Rating scales for shoulder and elbow range of motion impairment: call for a functional approach

Anouk M. Oosterwijk, Marianne K. Nieuwenhuis, Hennie J. Schouten, Cees P. van der Schans, Leonora J. Mouton

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND: To evaluate the effect of (new) treatments or analyse prevalence and risk factors of contractures, rating scales are used based on joint range of motion. However, cut-off points for levels of severity vary between scales, and it seems unclear how cut-off points relate to function. The purpose of this study was to compare severity ratings of different rating scales for the shoulder and elbow and relate these with functional range of motion.

METHODS: Often used contracture severity rating scales in orthopedics, physiotherapy, and burns were included. Functional range of motion angles for the shoulder and elbow were derived from a recent synthesis published by our group. Shoulder flexion and elbow flexion range of motion data of patients three months after a burn injury were rated with each of the scales to illustrate the effects of differences in classifications. Secondly, the shoulder and elbow flexion range of motion angles were related to the required angles to perform over 50 different activities of daily living tasks.

RESULTS: Eighteen rating scales were included (shoulder: 6, elbow: 12). Large differences in the number of severity levels and the cut-off points between scales were determined. Rating the measured range of motions with the different scales showed substantial inconsistency in the number of joints without impairment (shoulder: 14-36%, elbow: 26-100%) or with severe impairment (shoulder: < 10%-29%, elbow 0%-17%). Cut-off points of most scales were not related to actual function in daily living.

CONCLUSION: There is an urgent need for rating scales that express the severity of contractures in terms of loss of functionality. This study proposes a direction for a solution.

Original languageEnglish
JournalPLOS one
Volume13
Issue number8
DOIs
Publication statusPublished - 2018

Keywords

  • physical activities
  • contracture complications
  • physiopathology
  • elbows
  • shoulders

Cite this

Oosterwijk, Anouk M. ; Nieuwenhuis, Marianne K. ; Schouten, Hennie J. ; van der Schans, Cees P. ; Mouton, Leonora J. / Rating scales for shoulder and elbow range of motion impairment : call for a functional approach. In: PLOS one. 2018 ; Vol. 13, No. 8.
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title = "Rating scales for shoulder and elbow range of motion impairment: call for a functional approach",
abstract = "BACKGROUND: To evaluate the effect of (new) treatments or analyse prevalence and risk factors of contractures, rating scales are used based on joint range of motion. However, cut-off points for levels of severity vary between scales, and it seems unclear how cut-off points relate to function. The purpose of this study was to compare severity ratings of different rating scales for the shoulder and elbow and relate these with functional range of motion.METHODS: Often used contracture severity rating scales in orthopedics, physiotherapy, and burns were included. Functional range of motion angles for the shoulder and elbow were derived from a recent synthesis published by our group. Shoulder flexion and elbow flexion range of motion data of patients three months after a burn injury were rated with each of the scales to illustrate the effects of differences in classifications. Secondly, the shoulder and elbow flexion range of motion angles were related to the required angles to perform over 50 different activities of daily living tasks.RESULTS: Eighteen rating scales were included (shoulder: 6, elbow: 12). Large differences in the number of severity levels and the cut-off points between scales were determined. Rating the measured range of motions with the different scales showed substantial inconsistency in the number of joints without impairment (shoulder: 14-36{\%}, elbow: 26-100{\%}) or with severe impairment (shoulder: < 10{\%}-29{\%}, elbow 0{\%}-17{\%}). Cut-off points of most scales were not related to actual function in daily living.CONCLUSION: There is an urgent need for rating scales that express the severity of contractures in terms of loss of functionality. This study proposes a direction for a solution.",
keywords = "physical activities, contracture complications, physiopathology, elbows, shoulders, fysiotherapie, gewrichten, schouders, ellebogen",
author = "Oosterwijk, {Anouk M.} and Nieuwenhuis, {Marianne K.} and Schouten, {Hennie J.} and {van der Schans}, {Cees P.} and Mouton, {Leonora J.}",
year = "2018",
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Rating scales for shoulder and elbow range of motion impairment : call for a functional approach. / Oosterwijk, Anouk M.; Nieuwenhuis, Marianne K.; Schouten, Hennie J.; van der Schans, Cees P.; Mouton, Leonora J.

In: PLOS one, Vol. 13, No. 8, 2018.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Rating scales for shoulder and elbow range of motion impairment

T2 - call for a functional approach

AU - Oosterwijk, Anouk M.

AU - Nieuwenhuis, Marianne K.

AU - Schouten, Hennie J.

AU - van der Schans, Cees P.

AU - Mouton, Leonora J.

PY - 2018

Y1 - 2018

N2 - BACKGROUND: To evaluate the effect of (new) treatments or analyse prevalence and risk factors of contractures, rating scales are used based on joint range of motion. However, cut-off points for levels of severity vary between scales, and it seems unclear how cut-off points relate to function. The purpose of this study was to compare severity ratings of different rating scales for the shoulder and elbow and relate these with functional range of motion.METHODS: Often used contracture severity rating scales in orthopedics, physiotherapy, and burns were included. Functional range of motion angles for the shoulder and elbow were derived from a recent synthesis published by our group. Shoulder flexion and elbow flexion range of motion data of patients three months after a burn injury were rated with each of the scales to illustrate the effects of differences in classifications. Secondly, the shoulder and elbow flexion range of motion angles were related to the required angles to perform over 50 different activities of daily living tasks.RESULTS: Eighteen rating scales were included (shoulder: 6, elbow: 12). Large differences in the number of severity levels and the cut-off points between scales were determined. Rating the measured range of motions with the different scales showed substantial inconsistency in the number of joints without impairment (shoulder: 14-36%, elbow: 26-100%) or with severe impairment (shoulder: < 10%-29%, elbow 0%-17%). Cut-off points of most scales were not related to actual function in daily living.CONCLUSION: There is an urgent need for rating scales that express the severity of contractures in terms of loss of functionality. This study proposes a direction for a solution.

AB - BACKGROUND: To evaluate the effect of (new) treatments or analyse prevalence and risk factors of contractures, rating scales are used based on joint range of motion. However, cut-off points for levels of severity vary between scales, and it seems unclear how cut-off points relate to function. The purpose of this study was to compare severity ratings of different rating scales for the shoulder and elbow and relate these with functional range of motion.METHODS: Often used contracture severity rating scales in orthopedics, physiotherapy, and burns were included. Functional range of motion angles for the shoulder and elbow were derived from a recent synthesis published by our group. Shoulder flexion and elbow flexion range of motion data of patients three months after a burn injury were rated with each of the scales to illustrate the effects of differences in classifications. Secondly, the shoulder and elbow flexion range of motion angles were related to the required angles to perform over 50 different activities of daily living tasks.RESULTS: Eighteen rating scales were included (shoulder: 6, elbow: 12). Large differences in the number of severity levels and the cut-off points between scales were determined. Rating the measured range of motions with the different scales showed substantial inconsistency in the number of joints without impairment (shoulder: 14-36%, elbow: 26-100%) or with severe impairment (shoulder: < 10%-29%, elbow 0%-17%). Cut-off points of most scales were not related to actual function in daily living.CONCLUSION: There is an urgent need for rating scales that express the severity of contractures in terms of loss of functionality. This study proposes a direction for a solution.

KW - physical activities

KW - contracture complications

KW - physiopathology

KW - elbows

KW - shoulders

KW - fysiotherapie

KW - gewrichten

KW - schouders

KW - ellebogen

U2 - 10.1371/journal.pone.0200710

DO - 10.1371/journal.pone.0200710

M3 - Article

VL - 13

JO - PLOS one

JF - PLOS one

SN - 1932-6203

IS - 8

ER -