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Author Topic: How do you measure ROM  (Read 1828 times)

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Offline mjeffrey

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How do you measure ROM
« on: August 13, 2014, 09:39:33 AM »
Or rather how do you personally measure ROM?

When people talk about range of motion Iím guessing they are really talking about degrees of flexion so this topic is really about measuring flexion. Most people have some hyper extension as well.  See http://www.kneeguru.co.uk/KNEEnotes/courses/arthrofibrosis-12-part-course-frank-noyes-md/knee-range-motion-part-2-course-arthrofibrosis

Personally I think the ROM deficit is more important than an absolute figure: how much less ROM compared with the good leg.

I worked with 2 PTs and saw 3 OS none of whom measured my flexion. All done by eye and then a statement: that is X degrees. I suppose the actual figure is not that important and so a measurement is not strictly necessary but I like to track progress.

The 2 PTs were consistently about 10 degrees different from each other and I typically agreed with the one who was lower (although I wanted the higher figure of course). In fact I think the more optimistic figure was more correct.
When I got the CPM machine, it had a digital readout of the angle and went from -10 to 120 degrees. When I sent it back I was doing the full range so a ROM of 130. Note the starting point of -10 was probably not correct (it was probably closer to zero), it depends on how you adjust the machine, but the full range was still 130. Iím guessing that the machine was still pretty precise, (when new it is supposed to be). See the difference between precision and accuracy http://en.wikipedia.org/wiki/Accuracy_and_precision. When the machine read ninety I thought it was less so my judgement wasnít particularly accurate.
The CPM machine agrees pretty closely with the smartphone app(s) Iíve tried.

Here is an interesting article on 3 methods of measuring ROM.
http://www.amjorthopedics.com/fileadmin/qhi_archive/ArticlePDF/AJO/040120249.pdf

They talk about inter-rater and intra-rater reliability. Inter rater reliability just means that everyone who measures it gets close to the same result - this is important for publishing reproducible scientific results or comparing with some standard but not necessary for progress tracking where intra-rater reliability is more important. 

I found the smartphone way of doing things when I read this abstract http://www.ncbi.nlm.nih.gov/pubmed/24029833. Note that intra-rater reliability is good but inter-rater is not so good. This means you have reliable personal progress tracking but you may be off when comparing it against some number you have set as a goal.

This is the app itself. Safer to get it from the Play Store (android). I think it is also in the App store (IOS).
http://www.iorg.co.in/2013/05/goniometer-records-mobile-app/

My preferred app is this one: https://play.google.com/store/apps/details?id=com.FiveFufFive.GoniometerProPreviewAndroid&hl=en. Free for 12 readings but it still works afterwards if you are prepared to do a little mental arithmetic.

To get consistent results you need to measure in the same way each time and if you want accuracy then youíll need to follow  the instructions on where to put the phone. If you have bulging quads (unlikely after an accident) then where you put the phone makes a difference.

Other possibilities are a real goniometer, MDAL bought one (is that easy to use without assistance?).

Quote
MDAL:
Personally, I bought a manual 30cm goniometer, you can buy them from ebay for pennies...
Manual goniometers (ebay list), you can find good deals for less than 5 dollars:

http://www.ebay.com/sch/i.html?_trksid=p2050601.m570.l1313.TR0.TRC0.H0.Xgoniometer.TRS0&_nkw=goniometer&_sacat=0&_from=R40

I believe the longer ones even a bit more expensive help giving a better measure, but you can perfectly do the job with a cheaper short one.


In the early days I tried with a diy goniometer with a folding meter rule and basic trigonometry but it wasnít very successful :).

Anyway hope the post is useful to people, how have other people been tracking their ROM?
 
2014:
20 Feb: Comminuted patella fracture, 4 K-wires, Cercalge, Figure of 8
11 Mar: Staples removed Flex 50
22 Apr: Control Xray, flex 80, progress stalled
09 May: MUA: flex 120, 3 weeks CPM
23 Jun: Slow Running, Flex 135
06 Jul: Flex 140
08 Aug: Hardware removed
10 Sep: full flexion

Offline MDAL

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Re: How do you measure ROM
« Reply #1 on: August 13, 2014, 10:01:35 AM »
MJeffrey:

First, ROM means a Range, which goes from extension value to flexion value.

ROM measuring is not an exact science:

1) It depends on the methodology of measuring (what position you are, and how you make the alignments).

2) There is active ROM (your own push), Passive, with or without pressure.

3) ROM is not fixed, it changes through the day. Under inflammatory process you may wake up with a lock at 90 in the morning, take it to 130 with 10 minutes of exercise and then go for a walk, and having it locked at 115 when you get back.

The point of measuring ROM may have to do with functional evaluation (and by the eye a doctor can tell this), or if you are actively working on it, it is good to measure it daily (morning ROM), ROM after exercise, active and passive. I used to have an excel sheet where I tracked this progress and kept excel charts of it.

About techniques to measure, there is a wealth of explanations online, where physiotherapists by written or even in youtube videos show how to do it, and the mistakes you can make and how to avoid them.

Being an engineer, using a goniometer doesn't scare me, it's just measuring an angle, as long as I use common sense to align it correctly through the bone, not much can go terribly wrong. The important thing is to use always the same position and methodology, so you obtain valid measures of change through time.

Adding to this, cell phone apps, can be very imprecise, because there are many trigonometric issues int he leg alignment in other planes than the one captured by image. A manual one since you can align along the bones is always more trust worthy. If longer, you can also align through the bones, with less margin for error.
« Last Edit: August 13, 2014, 10:04:13 AM by MDAL »

Offline daihard

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Re: How do you measure ROM
« Reply #2 on: August 14, 2014, 06:52:05 AM »
Thanks for starting a new thread about this. I want to measure my ROM every day just so I can record my progress over time. I did find a physical goniometer in the garage, which I had bought and used to measure my knee angle while adjusting my bike saddle height. I would still prefer a cellphone app unless it is grossly less accurate than the physical device, simply because I should be able to store the results fairly easily using apps. Yes, I'm lazy.

As for the ROM changing throughout the day, I plan on recording the value I get on my last set, which I typically do around 9-10 PM. I tend to get the best result later in the day, probably because I try to move my bad leg as much as I can during the day. (I take the brace off at work while I'm at the desk.)

Dai
2014:
06-21  Fractured right patella
07-02  ORIF - figure 8
07-29  4-week post-op follow-up
07-31  Started PT - 60 ROM
08-07  90 ROM
08-14  115 ROM
08-21  Started bike trainer - 122 ROM
08-28  132 ROM
09-04  135 ROM
09-08  139 ROM

Offline MDAL

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Re: How do you measure ROM
« Reply #3 on: August 14, 2014, 01:54:10 PM »
Dai:

Smartphone apps, aren't too accurate... but might be sufficient.

I would also record morning lock. At the moment it is not too useful, but later in time, you might want to control the inflammatory process (which causes the morning locks).
















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