Inter-observer reproducibility of measurements of range of motion in patients with shoulder pain using a digital inclinometer

BACKGROUND: Reproducible measurements of the range of motion are an important prerequisite for the interpretation of study results. The digital inclinometer is considered to be a useful instrument because it is inexpensive and easy to use. No previous study assessed inter-observer reproducibility of range of motion measurements with a digital inclinometer by physical therapists in a large sample of patients. METHODS: Two physical therapists independently measured the passive range of motion of the glenohumeral abduction and the external rotation in 155 patients with shoulder pain. Agreement was quantified by calculation of the mean differences between the observers and the standard deviation (SD) of this difference and the limits of agreement, defined as the mean difference ± 1.96*SD of this difference. Reliability was quantified by means of the intraclass correlation coefficient (ICC). RESULTS: The limits of agreement were 0.8 ± 19.6 for glenohumeral abduction and -4.6 ± 18.8 for external rotation (affected side) and quite similar for the contralateral side and the differences between sides. The percentage agreement within 10° for these measurements were 72% and 70% respectively. The ICC ranged from 0.28 to 0.90 (0.83 and 0.90 for the affected side). CONCLUSIONS: The inter-observer agreement was found to be poor. If individual patients are assessed by two different observers, differences in range of motion of less than 20–25 degrees can not be distuinguished from measurement error. In contrast, acceptable reliability was found for the inclinometric measurements of the affected side and the differences between the sides, indicating that the inclimeter can be used in studies in which groups are compared

Impairment measures in rheumatic disorders for rehabilitation medicine and allied health care: a systematic review

The objective of this study is to provide a critical overview of available instruments to assess impairments in patients with rheumatic disorders, and to recommend reliable and valid instruments for use in allied health care and rehabilitation medicine. A computer-aided literature search (1982-2004) in several databases was performed to identify studies focusing on the clinimetric properties of instruments designed to assess impairments in function in patients with rheumatic disorders. Data on intra-rater reliability, inter-rater reliability and construct validity were extracted in a standardized way. Explicit criteria were applied for reliability and validity. Results: The search identified a total of 49 instruments to assess impairments in functions in patients with rheumatic disorders; 19 met the criteria for reliability, 22 met the criteria for validity, and 11 out of the 49 appeared to meet the criteria for both reliability and validity. In summary, evidence of both reliability and validity was only found for 11 out of 49 instruments for the assessment of impairments in patients with rheumatic disorders. Only a limited number of the identified instruments for the assessment of impairments is both reliable and valid. Allied health care professionals should be cautious in the selection of measurement instruments to assess their patient