Objective: To examine the intra-tester and inter-tester reliability of three different methods of measurement of knee range of motion in patients undergoing limb reconstruction with the Ilizarov external fixator.
Design: Twenty-five patients had the passive range of motion of their knee measured by 13 physiotherapists who were experienced in the use of goniometry. The testers were assigned into random pairs, each tester measured three or four patients who were allocated to them using the three different methods. These were: (1) a universal goniometer aligned against anatomical landmarks, (2) a universal goniometer aligned against the Ilizarov frame and (3) a modified universal goniometer.
Subjects: Twenty-five patients undergoing limb reconstruction using an Ilizarov external fixator on both the femur and tibia.
Results: Comparison of the three different goniometry methods showed that using a modified goniometer there was enhanced reliability compared with other methods. This method demonstrated good repeatability for both intra-tester and inter-tester measurements.
Conclusions: When serial measurements of knee range of motion are taken in patients wearing an Ilizarov external fixator the modified model of goniometer should be used.
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References
1.
Newschander GE, Dunst RM. Limb lengthening with the Ilizarov external fixator. Orthop Nurs1989; 8: 15–21.
2.
Simard S, Marchant M, Mencio G. The Ilizarov procedure: limb lengthening and its implications. Phys Ther1992; 72: 25–34.
3.
Green S. Post operative management during limb lengthening. Orthop Clin North Am1991; 22: 723–734.
4.
Kaljamae U, Martson A, Haviko T, Hanninen O. The effect of lengthening of the femur on the extensors of the knee. J Bone Joint Surg1995; 77-A: 247–250.
5.
Herzenberg JE, Scheufele LL, Paley D, Bechtel R, Tepper S. Knee range of motion in isolated femoral lengthening. Clin Orthop Rel Res1994; 301: 49–54.
6.
Aronson J. Limb-lengthening, skeletal reconstruction and bone transport with the Ilizarov method. J Bone Joint Surg1997; 79-A: 1243–1258.
7.
Paley D, Herzenberg JE, Paremain G, Bhave A. Femoral lengthening over an intermedullary nail. J Bone Joint Surg1997; 79-A: 1464–1480.
8.
Bowen JR, Levy EJ, Donohue M. Comparison of knee motion and callus formation in femoral lengthening with the Wagner or monolateral-ring device. J Pediatr Orthop1993; 13: 467–472.
9.
Watkins MA, Riddle DL, Lamb RL, Personius WJ. Reliability of goniometric measurements and visual estimates of knee range of motion obtained in a clinical setting. Phys Ther1991; 71: 90–97.
10.
Gogia PP, Braatz JH, Rose SJ, Norton BJ. Reliability and validity of goniometric measurements at the knee. Phys Ther1987; 67: 192–195.
11.
Rothstein JM, Miller PJ, Roettger RF. Goniometric reliability in a clinical setting: elbow and knee measurements. Phys Ther1983; 63: 1611–1615.
12.
Norkin CC, White DJ. Measurement of joint motion. A guide to goniometry. Philadelphia: FA Davis, 1995.
13.
Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet1986; i: 307–310.
14.
Bland M. An introduction to medical statistics. Oxford: Oxford University Press, 1994.
15.
Ekstrand J, Wiktorsson M, Oberg B, Gillquist J. Lower extremity goniometric measurements: a study to determine their reliability. Arch Phys Med Rehabil1982; 63: 1711–1775.
16.
Low JL. The reliability of joint measurement. Physiotherapy1978; 62: 227–229.
17.
Youdas JW, Bogard CL, Suman VJ. Reliability of goniometric measurements and visual estimates of ankle joint active range of motion obtained in a clinical setting. Arch Phys Med Rehabil1993; 74: 1113–1118.
