Reliability of measurements of cervical spine range of motion - comparison of three methods.Disorders of the cervical spine cervical spine Clinical anatomy The region of the vertebral column encompassing C1 through C7 often alter the normal active range of motion (AROM AROM Active range of movement. See Range of motion. ) of the neck. The response of a patient with neck pain to therapeutic intervention is often documented clinically by measuring or visually estimating changes in the AROM of the cervical spine. Although rehabilitation rehabilitation: see physical therapy. personnel frequently measure patients' available AROM, the quality of the technique and the consistency of the measurements often are taken for granted Adj. 1. taken for granted - evident without proof or argument; "an axiomatic truth"; "we hold these truths to be self-evident" axiomatic, self-evident obvious - easily perceived by the senses or grasped by the mind; "obvious errors" . [1] Cole [2] argued that clinical measurements of cervical spine motion are the least accurate of the common measurements of the mobility of the body's joints. He attributed this lack of accuracy to the lack of bony landmarks on the head and to the thickness of soft tissues overlying overlying suffocation of piglets by the sow. The piglets may be weak from illness or malnutrition, the sow may be clumsy or ill, the pen may be inadequate in size or poorly designed so that piglets cannot escape. segments of the cervical spine. Moll and Wright [3] stated that visual estimation (VE) is the most popular technique for recording spine mobility, although this was their personal opinion and they provided no supporting data. Moore, [4] however, discouraged use of VE because she believed it did not lead to reliable measurements. Although VE has been maligned ma·lign tr.v. ma·ligned, ma·lign·ing, ma·ligns To make evil, harmful, and often untrue statements about; speak evil of. adj. 1. Evil in disposition, nature, or intent. 2. as a subjective measurement of joint motion, to our knowledge no evidence has been published to document between-tester reliability of the VE technique for measuring cervical range of motion (ROM) in patients with neck pain. The full-circle goniometer goniometer /go·ni·om·e·ter/ (go?ne-om´e-ter) 1. an instrument for measuring angles. 2. a plank that can be tilted at one end to any height, used in testing for labyrinthine disease. , or universal goniometer (UG), is a versatile device for recording measurements of peripheral joint ROM in healthy subjects [TABULAR tab·u·lar adj. 1. Having a plane surface; flat. 2. Organized as a table or list. 3. Calculated by means of a table. tabular resembling a table. DATA OMITTED] and in patients. [5-8] Few studies, [9,10] however, have examined the reliability of measurements of cervical spine motion taken with the UG in healthy subjects. Some rehabilitation personnel have preferred the gravity goniometer (GG) to the UG because of problems in identifying bony landmarks in the cervical spine. A gravity goniometer usually contains a metallic gravity pointer encased en·case tr.v. en·cased, en·cas·ing, en·cas·es To enclose in or as if in a case. en·case  ment n. within a flat
protractor-like scale that moves freely about an axis. When the scale
is in the vertical plane, gravity pulls the pointer downward. Unlike
the UG, the GG is not influenced by errors in identifying anatomic anatomic /ana·tom·ic/ (an?ah-tom´ik) anatomical. Anatomic Related to the physical structure of an organ or organism. landmarks, and it requires only one hand for use, leaving the other hand free to move the joint being tested. [11] Despite these advantages, the GG generally lacks wide acceptance by rehabilitation personnel, presumably pre·sum·a·ble adj. That can be presumed or taken for granted; reasonable as a supposition: presumable causes of the disaster. because of the cumbersome mounting procedures. The cervical-range-of-motion (CROM CROM Confederación Regional Obrera Mexicana (Spanish: Regional Confederation of Mexican Workers, Mexico) CROM Regional Confederation of Mexican Workers CROM Control Read-Only Memory CROM Cervical Range of Motion ) instrument, [*] another type of GG, is now commercially available and is reported, by its manufacturer, to be clinically efficient and reliable for measuring all cervical motions. The purposes of this study were (1) to examine, in patients, the within-tester and between-tester reliabilities of measurements of AROM of the cervical spine in the three cardinal planes using the CROM device, the UG, and VE and (2) to compare the measurement errors of the three techniques. Method Subjects The subjects were 60 patients (39 women, 21 men) referred to the Mayo Clinic Mayo Clinic: see Mayo, Charles Horace. Mayo Clinic voluntary association of more than 500 physicians in Rochester, Minnesota. [Am. Hist.: EB, 11: 723] See : Medicine Department of Physical Medicine and Rehabilitation physical medicine and rehabilitation or physiatry or physical therapy or rehabilitation medicine Medical specialty treating chronic disabilities through physical means to help patients return to a comfortable, productive life despite a medical (Rochester, Minn) with orthopedic disorders (Tab. 1). The patients' ages ranged between 21 and 84 years (X=59.1, SD = 15.7), and the most frequent reason for physical therapy evaluation was cervical muscle pain (n=27, 45%). Descriptive information regarding the AROM of the patients for the six cervical motions is given in Table 2. Criteria for admission to the study were (1) that assessment of cervical AROM was an appropriate component of the patient's routine physical therapy evaluation and (2) that the patient was 18 years of age or older. Any patient with the diagnosis of spasmodic torticollis spasmodic torticollis Wry neck, see there, aka cervical dystonia was excluded. According to according to prep. 1. As stated or indicated by; on the authority of: according to historians. 2. In keeping with: according to instructions. 3. the patients' self-reports, repeated cervical motions did not exacerbate their clinical signs or symptons. Informed oral consent was obtained from all subjects. Using previously reported studies [6,7] as a model, we divided the data-collection process into three parts to minimize patients discomfort and to maintain the physical therapy department's productivity. Each part consisted [TABULAR DATA OMITTED] of an assessment of cervical AROM in 20 subjects in one cardinal plane of motion (Tab. 1). Testers The CROM, UG, and VE measurements were made by 11 volunteer physical therapists employed at the Mayo Clinic. Their clinical experience ranged from 2 to 27 years (X=7, SD=7), and they had graduated from three diffirent schools of physical therapy. Prior to the study, the therapists' self-reports indicated that they generally used VE for measuring cervical ROM and the UG for measuring ROM of the extremities ex·trem·i·ty n. pl. ex·trem·i·ties 1. The outermost or farthest point or portion. 2. The greatest or utmost degree: the extremity of despair. 3. a. ; they had no previous experience with the CROM device. Before the study began, we conducted a 60-minute training session using a written protocal that described each method of measurement. The standardized standardized pertaining to data that have been submitted to standardization procedures. standardized morbidity rate see morbidity rate. standardized mortality rate see mortality rate. measurement procedures were demonstrated, and the therapits practiced measuring AROM on themselves by using each of the three methods. The measurement protocol for the UG was modified from a previously reported technique. [12] Instrumentation We used large, plastic, 360-degree UGs+ with 30.5-cm (12-in) movable arms and study pivot joints piv·ot joint n. See trochoid joint. . The measurement scales of the UGs were marked in 1-degree increments. One side of each goniometer's scale was covred with white adhesive paper so that the physical therapist could not see the measurement, but the recorder could read the numbers from the reverse side of the goniometer and record them on prepared recording sheets. The UGs were not tested for their individual measurement accuracy. The CROM device (Fig. 1) consists of a plastic frame that is mounted over the subject's nose bridge and ears and secured to the head by a Velcro [R] (1) strap. Three dial angle meters an instrument for measuring angles, esp. for ascertaining the dip of strata. See also: Angle attached to the frame and aranged orthogonally or·thog·o·nal adj. 1. Relating to or composed of right angles. 2. Mathematics a. Of or relating to a matrix whose transpose equals its inverse. b. to one another indicate the subject's cervical ROM. Neck flexion flexion /flex·ion/ (flek´shun) the act of bending or the condition of being bent. flex·ion n. 1. The act of bending a joint or limb in the body by the action of flexors. 2. , extension, and laternal flexion movements are recorded by gravity goniometers. The cervical rotation (transverse plane transverse plane n. See horizontal plane. transverse plane, n any plane that passes through the body perpendicular to the sagittal dividing the body into superior and inferior sections. ) meter is a compass goniometer and operates in conjuction with a shoulder-mounted magnetic yoke yoke (yok) 1. a connecting structure. 2. jugum. yoke n. See jugum. yoke, n 1. something that connects or binds. . The dial meters were marked in 2-degree increments. The same CROM instrument was used throughout the study. The device was not checked for measurement accuracy. Procedure To decrease betwee-tester variability, we standardized subject position and placement of the measurement devices. All subjects sat in a standard metal-frame chair so that their thoracic thoracic /tho·rac·ic/ (thah-ras´ik) pectoral; pertaining to the thorax (chest). tho·rac·ic adj. Of, relating to, or situated in or near the thorax. spine maintained contact with the chair's backrest and their lumbosacral spine filled the gap between the seat and the backrest. Their feet were positioned flat on the floor, and their arms rested freely at their sides. As instructed by the tester, each subject performed three repetitions of neck AROM (warm-ups) in each direction within a designated cardinal plane to increase compliance of the neck's soft tissues. The tester then measured the subject's cervical AROM, in both directions within a cardinal plane, by each of the three techniques (CROM, UG, and VE) used in a randomized ran·dom·ize tr.v. ran·dom·ized, ran·dom·iz·ing, ran·dom·iz·es To make random in arrangement, especially in order to control the variables in an experiment. order. Immediately after the first six measurements, the subject repeated the same movements, providing two sets of six measurements for each tester. Except for the warm-ups, the subject completed the same movement sequence for a second tester, who likewise made two sets of six measurements. Thus, each subject completed a total of 30 cervical AROM movements (6 warmups + 24 measurements). Part 1. This part of the study investigated cervical flexion with chin tuck and extension with chin elevation. Tester and recorder stood on opposite sides of the subject, with the recorder always lateral to the subject's left shoulder. From this location, the recorder read numbers from the CROM device's sagittal plane sagittal plane n. A longitudinal plane that divides the body of a bilaterally symmetrical animal into right and left sections. sagittal plane, n GG or from the reverse side of the UG's protractor protractor Instrument for constructing and measuring plane angles. The simplest protractor is a semicircular disk marked in degrees from 0° to 180°. A more complex protractor, for plotting position on navigation charts, is called a three-arm protractor, or station scale. The starting position for both cervical flexion and extension was assumed after the tester manually adjusted the subject's neck so that the external acoustic meatus-to-base of nares reference line was parallel to the floor. Placement of the UG followed the technique previously described by Norkin and White. [12] The US's axis was centered over the external acoustic meatus acoustic meatus n. 1. The passage leading inward through the tympanic portion of the temporal bone, from the auricle to the tympanic membrane; external acoustic meatus. 2. (Fig. 1 [Top]); the fixed arm was held vertical, while the movable arm was aligned with the meatus-to-base of nares reference line as the subject actively flexed and extended the neck. For the CROM, the tester positioned the subject at the appropriate starting, position by using manual and verbal cues, without the aid of the sagittal sagittal /sag·it·tal/ (saj´i-t'l) 1. shaped like an arrow. 2. situated in the direction of the sagittal suture; said of an anteroposterior plane or section parallel to the median plane of the body. GG. The recorder wrote down both start and end points of the cervical AROM for the CROM device and the UG. For VE, the tester verbally reported to the recorder the cervical AROM to the neares 5 degrees, based on the landmarks described for placement of the UG. Part 2. We studied AROM of cervical lateral flexion. Each subject bent his or her head and cervical spine first left and then right without elevating his or her shoulder. For the VE and UG technique, the subject sat begtween the tester and the recorder; the tester was in fron of the patient (Fig. 2 [Middle]). The tester aligned the fixed arm of the UG parallel with a horizontal reference line between the patient's sternal sternal /ster·nal/ (ster´n'l) of or relating to the sternum. ster·nal adj. Of, relating to, or occurring near the sternum. sternal pertaining to the sternum. notch and acromion acromion /acro·mi·on/ (ah-kro´me-on) the lateral extension of the spine of the scapula, forming the highest point of the shoulder. a·cro·mi·on n. process; the movable arm was aligned with the midline mid·line n. A medial line, especially the medial line or plane of the body. midline, n the line equidistant from bilateral features of the head. of the patient's nose. The starting or neutral position was with the arms of the UG perpendicular. After the CROM device was nounted, the tester stood behind the subject and offered instructions and corrected substitution pattenrs; the recorder stood in fron of the subject and recorded readings from the frontal plane frontal plane n. See coronal plane. angle meter at the start and end points of movement. Part 3. We studies AROM of cervical rotation. Each subject rotated his or her head first left and then right. For VE and UG measurements, the tester stood behind the subject and gazed at the top of his or her head; the recorded faced the subject. The placement procedure for the UG has been described by Norkin and White. [12] The UG axis was centered on the top of the subject's head (Fig. 2 [Bottom]); the fixed arm was aligned parallel to an imaginary line In general, an imaginary line is any sort of line that has only an abstract definition, and does not exist in fact. As a geographical concept, an imaginary line may serve as an arbitrary division (such as a border). between the subject's acromion processes, and the movable arm was aligned with the subject's nose. After the CROM device was mounted with its magnetic needle and shoulder yoke, the tester faced the subject and gave instructions without looking at the magnetic dial meter. The recorder remained behind the subject, and recorded the readings of the magnetic needle at the start of end points of the motion. Data Analysis Intraclass correlation In statistics, the intraclass correlation (or the intraclass correlation coefficient[1]) is a measure of correlation, consistency or conformity for a data set when it has multiple groups. coefficients (ICC ICC See: International Chamber of Commerce [1,1]) [13] were calculated to express the reliability of the measurements. We calculated ICCs for within-tester reliability of the UG and CROM device by comparing the first and second measurements made by each tester with the same device (ie, 20 subjects were measured by two testers; thus, 40 paired measurements were recorded for each motion). Because the tester reported his or her measurements to the recorder, we did not evaluate within-tester reliability for the VE technique, because we believe the second measurement was biased by the first measurement. We calculated ICCs for between-device (parallel-forms) reliability by comparing the first measurements made by each tester with a given instrument with their first measurements made with one of the other instruments (40 paired measurements for each motion). We calculated ICCs for between-tester reliability by comparing the first measurements made by each pair of testers (20 paired measurements were taken for each motion). No universally acceptable levels have been adopted for correlation coefficients Correlation Coefficient A measure that determines the degree to which two variable's movements are associated. The correlation coefficient is calculated as: for the purpose of describing the reliability of measurements. [14] In the following sections, we use a previously reported scheme for defining the amount of reliability based on our ICC values: .90 to .99, high reliability; .80 to .89, good reliability; .70 to .79, fair reliability; and .69 and below, poor reliability. [15] Results Part 1 With the CROM device, ICCs for within-tester and between-tester reliability were larger compared with the UG for both flexion and extension motions (Tab. 3). The between-tester ICCs with both the CROM device and the UG were larger than the VE ICC for neck flexion and extension. The ICC values for interdevice comparisons (Tab. 4) among the three methods generally demonstrated poor to fair between-device reliability for flexion and extension. Part 2 For left lateral flexion, within-tester reliability was equal for the CROM device and the UG, whereas the CROM ICC was higher than the UG ICC for right lateral flexion (Tab. 3). The ICC for between-tester reliability was higher for the UG than for the CROM device in left lateral flexion, whereas the CROM ICC was larger than the UG ICC with right lateral flexion. Both the CROM and the UG ICCs were larger than the VE ICC for left and right neck flexion. The ICC values for interdevice comparisons (Tab. 4) among the three methods generally demonstrated poor to fair between-device reliability for both neck lateral flexion motions. Part 3 The ICCs for within-tester and between-tester reliability were larger with the CROM device than with the UG for both left and right neck rotations (Tab. 3). The CROM ICC was larger than the VE ICC for left and right rotation, whereas the UG ICC was lower than the VE ICC for both rotation motions. The ICC values for interdevice comparisons (Tab. 4) among the three methods generally demonstrated poor to fair between-device reliability for both neck rotation movements. Discussion Part 1 The high ICC values indicate that AROM measurements of neck flexion (ICC=.95) and extension (ICC=.90) obtained with the CROM device are highly reproducible when repeated by the same physical therapist (Tab. 3). The UG measurements demonstrated good reliability for both flexion (ICC=.86) and extension (ICC=.83). We believe that between-tester reliability for AROM measurements of neck flexion and extension (ICCs=.86) was good for the CROM device (Tab. 3), whereas the UG demonstrated poor reliability for flexion (ICC=.57) and fair reliability (ICC=.79) for extension. Tucci et al [9] likewise reported poor between-tester reliability for neck flexion (ICC=.08), although they reported good reliability for neck extension (ICC=.82) when healthy subjects were measured by two experienced examiners using a UG. With VE, the between-tester reliability for AROM measurements was poor (ICC=.42) for both flexion and extension. Between-device reliability for AROM measurements of neck flexion (ICC=.65) and extension (ICC=.46) was poor when the CROM device and the UG (Tab. 4) were compared. Generally, we also found poor to fair interdevice reliability for AROM measurements of neck flexion and extension when comparing either of the goniometric go·ni·om·e·ter n. 1. An optical instrument for measuring crystal angles, as between crystal faces. 2. A radio receiver and directional antenna used as a system to determine the angular direction of incoming radio signals. devices with the VE. Part 2 The AROM measurements of left neck lateral flexion demonstrated good reliability (ICCs=.84) when repeated by the same tester using either the CROM device or the UG; however, within-tester reliability for right neck flexion was high (ICC=.92) with the CROM and good (ICC=.85) with the UG (Tab. 3). Measurements obtained with both goniometric devices demonstrated Table 3. Intraclass Correlation Coefficients (ICCs) for Within-Tester and Between-Tester Reliability of Measurements of Active Range of Motion (a)
Within- Between-
Tester Tester
Motion (b) ICC (c) ICC (d)
Flexion
CROM .95 .86
UG .83 .57
VE . . . .42
Extension
CROM .90 .86
UG .86 .79
VE . . . .42
Left lateral flexion
CROM .84 .73
UG .84 .79
VE . . . .63
Right lateral flexion
CROM .92 .88
UG .85 .72
VE . . . .70
Left rotation
CROM .90 .82
UG .78 .54
VE . . . .69
Right rotation
CROM .93 .92
UG .90 .62
VE . . . .82
(a) Each part of the study (ie, part 1 = cervical
flexion-extension, part 2 = cervical lateral flexion,
part 3 = cervical rotation) involved 20 different
subjects.
(b) CROM=cervical-range-of-motion instrument,
UG=universal goniometer, VE=visual estimation. No
within-tester ICCs calculated for VE.
(c) Calculated by comparing the first measurements
of each tester; the sample size was 40.
(d) Calculated by comparing the first measurements
of each pair of testers; the sample size
was always 20.
only fair between-tester reliability for left lateral neck flexion, whereas for right lateral flexion the CROM device demonstrated good reliability (ICC=.88) and the UG demonstrated fair reliability (ICC=.72) (Tab. 3). Tucci et al [9] reported poor between-tester reliability for both left (ICC=.33) and right (ICC=.21) lateral flexion. With the VE method, between-tester reliability for AROM measurements of neck lateral flexion was poor to fair for both left (ICC=.63) and right (ICC=.70) movements. We found poor between-device reliability for AROM measurements of left (ICC=.66) and right (ICC=.60) lateral flexion with the CROM device and the UG (Tab. 4). Generally, we also found poor between-device reliability when each goniometric device was compared with the VE (Tab. 4). Part 3 The AROM measurements of left (ICC=.90) and right (ICC=.93) neck rotation were highly reliable when repeated by the same physical therapist (Tab. 3). With the UG, within-tester reliability was fair for left rotation Left rotation refers to the following
Between-tester reliability for AROM measurements of neck rotation with the CROM device ranged from good (ICC-.82) for left rotation to high for right rotation (ICC=.92) (Tab. 3). However, the UG demonstrated poor between-tester reliability for both left (ICC=.54) and right (ICC=.62) motions. Tucci et al [9] likewise reported poor between-tester reliability for left (ICC=.60) and right rotation (ICC=.52) with the UG. Cervical AROM measurements obtained by VE had poor reliability for left rotation (ICC=.69) but good reliability for right rotation (ICC=.82). We found fair between-device reliability (ICC=.72) for AROM measurements of left rotation and good reliability (ICC=.81) for right rotation with the CROM device and the UG (Tab. 4). Generally, repeated AROM measurements of cervical rotation obtained by replacing VE with either the CROM device or the UG demonstrated poor to fair reliability. Table 4. Interdevice (Parallel-Forms) Reliability of Measurements of Active Range of Motion (a) Motion (b) ICC (c) Flexion CROM vs UG .65 CROM vs VE .60 UG vs VE .80 Extension CROM vs UG .46 CROM vs VE .40 UG vs VE .73 Left lateral flexion CROM vs UG .66 CROM vs VE .68 UG vs VE .50 Right lateral flexion CROM vs UG .60 CROM vs VE .77 UG vs VE .47 Left rotation CROM vs UG .72 CROM vs VE .73 UG vs VE .60 Right rotation CROM vs UG .81 CROM vs VE .51 UG vs VE .78 (a) Each part of the study (ie, part 1=cervical flexion-extension, part 2=cervical lateral flexion, part 3=cervical rotation) involved 20 different subjects. (b) CROM=cervical-range-of-motion instrument, UG=universal goniometer, VE=visual estimation. (c) The first measurements obtained with each device by each tester were compared; sample size was 40. General Comments When used by the same physical therapist, both the CROM device and the UG demonstrated good to high reliability for AROM measurements of cervical motion in patients with orthopedic disorders. According to our data, the CROM device is preferable to the UG when two physical therapists take repeated measurements of cervical AROM on the same patient. It appears that the CROM device can be mounted consistently by two different therapists without need for locating specific anatomic landmarks. Both the UG and VE techniques generally gave poor between-tester reliability, even though we believe that our subjects assumed a consistent test position and that the testers used a standardized measurement procedure. Additionally, because between-device reliability was poor, a physical therapist should avoid interchanging the CROM device and the UG when performing repeated measurements of cervical AROM on the same patient. This study was conducted in one clinical outpatient department, so the results may not be generalized to all clinical departments. All patients studied had orthopedic disorders, and repeated cervical movements did not aggravate their neck pain, according to their self-reports. Like other researchers, [6,7,16] we found that determination of goniometric reliability is possible even in a busy outpatient setting. We used a previously reported design as a model for our project [6,7]; however, our design differed from the previous design in that we used a standardized method for testing. By attempting to decrease individual variation in testing method, we sought to account for a large amount of the measurement error. Despite these efforts, within-tester and between-tester reliabilities of goniometric measurements of cervical AROM generally were lower than previously reported passive ROM measurements at the elbow very near; at hand. See also: Elbow , knee, and shoulder. [6,7] Such differences indicate that the reliability of measuring joint ROM is specific to the movement measured and to the regional anatomy regional anatomy n. The study of regions of the body. Also called topographic anatomy. and the biomechanics The study of the anatomical principles of movement. Biomechanical applications on the computer employ stick modeling to analyze the movement of athletes as well as racing horses. Biomechanics . [17] For example, repeated measurements of AROM of the elbow generally would show less day-to-day variability than would repeated measurements of AROM of the cervical spine. The cervical spine consists of a complex series of multiaxial joints mul·ti·ax·i·al joint n. A joint in which movement occurs in a number of axes. Also called polyaxial joint. in which movements are controlled by numerous muscles that act across several joints simultaneously. Physical therapists have been urged to avoid the VE technique for measurement of joint ROM, presumably because of the subjective nature of this measure. [4] Recently, Rothstein [18] defined a subjective measurement operationally as lacking a reasonable level of between-tester reliability. To our knowledge, our study is the first to document the between-tester reliability of VE for measuring AROM of the cervical spine in patients. Compared with goniometric techniques, the between-tester reliability of VE is poor overall, with moderate measurement error. We urge physical therapists to avoid using VE when two or more therapists take repeated AROM measurements of the cervical spine in the same patient. Clinicians may erroneously conclude that a patient's AROM has indeed changed because of treatment effects when the change could probably be attributed to inherent measurement error. Conclusion Based on our clinical study of 60 patients with orthopedic disorders in a physical therapy outpatient department, we conclude that AROM measurements on the cervical spine made by the same physical therapist have good to high reliability, regardless of whether the therapist used the CROM device or the UG. When different physical therapists measured the same subject's AROM, the CROM device was the most reliable testing instrument. Repeated measurements with the UG and VE had poor to fair between-tester reliability, even though the subject's body position was controlled and the testers used operationally defined measurement techniques. Based on low overall ICC values, we believe that goniometric and nongoniometric devices should not be interchanged when taking repeated measurements of cervical AROM in patients with neck pain. References [1] Miller PJ. Assessment of joint motion. In: Rothstein JM, ed. Measurement in Physical Therapy. New York New York, state, United States New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of , NY: Churchill Livingstone Imprint of a medical publishing company owned by Elsevier Ltd, but previously owned by Harcourt and Pearsons. Originally formed from Livingstone, Edinburgh, Scotland, and J & A Churchill, London, UK, and subsequently with an office in New York, but now integrated with the rest of Inc; 1985;7:103-136. [2] Cole TM. Measurement of musculoskeletal musculoskeletal /mus·cu·lo·skel·e·tal/ (-skel´e-t'l) pertaining to or comprising the skeleton and muscles. mus·cu·lo·skel·e·tal adj. Relating to or involving the muscles and the skeleton. function: goniometry goniometry /go·ni·om·e·try/ (go?ne-om´e-tre) the measurement of angles, particularly those of range of motion of a joint. goniometry the measurement of range of motion in a joint. . In: Kottke FJ, Stillwell GK, Lehmann JF, eds. Krusen's Handbook of Physical Medicine and Rehabilitation. 3rd ed. Philadelphia, Pa: WB Saunders Co; 1982:19-33. [3] Moll JMH JMH Jackson Memorial Hospital JMH Schaumburg, Illinois (Airport Code) JMH JSSIS Message Handler JMH James Monroe High school JMH Joint Message Holder (US DoD) , Wright V. Measurement of joint motion. Clin Rheum rheum (rldbomacm) any watery or catarrhal discharge. rheum n. A watery or thin mucous discharge from the eyes or nose. rheum any watery or catarrhal discharge. Dis. 1976;2:3-26. [4] Moore ML. The measurement of joint motion, part I: introductory review of the literature. Phys Ther Rev. 1949;29:195-205. [5] Boone DC, Azen SP, Lin C-M C-M Control-Monitor C-M Constant Modulus , et al. Reliability of goniometric measurements. Phys Ther. 1978;58:1355-1360. [6] Rothstein JM, Miller PJ, Roettger RF. Goniometric reliability in a clinical setting: elbow and knee measurements. Phys Ther. 1983;63:1611-1615. [7] Riddle DL, Rothstein JM, Lamb RL. Goniometric reliability in a clinical setting: shoulder measurements. Phys Ther. 1987;67:668-673. [8] Low JL. The reliability of joint measurement. Physiotherapy physiotherapy: see physical therapy. . 1976;62:227-229. [9] Tucci SM, Hicks Hicks , Edward 1780-1849. American painter of primitive works, notably The Peaceable Kingdom, of which nearly 100 versions exist. JE, Gross EG, et al. Cervical motion assessment: a new, simple and accurate method. Arch Phys Med Rehabil. 1986:67:225-230. [10] Zachman ZJ, Traina AD, Keating JC Jr, et al. Interexaminer reliability and concurrent validity concurrent validity, n the degree to which results from one test agree with results from other, different tests. of two instruments for the measurement of cervical ranges of motion. J Manipulative ma·nip·u·la·tive adj. Serving, tending, or having the power to manipulate. n. Any of various objects designed to be moved or arranged by hand as a means of developing motor skills or understanding abstractions, especially in Physiol Ther. 1989;12:205-210. [11] Dhir RS, Ribera VA, Jacobson MI. Gravity goniometer: a simple and multipurpose mul·ti·pur·pose adj. Designed or used for several purposes: a multipurpose room; multipurpose software. multipurpose Adjective tool Clin Orthop. 1971;78:336-341. [12] Norkin CC, White DJ. Measurement of Joint Motion: A Guide to Goniometry. Philadelphia, Pa: FA Davis Co; 1985:114-123. [13] Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater rat·er n. 1. One that rates, especially one that establishes a rating. 2. One having an indicated rank or rating. Often used in combination: a third-rater; a first-rater. reliability. Psychol Bull. 1979;86:420-428. [14] Currier DP. Elements of Research in Physical Therapy. 3rd ed. Baltimore, Md: Williams & Wilkins; 1990:167. [15] Blesh TE. Measurement in Physical Education. 2nd ed. New York, NY: The Ronald Press Co; 1974. [16] Elveru RA, Rothstein JM, Lamb RL. Goniometric reliability in a clinical setting: subtalar and ankle joint ankle joint n. A hinge joint formed by the articulating of the tibia and the fibula with the talus below. Also called mortise joint, talocrural joint. measurements. Phys Ther. 1988;68:672-677. [17] Gajdosik RL, Bohannon RW. Clinical measurement of range of motion: review of goniometry emphasizing reliability and validity. Phys Ther. 1987;67:1867-1872. [18] Rothstein JM. On defining subjective and objective measurements. Phys Ther. 1989;69:577-579. (*) Performance Attainment Associates, 958 Lydia Dr, Roseville, MN 55113. (+) International Standard Goniometer, Fred Sammons Inc, 145 Tower Dr, Burr burr (bur) bur. burr n. Variant of bur. burr 1. a plant seed capsule carrying many hooked structures which catch in animal coats thus promoting dissemination of the plant. Ridge, IL 60521. (1) Velcro USA Inc, 406 Brown Ave, Manchester, NH 03103. J Youdas, MS, PT, is Physical Therapist, Physical Therapy Program, Mayo School of Health-Related Sciences, and Assistant Professor of Physical Therapy, Mayo Medical School Mayo Medical School is a part of the Mayo Clinic in Rochester, Minnesota. It grants degrees in medicine, and is accredited by the North Central Association of Colleges and Schools. , 200 First St SW, Rochester, MN 55905. Address all correspondence to Mr Youdas at Mayo Clinic, 200 First St SW, Rochester, MN 55905 (USA). J Carey, PhD, PT, is Senior Associate Consultant, Physical Therapy Program, Mayo School of Health-Related Sciences, and Assistant Professor of Physical Therapy, Mayo Medical School. T Garrett, BS, PT, is Physical Therapist, Physical Therapy Program, Mayo School of Health-Related Sciences, and Assistant Professor of Physical Therapy, Mayo Medical School. |
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