Interobserver Reproducibility of the Visual Estimation of Range of Motion of the Shoulder

Abstract

Objectives: To assess interobserver reproducibility (agreement and reliability) of visually estimated shoulder range of motion (ROM) and to study the influence of clinical characteristics on the reproducibility.Design: Test-retest analyses. Setting: Various health care settings in the Netherlands. Participants: Consecutive patients with shoulder complaints (Nϭ201) referred by 20 general practitioners, 2 orthopedic physicians, and 20 rheumatologists.Interventions: Not applicable. Main Outcome Measures: Independent visual estimation by 2 physiotherapists of the ROM. Agreement was calculated as the mean difference in visual estimation between examiners Ϯ1.96 ϫ standard deviations of this mean difference. The intraclass correlation coefficient (ICC) was calculated as a measure of reliability, based on a 2-way random effects analysis of variance.Results: The lowest level of agreement was for visual estimation of active and passive elevation (limits of agreement, Ϫ43.4 to 39.8 and Ϫ46.7 to 41.5, respectively, for the difference between the affected and contralateral sides), for which the level of agreement was most clearly associated with pain severity and disability. The ability to differentiate between subjects was acceptable for all movements for the difference between the affected and contralateral sides (ICCs, Ͼ.70) except for horizontal adduction (ICCϭ.49).Conclusions: Interobserver agreement was low for the assessment of active and passive elevation, especially for patients with a high pain severity and disability. Except for horizontal adduction, visual estimation seems suitable for distinguishing differences between affected and contralateral ROM between subjects.Key Words: Range of motion, articular; Rehabilitation; Reproducibility of results; Shoulder.© by American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and RehabilitationC OMPLAINTS OF SHOULDER DYSFUNCTION are often associated with restricted range of motion (ROM). [1][2][3][4] The difference between the affected and the contralateral sides is related to the ability to perform the activities of daily life, such as dressing, washing, and lifting above shoulder level. [4][5][6] Measurement of the ROM plays a vital role in diagnosis, 7-9 assessment of the severity of disability, and the assessment of treatment outcome in clinical practice and research. 9 Several methods are available for quantifying ROM, such as goniometry, inclinometry, and even high-speed cinematography. High reproducibility is an important prerequisite if measurements are to be useful for discriminative and evaluative purposes. The reproducibility of the various devices used to assess shoulder ROM has been evaluated in several studies. [10][11][12][13][14][15][16][17][18][19] Although in clinical practice ROM assessment is often based on visual inspection of the movement, insight into the reproducibility of the visual estimation of shoulder ROM is limited. 20,21 The level of reproducibility of ROM measurement may be influenced by many factors such ...

Validity of Goniometric Elbow Measurements: Comparative Study with a Radiographic Method

“…The augmented flexion mean with the goniometer cancels the diminished extension, resulting in similar ROM means (Table 1). When reviewing the literature, there are numerous methods for measuring ROM: visual estimation [2,13,32,33], photographic [7], fluid-based [10,24] or electrogoniometer [10,11,34]. Results regarding the validity of the goniometer are ambivalent.…”

Physical Therapy Diagnosis and Management of a Patient with Chronic Daily Headache: A Case Report

“…Interrater agreement for visual estimation of shoulder AROM tests is poor to good (ICC=0.15-0.88) but decreases when pain and disability is present. However, with the exception of horizontal adduction, it is suitable for distinguishing between the affected and normal side indicating that its use here as a screening tool was appropriate 47 . A neuroconductive examination yielded bilateral normal (5/5) results for C2-T1 myotomal muscle strength tests.…”

Validity and Reliability of an Inertial Measurement Unit-Based 3D Angular Measurement of Shoulder Joint Motion

“…1 Measurement of ROM plays a vital role in diagnosing disease, assessing disability levels, and determining treatment outcomes. 2 Because the shoulder joint has the greatest ROM of all body joints, it's motion would essentially affect the ability to perform activities of daily life such as dressing, washing, and reaching above shoulder level. 2,3 Therefore, evaluation of the shoulder joint ROM is essential in individuals with shoulder dysfunction.…”