Sunday, April 24, 2016

Patient self-assessed range of motion - is this the information we need and how good is it?

Agreement between patient self-assessment and physician assessment of shoulder range of motion.

These authors compared patient self-evaluation of range of motion and physician evaluation of range of motion in 30 patients at 6-months after surgery on the labrum or capsule. Patients used the  Multicenter Orthopaedic Outcomes Network (MOON) shoulder instability followup form to record their motion.

Exact agreement was moderate (57%) for forward elevation; fair for abduction (25%) and external rotation at 90° (34%); and poor for internal rotation at 90° (3%) and external rotation with the arm at the side (12%). Approximate agreement within a range of positive or negative 20° range was very good for forward elevation (94%), abduction (92%), and external rotation at 90° (87%); moderate for external rotation with the arm at the side; and fair for internal rotation at 90°.

Comment: We suggest that it is more informative to present results comparing two methods of measurements using a scatter plot so that the reader can get a view of all the data and the relationships without converting continuous variables into categorical variables.  For example these patients appeared to overestimate their range of motion as shown in this table

This tendency for patient overestimation seems more important that the percent of shoulders that had exact or approximate agreement. The key relationships would show up nicely on a scatterplot. The hypothetical scatterplot below shows the linear regression line (red) and equation for the two sets of measurements as well as the number of cases in which the patient over and under estimated the range of motion (overestimations would lie over the blue line of identity and underestimations below).

Another point to consider in following patients is what data are to be collected and how. We recognize the problem of questionnaire fatigue as a reason for patients being lost to followup. In designing clinical studies we need to decide, for example, using the available time and space is it more important to inquire about range of motion or about shoulder function? 


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