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METHODS: Four evaluators (two for goniometry and two for biophotogrammetry) assessed 11 males, 16 - 26 years old, right-handed and with no shoulder anomalies. A universal plastic goniometer was used for the goniometry assessment. The biophotogrammetry assessment involved the use of a digital camera Sony DSC-W1 (5.1Mp), with non-reflective markers placed on the subjects. Photographic frames were analyzed the though the SAPO software (version 0.67). Each evaluator was blinded to data from all other valuators; inter-rater datas were compared. Seven days after the first assessment, all measurements were repeated in order to complete the intra-rater comparison.
The Wilcoxon test was used to check statistical significance, the Spearman correlation was calculated and inter-class correlations coefficients were determined. INTRODUCTION Measurement of articulation angles is important for diagnosis, assessment, and monitoring of treatment progression for motion/movement disorders; however, these measurements must be valid and reliable to enable the success of such procedures. Reliability of a measurement is the consistency between successive measurements of a variable from the same subject in identical conditions. Validity refers to how much the measurement represents the real value of the variable, assessed through its comparison to an alternative measurement, made through a different standardized instrument or by means of an established standard.
For angular measurements in clinical practice and in research, the universal manual goniometer is the most commonly used device - because it is easy to handle, has low cost and yields a rapid evaluation. However, published data have not assessed validity or reliability of the goniometer in comparison to other measuring devices for all articulations.
The reliability of goniometry has been demonstrated for some joints. Investigated the intra- and inter-rater reliability of goniometry measurements for the evaluation of head posture in relation to the shoulders and found the method to be reliable. Most studies on the knee joint present high intra-rater reliability., As for the validity of goniometry, only comparisons between this method and radiographic measurements have been reported. The majority of studies that assess medial and lateral rotation movements of the shoulder make use of goniometry. These studies usually involve the assessment of the medial rotation deficit on the dominant shoulder of overhead throwing athletes compared to the non-dominant side. These reports do not describe the reliability of goniometry.
But in some cases the inter- and intra-rater comparison was performed before the execution of the study proper, with the intention of testing the accuracy of the researchers. In some cases, in which the inter-rater variation was very significant, evaluators were led to perform it in pairs, one to immobilize the subject and the other to execute the measurements with the goniometer; this resulted in the single 'assessment system'.
Measurements based on photographs can be employed to determine articulation angles, introducing it as an alternative to goniometry. Photogrammetry began with cartography and was adapted for medical use, renamed biophotogrammetry, - or computerized biophotogrammetry when performed through a computer program.
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The objective of this research was to verify the inter- and intra-rater reliability of manual goniometry versus computerized biophotogrammetry on the assessment of the range of motion of shoulder medial and lateral rotations. Outcome measurements Measurements through the software were executed with a 100% zoom, on computers with 1280x1024 pixels of screen resolution. All assessments were repeated seven days later for intra-rater comparison; they were designated D1 and D2. Participants were instructed to not to modify their habits concerning physical activities during the interval.
For inter-rater goniometric reproducibility analysis measurements obtained by Evaluators A and Evaluators B, D1 and D2 were used. For biophotogrammetric reproducibility inter-rater analysis, the measurements obtained by Evaluator C and D were also compared in D1 and D2. Intra-rater goniometric and biophotogrammetric repeatability analysis was obtained by internally comparing D1 and D2, for each of the four evaluators. Data analysis Wilcoxon signed-ranks test was used to evaluate possible statistical differences between the data. The value p≤0,05 was assumed as statistically significant. To assess inter- and intra-rater reliability of each procedure, the Spearman correlation test was applied on all analysis and it was possible to verify types 1,1 and 3,1 Intra-class correlation coefficients (ICC), according to Yaffe, within the analyzed data. The value ≥0,80 was assumed as an excellent reliability level, as suggested by Yaffe.
The other reliability intervals were as proposed by Fleiss: values. RESULTS The subjects mean age was 22.2±3.2 (range 16-26) years; the average body weight was 75.9±6.6 Kg; the mean height was 1.76±0.06 m, and the mean body mass index (BMI) was 23.6±2.0 Kg/m.
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A total of 9 of the assessed subjects practiced some kind of physical activity. None of the subjects presented shoulder instability for apprehension and posterior displacement, on either side; the AP Drawer test was negative in 91% of the cases on both sides; the sulcus test was 91% negative for the right side, and 82% negative for the left side. The statistical values of the data of each movement, of all evaluators, with each measuring method and on each day of evaluation, are displayed in. Evaluator C Evaluator D Evaluator A Evaluator B D1 D2 D1 D2 D1 D2 D1 D2 r(p) r(p) r(p) r(p) r(p) r(p) r(p) r(p) Evaluator C.93(.47) 1.0(.22) 96(. DISCUSSION Several studies have measured shoulder rotation range of motion and have invariably used manual goniometry as the measuring method; however, the reliability indexes of this technique were not reported. These papers report medial rotation deficit in the dominant upper limb for throwing (Glenohumeral Internal Rotation Deficit - GIRD), a context which indicates primary functional diagnostics for clinical practice. The precision of these functional diagnoses is of fundamental importance because they apply to preventive treatment for subjects predisposed to develop symptoms of shoulder pain due to such rotational alterations.
Symptomatic subjects usually present medial rotation deficits above 25º compared to the non-dominant upper limb. Therefore, it is important that, apart from reliability assessments, the validation of the methodology should be obtained. The procedures used for validation were described by Amorim et al. And Ellenbecker et al. Another fundamental issue is the standardization of the method, given that, without it, the results may be imprecise. Thus, the procedures used in this study were described in detail.