J Knee Surg 2017; 30(08): 829-834
DOI: 10.1055/s-0037-1598174
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Patient Self-Assessed Passive Range of Motion of the Knee Cannot Replace Health Professional Measurements

Jens Borgbjerg
1   Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
,
Frank Madsen
2   Department of Orthopaedic Surgery, Aarhus Universty Hospital, Aarhus, Denmark
,
Anders Odgaard
3   Department of Orthopaedic Surgery, Copenhagen University Hospital Gentofte, Copenhagen, Denmark
› Author Affiliations
Further Information

Publication History

13 October 2016

19 December 2016

Publication Date:
01 March 2017 (online)

Abstract

The purpose of this study was to investigate whether patients can accurately self-assess their knee passive range of motion (PROM). A picture-based questionnaire for patient self-assessment of knee PROM was developed and posted to patients. The self-assessed PROM from 58 patients was compared with surgeon-assessed PROM using a short-arm goniometer. Agreement between the measurement methods was calculated with the Bland-Altman method. We calculated the sensitivity and specificity of patient-assessed PROM in dichotomously detecting knee motion impairment in both flexion (≤ 100 degrees) and extension (≥ 10-degree flexion contracture). Surgeon- and patient-assessed knee PROM showed a mean difference (95% limits of agreement) of −2.1 degrees (−42.5 to 38.3 degrees) for flexion and −8.1 degrees (−28.8 to 12.7 degrees) for extension. The sensitivity of patient self-assessed PROM in identifying knee flexion and extension impairments was 86 and 100%, respectively, whereas its specificity was 84 and 43%, respectively. Although wide limits of agreement were observed between surgeon- and patient-assessed knee PROM, the picture-based questionnaire for patient assessment of knee ROM was found to be a valid tool for dichotomously detecting knee motion impairment in flexion (≤ 100 degrees). However, the specificity of the questionnaire for detection of knee extension impairments (≥ 10-degree flexion contracture) was low, which limits is practical utility for this purpose.

Supplementary Material

 
  • References

  • 1 Kurtz SM, Lau E, Ong K, Zhao K, Kelly M, Bozic KJ. Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030. Clin Orthop Relat Res 2009; 467 (10) 2606-2612
  • 2 Losina E, Thornhill TS, Rome BN, Wright J, Katz JN. The dramatic increase in total knee replacement utilization rates in the United States cannot be fully explained by growth in population size and the obesity epidemic. J Bone Joint Surg Am 2012; 94 (03) 201-207
  • 3 Ravi B, Croxford R, Reichmann WM, Losina E, Katz JN, Hawker GA. The changing demographics of total joint arthroplasty recipients in the United States and Ontario from 2001 to 2007. Best Pract Res Clin Rheumatol 2012; 26 (05) 637-647
  • 4 Weinstein AM, Rome BN, Reichmann WM. , et al. Estimating the burden of total knee replacement in the United States. J Bone Joint Surg Am 2013; 95 (05) 385-392
  • 5 Noble PC, Scuderi GR, Brekke AC. , et al. Development of a new Knee Society scoring system. Clin Orthop Relat Res 2012; 470 (01) 20-32
  • 6 Piriyaprasarth P, Morris ME. Psychometric properties of measurement tools for quantifying knee joint position and movement: a systematic review. Knee 2007; 14 (01) 2-8
  • 7 Lenssen AF, van Dam EM, Crijns YH. , et al. Reproducibility of goniometric measurement of the knee in the in-hospital phase following total knee arthroplasty. BMC Musculoskelet Disord 2007; 8: 83
  • 8 Gioe TJ, Pomeroy D, Suthers K, Singh JA. Can patients help with long-term total knee arthroplasty surveillance? Comparison of the American Knee Society score self-report and surgeon assessment. Rheumatology (Oxford) 2009; 48 (02) 160-164
  • 9 Khanna G, Singh JA, Pomeroy DL, Gioe TJ. Comparison of patientreported and clinician-assessed outcomes following total knee arthroplasty. J Bone Joint Surg Am 2011; 93 (20) e117(1)-(7)
  • 10 Collins JE, Rome BN, Daigle ME, Lerner V, Katz JN, Losina E. A comparison of patient-reported and measured range of motion in a cohort of total knee arthroplasty patients. J Arthroplasty 2014; 29 (07) 1378-1382.e1
  • 11 Scuderi GR, Kochhar T. Management of flexion contracture in total knee arthroplasty. J Arthroplasty 2007; 22 (4, Suppl 1): 20-24
  • 12 Norkin CC, White DJ. Measurement of Joint Motion: A Guide to Goniometry. 5th ed. Philadelphia, PA: F.A. Davis; 2016: 317-321
  • 13 El-Daly I, Ibraheim H, Rajakulendran K, Culpan P, Bates P. Are patient-reported outcome measures in orthopaedics easily read by patients?. Clin Orthop Relat Res 2016; 474 (01) 246-255
  • 14 Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1 (8476): 307-310
  • 15 Miner AL, Lingard EA, Wright EA, Sledge CB, Katz JN. ; Kinemax Outcomes Group. Knee range of motion after total knee arthroplasty: how important is this as an outcome measure?. J Arthroplasty 2003; 18 (03) 286-294
  • 16 Mitsuyasu H, Matsuda S, Miura H, Okazaki K, Fukagawa S, Iwamoto Y. Flexion contracture persists if the contracture is more than 15° at 3 months after total knee arthroplasty. J Arthroplasty 2011; 26 (04) 639-643
  • 17 Dawson J, Fitzpatrick R, Murray D, Carr A. Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br 1998; 80 (01) 63-69
  • 18 Gajdosik RL, Bohannon RW. Clinical measurement of range of motion. Review of goniometry emphasizing reliability and validity. Phys Ther 1987; 67 (12) 1867-1872
  • 19 Bland M. How can I decide the sample size for a study of agreement between two methods of measurement?. http://www-users.york.ac.uk/~mb55/meas/sizemeth.htm. Accessed November 7, 2016
  • 20 Carter CW, Levine WN, Kleweno CP, Bigliani LU, Ahmad CS. Assessment of shoulder range of motion: introduction of a novel patient self-assessment tool. Arthroscopy 2008; 24 (06) 712-717
  • 21 Acquadro C, Bayles A, Juniper E. Translating patient-reported outcome measures: a multi-step process is essential. J Bras Pneumol 2014; 40 (03) 211-212
  • 22 Naylor JM, Ko V, Adie S. , et al. Validity and reliability of using photography for measuring knee range of motion: a methodological study. BMC Musculoskelet Disord 2011; 12: 77
  • 23 Verhaegen F, Ganseman Y, Arnout N, Vandenneucker H, Bellemans J. Are clinical photographs appropriate to determine the maximal range of motion of the knee?. Acta Orthop Belg 2010; 76 (06) 794-798
  • 24 Smith AUS. Smartphone Use in 2015. Available at http://www.pewinternet.org/2015/04/01/us-smartphone-use-in-2015/ . Accessed July 1, 2016