Hypothesis: We hypothesized that at-home photography-based wrist range of motion (WROM) measurements would be as reliable as traditional physician-performed goniometry. Methods: Sixty-nine postoperative patients who had wrist surgery greater than 3 months prior were enrolled in this study according to an approved institutional review board protocol. Active and passive wrist flexion/extension and radial/ulnar deviation were recorded by 1 of 2 attending surgeons with a 1° resolution goniometer at the last postoperative office visit. Patients were then provided an illustrated instruction sheet detailing how to take digital photographs at home in 6 wrist positions (active and passive flexion/extension and radial/ulnar deviation). Photographs were reviewed by both attending surgeons in a randomized, blinded fashion on 2 separate occasions greater than 2 weeks apart using the same goniometer. Reliability analysis was performed using the intraclass correlation coefficient (ICC) to assess agreement between clinical and photography-based goniometry, as well as intraobserver and interobserver agreement. Results: Out of 69 enrolled patients, 30 patients sent digital images (43% response rate). Of the 180 digital photographs taken by patients at home, only 9 (5%) were missing or deemed inadequate for WROM measurements. Agreement between clinical and photography-based measurements was “almost perfect” for passive wrist flexion/extension (ICC > .80, P < .01) and “substantial” for active wrist flexion/extension and radial/ulnar deviation (.60 < ICC = .80, P < .01). Interobserver and intraobserver agreement for the 2 attending surgeons for all 6 photography-based measurements was “almost perfect” (ICC > .80, P < .01). Conclusion: This study validates a photography-based goniometry protocol allowing accurate and reliable range of motion (ROM) measurements without direct physician contact. Passive ROM was more accurately measured from photographs than active ROM. This study builds on previous photography-based goniometry literature by validating a protocol in which patients take their own photographs. Patient-performed photography-based goniometry represents an alternative to traditional clinical goniometry with the potential to enable longer term patient follow-up, overcome travel or distance impediments to office visits, improve patient convenience, and increase cost savings.
