Goniometry and linear assessments to monitor movement outcomes: are they reliable tools in burn survivors?

Abstract

Despite common use and theoretical construct validity, goniometry is not reported to be reliable for the measurement of burn-affected joint range of motion. Similarly, a number of simple objective measures commonly used to document hand mobility have eluded this rigour. This study aimed to examine the within sessions of intra-rater and inter-rater reliability of active joint range of motion measurement in patients with burns. Intra-rater reliability: One physical therapist (PT) recorded duplicate measurements on each burn-affected joint after a 5-min interval in a subset of patients (n=21). Inter-rater reliability: Four qualified PTs took part in repeated measures testing of 45 patients on the same day. Intra-rater reliability was excellent with intraclass correlation coefficients (ICCs>.99) and 95% confidence intervals (CIs)=.99-1.0. Inter-rater reliability was also excellent with ICCs>.94 (95% CIs=.90-.99). The minimum detectable change using goniometry at the ankle was > or =5 degrees and for all other joints tested was > or =9 degrees. For linear hand measures a change of >1cm and thumb opposition > or =1/2 of one scale point indicated measurable difference. This study demonstrated excellent intra-rater and inter-rater reliability and measurement of clinically relevant change for all measurements when applied with a standardised protocol. Therefore, assessing joint range of motion (ROM) with a goniometer or hand movement with linear or scale measurements can provide accurate, objective measures in the burns population.