Article

Goniometric measurements of hemiplegic arm joints must be reliable to
draw proper clinical and scientific conclusions. Previous reliability studies
were cross-sectional and based on small samples. Knowledge about the
contributions of sources of variation to these measurement results is lacking.
Objective The aims of this study were to determine the interobserver reliability
of measurements of passive range of motion (PROM) over time, explore sources of
variation associated with these measurement results, and generate smallest
detectable differences for clinical decision making. Design This investigation
was a measurement-focused study with a longitudinal design, nested within a 2-arm
randomized controlled trial. METHODS: /b> Two trained physical therapists
assessed 7 arm movements at baseline and after 4, 8, and 20 weeks in 48 people
with subacute stroke using a standardized protocol. One physical therapist
performed the passive movement, and the other read the hydrogoniometer. The
therapists then switched roles. The relative contributions of several sources of
variation to error variance were explored with analysis of variance. RESULTS: /b>
Interobserver reliability coefficients ranged from .89 to .97. The PROM
measurements were influenced by error variance ranging from 31% to 50%. The
participant x time interaction made the largest contribution to error variance,
ranging from 59% to 81%. Smallest detectable differences were 6 to 22 degrees and
were largest for shoulder movements. Limitations Verification of shoulder pain
and hypertonia as sources of error variance led to a substantial number of
unstable variance components, necessitating a simpler analysis. CONCLUSIONS: /b>
The assessment of PROM with a standardized protocol, a hydrogoniometer, and 2
trained physical therapists yielded high interobserver reliability indexes for
all arm movements. Error variance made a large contribution to the variation in
measurement results. The resulting smallest detectable differences can be used to
interpret future hemiplegic arm PROM measurements with more confidence.

Langue : ANGLAIS