Therapy, College of Biomedical Sciences, Doña Remedios Trinidad Romualdez Educational Foundation Inc., Tacloban City, Leyte Philippines
Gwynth Kaye Sudario Department of Physical Therapy, College of Biomedical Sciences, Doña Remedios Trinidad Romualdez Educational Foundation Inc., Tacloban City, Leyte Philippines
Faivy Kristine Alcalde Department of Physical Therapy, College of Biomedical Sciences, Doña Remedios Trinidad Romualdez Educational Foundation Inc., Tacloban City, Leyte Philippines
Julienne Daffon Department of Physical Therapy, College of Biomedical Sciences, Doña Remedios Trinidad Romualdez Educational Foundation Inc., Tacloban City, Leyte Philippines

Keywords:

universal goniometer, video goniometer, range of motion, knee osteoarthritis, reliability

Abstract

Objectives: To compare the reliability of universal goniometer (UG) and video goniometer (VG) applications in assessing the range of motion of lower extremity involvement in patients with osteoarthritis during gait

Study design: A comparative study design

Setting: Department of Physical Therapy, Community-Based Rehabilitation of Doña Remedios Trinidad Romualdez Educational Foundation Inc., Tacloban City, Leyte, Philippines

Subjects: Forty-three participants with knee osteoarthritis

Methods: The research involved 43 participants aged 40 to 80 with persisting unilateral knee pain for at least 6 months and above who can perform independent walking activities recruited from Palo and Tacloban City, Leyte, Philippines, through a community- based program. Data collection included demographic information and range of motion (ROM) measurements during walking, which occurred over specific dates with a two-day gap between trials. Joint angles were measured using a universal goniometer and a video goniometer, with the universal goniometer attached to key joints like the knee, hip, and ankle during specific gait cycles. The video goniometer employed the Angles application to measure joint angles in the sagittal plane, using anatomical landmarks such as the greater trochanter, lateral epicondyle, and lateral malleolus. Measurements were adjusted to ensure consistency, with specific angles for hip flexion/extension, knee flexion/extension, and ankle dorsiflexion/plantarflexion recorded. To ensure impartiality, researchers randomized video sequences and restricted access to measurements. Reliability was assessed using the intraclass correlation coefficient (ICC) for inter and intra- rater assessments.

Results: The difference between the interrater reliability among UG and VG showed that UG (ICC = 0.536) is more reliable than VG (ICC = 0.318) in assessing hip, knee, and ankle range of motion (ROM). The difference between the intra-rater reliability among UG and VG, on the other hand, showed that VG (ICC = 0.714) is more reliable than UG (ICC = 0.611) in assessing hip, knee, and ankle ROM.

Conclusions: In conclusion, when assessing ROM in patients with arthritis with multiple assessors, the universal goniometer shows better consistency among assessors (interrater reliability), while the video goniometer demonstrates more consistent assessments by individual assessors across multiple trials (intra-rater reliability).

References

Otter SJ, Agalliu B, Baer N, Hales G, Harvey K, James K, Keating R, McConnell W, Nelson R, Qureshi S, Ryan S. The reliability of a smartphone goniometer application compared with a traditional goniometer for measuring first metatarsophalangeal joint dorsiflexion. J Foot Ankle Res. 2015 Dec [cited 2025 Jan 9];8:1-7. Available from: https://link.springer.com/article/10.1186/s13047-015-0088-3. doi: 10.1186/s13047-015-0088-3

Keogh JW, Cox A, Anderson S, Liew B, Olsen A, Schram B, Furness J. Reliability and validity of clinically accessible smartphone applications to measure joint range of motion: A systematic review. PLoS One. 2019 May [cited 2025 Jan 9];14(5):e0215806. Available from: https://journals.plos.org/plosone/article?id = 10.1371/journal.pone.0215806. doi: 10.1371/journal.pone.0215806

Kiatkulanusorn S, Luangpon N, Srijunto W, Watechagit S, Pitchayadejanant K, Kuharat S, Bég OA, Suato BP. Analysis of the concurrent validity and reliability of five common clinical goniometric devices. Sci Rep. 2023 Nov [cited 2025 Jan 9];13(1):20931. Available from: https://www.nature.com/articles/s41598-023-48344-6 doi: 10.1038/s41598-023-48344-6.

Vijayan V, Connolly JP, Condell J, McKelvey N, Gardiner P. Review of wearable devices and data collection considerations for connected health. Sensors (Basel). 2021 Aug [cited 2025 Jan 9];21(16):5589. Available from: https://www.mdpi.com/1424-8220/21/16/5589 doi: 10.3390/s21165589.

Parks MT, Wang Z, Siu KC. Current low-cost video-based motion analysis options for clinical rehabilitation: a systematic review. Phys Ther. 2019 Oct [cited 2025 Jan 9];99(10):1405-25. Available from: https://academic.oup.com/ptj/article/99/10/1405/5531059 doi: 10.1093/ptj/pzz097.

McKinnon CD, Ehmke S, Kociolek AM, Callaghan JP, Keir PJ. Wrist posture estimation differences and reliability between video analysis and electrogoniometer methods. Hum Factors. 2021 Nov [cited 2025 Jan 9];63(7):1284-94. doi: 10.1177/0018720820923839.

Cunha AB, Babik I, Harbourne R, Cochran NJ, Stankus J, Szucs K, et al. Assessing the validity and reliability of a new video goniometer app for measuring joint angles in adults and children. Arch Phys Med Rehabil. 2020 Feb [cited 2023 Jun];101(2):275-82. doi: 10.1016/j.apmr.2019.07.008.

Edriss S, Romagnoli C, Caprioli L, Zanela A, Panichi E, Campoli F, Padua E, Annino G, Bonaiuto V. The role of emergent technologies in the dynamic and kinematic assessment of human movement in sport and clinical applications. Appl Sci. 2024 Jan [cited 2025 Jan 9];14(3):1012. Available from: https://www.mdpi.com/2076-3417/14/3/1012 doi: 10.3390/app14031012.

Huang J, Tian F, Zhang Z, Shi W, Lin J, Chen L, et al. Reliability and concurrent validity of angle measurements in lower limb: EOS 3D goniometer versus 2D manual goniometer. J Orthop Transl. 2020 Sep [cited 2023 Jun];24:96-102. Available from: https://www.sciencedirect.com/science/article/pii/S2214031X20300681 doi.org/10.1016/j.jot.2020.05.002.

Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2017 Apr [cited 2024 Jul];4(4):CD011279. doi: 10.1002/14651858.CD011279.pub3.

Epskamp S, Dibley H, Ray E, Bond N, White J, Wilkinson A, et al. Range of motion as an outcome measure for knee osteoarthritis interventions in clinical trials: an integrated review. Phys Ther Rev. 2020 [cited 2024 Jul];25(5–6):462–81. doi:10.1080/10833196.2020.1867393.

Aafreen A, Khan A, Khan AR, Ahmad A, Parween S, Maurya NK, Alshehri MM, Shaphe MA, Ahmed H, Mirza H. Reliability and validity of a smartphone goniometer application for measuring the quadriceps angle in healthy women: a cross-sectional study. Int J Ther Rehabil. 2024 Feb [cited 2025 Jan 9];31(2):1-0. doi: 10.12968/ijtr.2023.0048.

Al-Mahmood MR, Uddin MT, Islam MT, Fuad SM, Shah TR. Correlation between goniometric measurements of range of motion and radiographic scores in osteoarthritis knee: an observational study among females. Medicine (Baltimore). 2022 Aug [cited 2023 Jun];101(32):e29995. Available from: https://journals.lww.com/md-journal/fulltext/2022/08120/Correlation_between_goniometric_measurements_of.73.aspx?context = LatestArticles doi: 10.1097/MD.0000000000029995.

Perry J, Burnfield JM. Gait analysis: normal and pathological function. 2nd ed. Thorofare (NJ): SLACK Incorporated; 2010 [cited 2023 Jun].

Felson DT. Epidemiology of hip and knee osteoarthritis. Epidemiol Rev. 1988 [cited 2023 Jun];10:1-28. doi: 10.1093/oxfordjournals.epirev.a036019.

McAlindon TE, Bannuru RR, Sullivan MC, Arden NK, Berenbaum F, Bierma-Zeinstra SM, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage. 2014 Mar [cited 2024 Jul];22(3):363-88. Available from: https://www.sciencedirect.com/science/article/pii/S1063458414000168 doi: 10.1016/j.joca.2014.01.003.

Szilagyi IA, Waarsing JH, van Meurs JBJ, Bierma-Zeinstra SMA, Schiphof D. A systematic review of the sex differences in risk factors for knee osteoarthritis. Rheumatology (Oxford). 2023 Jun [cited 2024 Jul];62(6):2037-2047. Available from: https://academic.oup.com/rheumatology/article/62/6/2037/6887132 doi: 10.1093/rheumatology/keac688.

Tschon M, Contartese D, Pagani S, Borsari V, Fini M. Gender and sex are key determinants in osteoarthritis not only confounding variables. A systematic review of clinical data. J Clin Med. 2021 Jul [cited 2024 Jul];10(14):3178. Available from: https://www.mdpi.com/2077-0383/10/14/3178 doi: 10.3390/jcm10143178.

Lopes DG, Costa D, Cruz EB, Mendonça N, Henriques AR, Branco J, et al. Association of physical activity with physical function and quality of life in people with hip and knee osteoarthritis: longitudinal analysis of a population-based cohort. Arthritis Res Ther. 2023 Jan [cited 2024 Jul];25(1):14. Available from: https://link.springer.com/article/10.1186/s13075-023-02996-x doi: 10.1186/s13075-023-02996-x.

Simic M, Harmer AR, Agaliotis M, Nairn L, Bridgett L, March L, et al. Clinical risk factors associated with radiographic osteoarthritis progression among people with knee pain: a longitudinal study. Arthritis Res Ther. 2021 Jun [cited 2024 Jul];23(1):160. Available from: https://link.springer.com/article/10.1186/s13075-021-02540-9 doi: 10.1186/s13075-021-02540-9.

Brosseau L, Balmer S, Tousignant M, O’Sullivan JP, Goudreault C, Goudreault M, et al. Intra-and intertester reliability and criterion validity of the parallelogram and universal goniometers for measuring maximum active knee flexion and extension of patients with knee restrictions. Arch Phys Med Rehabil. 2001 Mar [cited 2023 Jun];82(3):396-402. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0003999301234303 doi: 10.1053/apmr.2001.19250.

Takeda Y, Furukawa K. Clinical reliability and usability of smartphone goniometers for hip range of motion measurement. J Phys Ther Sci. 2022 [cited 2023 Jun];34(6):433-9. Available from: https://www.jstage.jst.go.jp/article/jpts/34/6/34_2021-210/_article/-char/ja/ doi: 10.1589/jpts.34.433.

Rossettini G, Geri T, Polli A, Signori A, Testa M. Interrater reliability of procedures measuring the passive range of motion of lower extremity joints in healthy and symptomatic subjects. A systematic review. Ital J Physiother. 2012 Mar [cited 2024 Jul];2:12-31. Available from: https://www.sif-fisioterapia.it/media/24/IT-Journal-of-Physioyherapy-1-2012.pdf#page = 17

Parati M, Gallotta M, De Maria B, Pirola A, Morini M, Longoni L, et al. Video-based goniometer applications for measuring knee joint angles during walking in neurological patients: A validity, reliability and usability study. Sensors (Basel). 2023 Feb 16 [cited 2023 Jun];23(4):2232. Available from: https://www.mdpi.com/1424-8220/23/4/2232 doi: 10.3390/s23042232

Williams MA, McCarthy CJ, Chorti A, Cooke MW, Gates S. A systematic review of reliability and validity studies of methods for measuring active andPassive cervical range of motion. J Manipulative Physiol Ther. 2010 Feb [cited 2023 Jun];33(2):138-55. Available from: https://www.researchgate.net/profile/Christopher-Mccarthy-4/publication/41507566_A_Systematic_Review_of_Reliability_and_Validity_Studies_of_Methods_for_Measuring_Active_andPassive_Cervical_Range_of_Motion/links/604a008b92851c1bd4df22d5/A-Systematic-Review-of-Reliability-and-Validity-Studies-of-Methods-for-Measuring-Active-andPassive-Cervical-Range-of-Motion.pdf doi: 10.1016/j.jmpt.2009.12.009.

Alawna MA, Unver BH, Yuksel EO. The reliability of a smartphone goniometer application compared with a traditional goniometer for measuring ankle joint range of motion. J Am Podiatr Med Assoc. 2019 Jan [cited 2023 Jun];109(1):22-9. doi: 10.7547/16-128.

Shamsi M, Mirzaei M, Khabiri SS. Universal goniometer and electro-goniometer intra-examiner reliability in measuring the knee range of motion during active knee extension test in patients with chronic low back pain with short hamstring muscle. BMC Sports Sci Med Rehabil. 2019 Dec [cited 2023 Jun];11:1-5. Available from: https://link.springer.com/article/10.1186/s13102-019-0116-x doi: 10.1186/s13102-019-0116-x

Gajdosik RL, Bohannon RW. Clinical measurement of range of motion: review of goniometry emphasizing reliability and validity. Phys Ther. 1987 Dec [cited 2023 Jun];67(12):1867-72. Available from: https://www.researchgate.net/profile/Richard-Bohannon-2/publication/19477050_Clinical_Measurement_of_Range_of_Motion_Review_of_Goniometry_Emphasizing_Reliability_and_Validity/links/0c96051844b64e474d000000/Clinical-Measurement-of-Range-of-Motion-Review-of-Goniometry-Emphasizing-Reliability-and-Validity.pdf doi: 10.1093/ptj/67.12.1867.

Watkins MA, Riddle DL, Lamb RL, Personius WJ. Reliability of goniometric measurements and visual estimates of knee range of motion obtained in a clinical setting. Phys Ther. 1991 Feb [cited 2023 Jun];71(2):90-6. Available from: https://citeseerx.ist.psu.edu/document?repid = rep1&type = pdf&doi = ec07d3c06571530d5a8306488baa6115f1b4ca0d doi: 10.1093/ptj/71.2.90.

Fernández-González P, Koutsou A, Cuesta-Gómez A, Carratalá-Tejada M, Miangolarra-Page JC, Molina-Rueda F. Reliability of kinovea® software and agreement with a three-dimensional motion system for gait analysis in healthy subjects. Sensors (Basel). 2020 Jun [cited 2023 Jun];20(11):3154. Available from: https://www.mdpi.com/1424-8220/20/11/3154 doi: 10.3390/s20113154.

Kamper SJ, Maher CG, Mackay G. Global rating of change scales: a review of strengths and weaknesses and considerations for design. J Man Manip Ther. 2009 Jul [cited 2023 Jun];17(3):163-70. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2762832/ doi: 10.1179/jmt.2009.17.3.163.

Mohsin F, McGarry A, Bowers R. The reliability of a video analysis system (PnO clinical movement data) and the universal goniometer in the measurement of hip, knee, and ankle sagittal plane motion among healthy subjects. J Prosthet Orthot. 2018 Jul [cited 2023 Jun];30(3):145-51. Available from: https://journals.lww.com/jpojournal/fulltext/2018/07000/the_reliability_of_a_video_analysis_system__pno.8.aspx doi: 10.1097/JPO.0000000000000201.

Kagee A. Addressing psychosocial problems among persons living with HIV. Afr J Psychiatry (Johannesbg). 2012 Nov [cited 2023 Jun];15(6):424-6. Available from: https://hdl.handle.net/10520/EJC127136

Beshara P, Anderson DB, Pelletier M, Walsh WR. The reliability of the microsoft kinect and ambulatory sensor-based motion tracking devices to measure shoulder range-of-motion: A systematic review and meta-analysis. Sensors (Basel). 2021 Dec [cited 2023 Jun];21(24):8186. Available from: https://www.mdpi.com/1424-8220/21/24/8186 doi: 10.3390/s21248186

Zheng H, Tulu B, Choi W, Franklin P. Using mHealth app to support treatment decision-making for knee arthritis: patient perspective. EGEMS (Wash DC). 2017 [cited 2023 Jun];5(2). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5994956/ doi: 10.13063/2327-9214.1284

Melián-Ortiz A, Varillas-Delgado D, Laguarta-Val S, Rodríguez-Aparicio I, Senent-Sansegundo N, Fernández-García M, Roger-de Oña I. Fiabilidad y validez concurrente de la app Goniometer Pro vs goniómetro universal en la determinación de la flexión pasiva de rodilla. Acta Ortop Mex. 2019 Feb [cited 2023 Jun];33(1):18-23. Available from: https://www.scielo.org.mx/scielo.php?pid = S2306-41022019000100018&script = sci_arttext

Felthun JZ, Taylor S, Shulruf B, Allen DW. Assessment methods and the validity and reliability of measurement tools in online objective structured clinical examinations: a systematic scoping review. J Educ Eval Health Prof. 2021 [cited 2024 Jul];18:11. Available from: https://synapse.koreamed.org/articles/1149208 doi: 10.3352/jeehp.2021.18.11.

Saiki Y, Kabata T, Ojima T, Kajino Y, Kubo N, Tsuchiya H. Reliability and validity of pose estimation algorithm for measurement of knee range of motion after total knee arthroplasty. Bone Joint Res. 2023 May [cited 2024 Jul];12(5):313-320. Available from: https://boneandjoint.org.uk/article/10.1302/2046-3758.125.BJR-2022-0257.R1 doi: 10.1302/2046-3758.125.BJR-2022-0257.R1.

Michelini A, Eshraghi A, Andrysek J. Two-dimensional video gait analysis: A systematic review of reliability, validity, and best practice considerations. Prosthet Orthot Int. 2020 Aug [cited 2024 Jul];44(4):245-262. Available from: https://journals.sagepub.com/doi/full/10.1177/0309364620921290. doi: 10.1177/0309364620921290.

Roggio F, Ravalli S, Maugeri G, Bianco A, Palma A, Di Rosa M, et al. Technological advancements in the analysis of human motion and posture management through digital devices. World J Orthop. 2021 Jul [cited 2024 Jul];12(7):467-484. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8316840/ doi: 10.5312/wjo.v12.i7.467.

Soeters R, Damodar D, Borman N, Jacobson K, Shi J, Pillai R, Mehran N. Accuracy of a smartphone software application compared with a handheld goniometer for measuring shoulder range of motion in asymptomatic adults. Orthop J Sports Med. 2023 Jul [cited 2024 Jul];11(7):23259671231187297. Available from: https://journals.sagepub.com/doi/full/10.1177/23259671231187297 doi: 10.1177/23259671231187297.

Yaikwawongs N, Limpaphayom N, Wilairatana V. Reliability of digital compass goniometer in knee joint range of motion measurement. J Med Assoc Thai. 2009 Apr [cited 2024 Jul];92(4):517-22. Available from: https://www.thaiscience.info/Journals/Article/JMAT/10402800.pdf

Van Crombrugge I, Sels S, Ribbens B, Steenackers G, Penne R, Vanlanduit S. Accuracy assessment of joint angles estimated from 2d and 3d camera measurements. Sensors (Basel). 2022 Feb [cited 2024 Jul];22(5):1729. Available from: https://www.mdpi.com/1424-8220/22/5/1729 doi: 10.3390/s22051729.

Guerra E, Licciardi L, Van Veenendaal P, Robinson LS. Reliability and clinical utility of a novel telehealth-based goniometry approach to measure range of motion of the digits of the hand. J Hand Ther. 2024 Jan-Mar [cited 2024 Jul];37(1):83-93. doi: 10.1016/j.jht.2023.05.004.