Reliability of Water Volumetry and the Figure of Eight Method on Subjects With Ankle Joint Swelling

Abstract

Study Design: Single-group repeated measures with 2 raters. Objectives: To determine the interrater and intrarater reliability of water volumetry and the figure of eight method on subjects with ankle joint swelling. Background. Measurements of ankle swelling are commonly performed to determine the nature and stage of injury and to monitor progress made during rehabilitation. Water volumetry and the figure of eight method are 2 techniques used to measure ankle swelling. Methods and Measures: Twenty-nine subjects with ankle swelling were measured by 2 raters with the hypothesis that both measurement techniques would be reliable. Each rater performed 3 measurements of the swollen ankle using both measurement techniques during a single test &ion. The order of the rater and of the measurement technique was randomized, and the raters were blinded to each other' s measurements. Results: We found high intenater reliability for both the water volumetry (KC [intraclass correlation coefficientl = 0.99) and figure of eight methods (ICC = 0.98). Additionally, intrarater reliability was high for both raters using both methods (ICCs = 0.98-0.99).Conclusions: Both methods are reliable measures of ankle swelling. The authors recommend the figure of eight method because of its ease of use, time efficiency, and cost effectiveness. However, water volumetry may be more appropriate when measuring diffuse lower-extremity swelling. Reliability of these 2 methods was established using subjects with foot or ankle pathology. Therefore, the results are applicable and Clinicians and researchers have used several methods to measure limb volume. These methods include girth m e a s~r e r n e n t s ,~~~~~~~~ water displacement,lS:'.~~10-12.14~141833 bioelectric impedan~e,2~.~~ and computer m~d e l i n g .~.~ The 2 most common clinical methods to measure limb volume are girth measurements with a tape measure and ankle volume measurements with a water volumeter.

Reliability and Feasibility of Methods to Quantitatively Assess Peripheral Edema

“…16,26,32 The high reliability of water-displacement volumetry observed in the current study is similar to that seen previously. 26 However, measurements in the current study were more variable with a range of average absolute differences between examiners of 5.1 mL to 71.9 mL. Petersen reported average differences of 11 mL to 18 mL.…”

“…While the figure-of-eight method has been shown to be a reliable measure in both healthy volunteers and volunteers with recent ankle injury, 14,16,26 reliability was inconsistent in the current study, with the agreement for the left ankle (ICC=0.86) much better than for the right ankle (ICC=0.64). In studies of healthy volunteers 14 and in patients with recent ankle or lower leg injuries, 16,26 reliability, as measured by the ICC, was 0.99.…”

“…14,16,26,28 Unlike the previously published methods, a tension-controlled measuring tape, rather than a standard measuring tape, was wrapped around the ankle/foot following the eight landmarks.…”

“…In clinical studies, peripheral edema, as a pharmacologically-mediated adverse event, has typically been captured through water-displacement volumetry, patient self-report, or other, often non-validated, investigator assessments. [20][21][22][23][24][25] Water-displacement volumetry is widely considered to be the reference method of edema assessment; 26 however, it is also considered to be time-consuming, difficult to perform, and inappropriate in some clinical situations (e.g., postoperative), limiting the use of this method. 12,27 Documentation of the accuracy and reliability of other methods of measuring peripheral edema vary.…”

Bone Mineral Density During Total Contact Cast Immobilization for a Patient With Neuropathic (Charcot) Arthropathy

“…In the hand, the volumeter has been found to be accurate to within 1% of the measured volume when used according to the manufacturer's directions. 23 Petersen et al 24 reported ICCs of .99 for interrater reliability and .98 to .99 for intrarater reliability for foot water volumetry. The water temperature was not measured but was considered cool (tap water).…”