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

Shoulder joint range of motion in healthy adults aged 20 to 49 years

Studies of adults aged 50 years and older have shown that shoulder range of motion (ROM) is significantly less than the norms reported by the American Academy of Orthopaedic Surgeons (AAOS) and decreases with age. However, there has been little investigation of the shoulder ROM of younger adults. The aims of this study were to measure the ROM of healthy younger Australian adults aged 20 to 49 years to (1) pool with data on healthy older Australian adults aged 50 years and older from the study by McIntosh et al (2003) to provide shoulder ROM values across the adult life span; (2) compare their shoulder ROM with AAOS norms; and (3) determine the effect of background factors (age, gender, body mass index [BMI] and current activity level) on active shoulder ROM. Goniometric measurement of bilateral passive and active shoulder flexion, abduction, internal rotation and external rotation of 72 participants was compared with the AAOS norms using one-sample t-tests. The effect of the background factors on shoulder ROM was analysed using univariate General Linear Models. Significantly lower active and passive ROM (p ≤ 0.001) for all movements compared with AAOS norms was found. Active shoulder flexion, abduction and internal rotation were not significantly affected by any of the background factors. Decreased active external rotation was found for males (p = 0.020) and for older (p = 0.048) and less active (p = 0.048) participants. This study highlights the inaccuracies of the AAOS norms for younger adults aged 20 to 49 years and shows that age, gender, BMI and current activity level do not consistently have an impact on active shoulder ROM in this age group. The relevance of the AAOS norms to other joints needs investigation

Patients with fixed flexion deformity after total knee arthroplasty do just as well as those without: ten-year prospective data

Range of motion (ROM) is an important outcome variable after total knee arthroplasty (TKA). This may be compounded by a pre-existing fixed flexion deformity (FFD). We therefore examined the long-term outcomes of patients with a flexion deformity undergoing TKA compared to those without a preoperative fixed flexion deformity. Participants who had undergone TKA at our centre between 1989 and 2002 were examined preoperatively, one, five and ten years after TKA (Kinemax PS; Howmedica, Rutherford, NJ, USA). Examining those with a preoperative FFD of greater than ten degrees with complete ten year follow-up data revealed 77 individuals. Seventy seven age, sex and body mass index matched patients were identified and the effect of TKA on indices of knee function (fixed flexion, maximum flexion, total ROM and Knee Society score (KSS) in both groups were analysed using repeated measures ANOVA. A significant difference between the groups with respect to fixed flexion (p < 0.001), total ROM (p = 0.001) and KSS (p < 0.001) was observed between baseline and year one suggesting that those with a preoperative FFD improved more than those without. A significant difference with regard to fixed flexion was also observed between years one to five (p = 0.001) and just failed to reach statistical significance between five to ten years (p = 0.052) between the groups. This study demonstrates that patients with a preoperative fixed flexion deformity show continued improvement in their fixed flexion up to ten years post arthroplasty and have similar outcomes to those with no preoperative fixed flexion

Muscle Length and Joint Range of Motion in Children with Cystic Fibrosis Compared to Children Developing Typically

Purpose: To explore range of motion in children with cystic fibrosis (CF) compared to children developing typically. With the increasing longevity of people with CF, musculoskeletal concerns are becoming more prevalent and should be identified and considered in management plans. Reduced range of motion (ROM) in older people with CF has been demonstrated, and the age at which these changes begin to occur must be explored