Can the Internet be used as a medium to evaluate knee angle?

T.G. Russell, G.A. Jull and R. Wootton

Manual Therapy

Volume 8, Issue 4, November 2003, Pages 242-246

Russell et al have examined an area of particular interest to PhysioRoom.com. One of the interesting aspects of the introduction of our 'Ask The Experts' feature is the degree to which we cover the globe. Clinicians in the United Kingdom and United States answer clinical queries from users in Australasia, Europe and the Indian sub continent. Distance is immaterial - patients in remote areas can now have access to the world's leading clinicians. This concept, and the practical delivery of it, is the topic of the authors' study.

One of the practical problems of internet based medicine is the difficulty in accurately assessing patients using conventional measurement tools. One such measurement tool frequently used by physiotherapists is the goniometer, which is used to evaluate joint range of motion. The authors have developed a low-cost application for the delivery of physiotherapy intervention to the home, known as an Internet Based Goniometer (IBG). This application operates on a conventional Internet enabled personal computer over an inexpensive low bandwidth internet connection, via a standard modem. A real-time video and audio connection is facilitated with the use of low-cost web cameras.

The IBG was found to be a highly reliable tool for measuring knee range of motion remotely. Intra-tester (same tester, repeated measures) reliability was higher than inter-tester (between several testers) reliability, a phenomenon consistent with the conventional goniometer. The authors further proposed that the low cost and ease of use of this tool makes it suitable for the field of Internet-based clinical practice.

Although this study is very supportive of internet based clinical practice, we believe this ideal is still some way off. The complexities of the patient-therapist relationship is dependent on very detailed and subtle communication. Until further technological advances are made available to facilitate this then internet based clinical practice will not be suitable in many circumstances. For now general e-advocacy by a clinician is the extent of internet based clinical practice but, in the future, who knows?

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