- •The precision and inter-rater reliability of the intermetacarpal distance measurement method for palmar and radial abduction have been established for persons with medical diagnosis of or clinical exam consistent with thumb CMC osteoarthritis.
- •Interrater reliability was excellent for radial and palmar abduction and precision was acceptable to excellent for these measurements.
- •The findings suggest that this method to assessing thumb CMC abduction are more reliable and precise than other methods for this population. Hand therapists should use this assessment over others.
Psychometric study of inter-rater reliability.
Functional use of the thumb can be limited in individuals with thumb carpometacarpal (CMC) osteoarthritis(OA), especially in the presence of a thumb adduction contracture. Goniometry is a common method of assessing palmar and radial abduction of the thumb base and can be used as a method of determining effectiveness of an intervention for adduction contracture. However, goniometry for the assessment of these motions has been shown to have low to moderate reliability. The intermetacarpal distance (IMD) measurement method has been shown to be the most reliable for measuring CMC palmar abduction in individuals with healthy hands but has not been studied in persons with thumb CMC OA.
The purpose of this study was to determine the inter-rater reliability and precision of the inter-metacarpal distance method for measuring palmar and radial abduction in persons with symptoms of thumb CMC OA.
Two trained hand therapists utilized the IMD method to measure palmar and radial abduction in the affected hands of 22 subjects (28 thumbs) with a physician-confirmed diagnosis or positive provocative test consistent with a diagnosis of thumb CMC OA. The intraclass correlation coefficient (ICC2,2) was used to assess inter-rater reliability of the IMD method. To determine the precision of the measurements, the standard error of measurement (SEM), minimal detectable change (MDC), and MDC percent were calculated. Findings were supplemented with descriptive data on the IMD values as well as descriptive data on the sample.
Intraclass correlation coefficients for both radial and palmar abduction were found to be >.75, indicating excellent reliability. The precision of the IMD measurements were acceptable-to-excellent as evidenced by MDC% values of <30% and <10% for radial and palmar abduction respectively.
We present a new method for measuring thumb radial abduction. The inter-metacarpal distance method has excellent inter-rater reliability and acceptable-to-excellent precision when measuring palmar and radial abduction in individuals with or suspected to have thumb CMC OA. Currently, it is the most reliable tool for measuring thumb abduction.
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JHT Read for Credit
Quiz: # 874
Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.
- # 1.Goniometry of thumb abduction has been shown to be
- a.highly reliable
- b.virtually unreliable
- c.only moderately reliable
- d.one of the most accurate measures known to hand therapy
- # 2.Inter-rater reliability was determined by
- a.an ICC
- b.the Pearson Correlation Coefficient
- c.an ANOVA
- d.a Kappa
- # 3.Precision of the measures was analyzed by
- a.a team of university statisticians
- b.digital scanning
- d.MDC and SEM
- # 4.Radial abduction was measured with
- a.X-ray analysis
- b.a plastic goniometer
- c.a caliper placed on the thumb MPJ and the index MPJ
- d.a straightedge placed between the index MPJ and the thumb MPJ
- # 5.The IMD method was shown to be reliable
When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.
Published online: March 05, 2021
Accepted: March 1, 2021
Received in revised form: December 23, 2020
Received: May 26, 2020
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