BackgroundFinger mobility plays a crucial role in everyday living and is a leading indicator during hand rehabilitation and assistance tasks. Depth-based hand pose estimation is a potentially low-cost solution for the clinical and home-based measurement of symptoms of limited human finger motion. ObjectiveThe purpose of this study was to achieve the contactless measurement of finger motion based on depth-based hand pose estimation using Azure Kinect depth cameras and transfer learning, and to evaluate the accuracy in comparison with a three-dimensional motion analysis (3DMA) system. MethodsThirty participants performed a series of tasks during which their hand motions were measured concurrently using the Azure Kinect and 3DMA systems. We propose a simple and effective approach to achieving real-time hand pose estimations from single depth images using ensemble convolutional neural networks trained by a transfer learning strategy. Algorithms to calculate the finger joint motion angles are presented by tracking the locations of the 24 hand joints. To demonstrate their potential, the Azure-Kinect-based 3D finger motion measurement system and algorithms are experimentally verified through comparison with a camera-based 3DMA system, which is the gold standard. ResultsOur results revealed that the Azure-Kinect-based hand pose estimation system produced highly correlated measurements of hand joint coordinates. Our method achieved excellent performance in terms of the fraction of good frames ( >80%) when the error thresholds were larger than approximately 2 cm, and the range of mean error distance was 0.23−−1.05 cm. For joint angles, the Azure Kinect and 3DMA systems had comparable inter-trial reliability (ICC2,1 ranging from 0.89 to 0.97) and excellent concurrent validity, with Pearsons r-values >0.90 for most measurements (range: 0.88−−0.97). The 95% BlandAltman limits of agreement were narrow enough for the Azure Kinect to be considered a valid tool for the measurement of all reported joint angles of the index finger and thumb in pinching. Moreover, our method runs in real time at over 45 fps. ConclusionThe results of this study suggest that the proposed method has the capacity to measure the performance of fine motor skills.