Articlegold2009

Is visual estimation of passive range of motion in the pediatric lower limb valid and reliable

Rami Rachkidi · Ismat B. Ghanem · Ibrahim Kalouche · Samer El Hage · Fernand Dagher · Khalil E. Kharrat

28 citations0/0 files storedBMC Musculoskeletal Disorders

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Reliability and Agreement in Measurement Lower Extremity Biomechanics and Pathologies Musculoskeletal Disorders and Rehabilitation

Abstract

BACKGROUND: Visual estimation (VE) is an essential tool for evaluation of range of motion. Few papers discussed its validity in children orthopedics' practice. The purpose of our study was to assess validity and reliability of VE for passive range of motions (PROMs) of children's lower limbs. METHODS: Fifty typically developing children (100 lower limbs) were examined. Visual estimations for PROMs of hip (flexion, adduction, abduction, internal and external rotations), knee (flexion and popliteal angle) and ankle (dorsiflexion and plantarflexion) were made by a pediatric orthopaedic surgeon (POS) and a 5th year resident in orthopaedics. A last year medical student did goniometric measurements. Three weeks later, same measurements were performed to assess reliability of visual estimation for each examiner. RESULTS: Visual estimations of the POS were highly reliable for hip flexion, hip rotations and popliteal angle (rhoc >or= 0.8). Reliability was good for hip abduction, knee flexion, ankle dorsiflexion and plantarflexion (rhoc >or= 0.7) but poor for hip adduction (rhoc = 0.5). Reproducibility for all PROMs was verified. Resident's VE showed high reliability (rhoc >or= 0.8) for hip flexion and popliteal angle. Good correlation was found for hip rotations and knee flexion (rhoc >or= 0.7). Poor results were obtained for ankle PROMs (rhoc < 0.6) as well as hip adduction and abduction, the results of which not being reproducible. Influence of experience was clearly demonstrated for PROMs of hip rotations, adduction and abduction as well as ankle plantarflexion. CONCLUSION: Accuracy of VE of passive hip flexion and knee PROMs is high regardless of the examiner's experience. Same accuracy can be found for hip rotations and abduction whenever VE is performed by an experienced examiner. Goniometric evaluation is recommended for passive hip adduction and for ankle PROMs.

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References

1986STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT 1989A Concordance Correlation Coefficient to Evaluate Reproducibility 1995Comparing methods of measurement: why plotting difference against standard method is misleading 1987Clinical Measurement of Range of Motion 1978Reliability of Goniometric Measurements 1992Assay Validation Using the Concordance Correlation Coefficient 1991Reliability of Goniometric Measurements and Visual Estimates of Knee Range of Motion Obtained in a Clinical Setting 2002Overall Concordance Correlation Coefficient for Evaluating Agreement Among Multiple Observers

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