Range of Motion in Clinical Outcome Measurement - Assignment Example

Range of Motion in Clinical Outcome Measurement of of 30 November, Contents Introduction 3 PART A 3 Rangeof Motion 3 Clinimetrics and ROM 4 Validity and Reliability of ROM in Musculoskeletal Rehabilitation 5 Validity of ROM 5 Reliability of ROM 6 Sensitivity 7 Standardisation and ROM 8 Issues Relating to the Application of ROM 9 PART B 10 Bibliography 13 Introduction Range of Motion (ROM) and goniometry are important measures that are used for the analysis of the clinical outcomes of various physiotherapy treatments. This involves the use of various techniques to evaluate the level of movement and the ability of patients to do certain tasks based on the treatment methods. The purpose of this paper is to critically evaluate and analyse Range of Motion (ROM) as a technique for outcome measurement. This will culminate in the presentation of important elements and approaches to the technique in measuring treatments in musculoskeletal physiotherapist treatments. The research will commence by examining the fundamental definitions and components of ROM. This will involve the analysis of what constitutes ROM and how it is conducted. From there, the study will evaluate absolute and relativistic strengths of ROM as a measure for clinical treatments in musculoskeletal physiotherapy. This paper will be written in two parts. In the first part, a critical evaluation of ROM as a measure for clinical treatments in physiotherapy will be conducted. In the second part, the writer will present a reflective analysis of the research and its implication to his personal practice as a physiotherapist. PART A Range of Motion There are several definitions of the concept of Range of Motion (ROM). One of them states that “...range of motion refers to the measurement of movement around a joint from full flexion to full extension.” (Delisa, Gans, & Walsh, 2010, p. 286). This implies that range of motion refers to the extent to which a given patient can stretch and move around a given pivot point. This provides some scientific evidence about how well the individual in question is responding to some form of treatment process. ROM is important because weaknesses and injuries typically prevent active movement around certain joints (Frontera, Silver, & Rizzo, 2012). This therefore means that ROM is about movement abilities after a given period of intensive treatments and care by a clinical professional. In kinetic measurements, ROM is about the distance that a movable object (linear or angular) normally travels whilst properly attached to another. The main instruments used for ROM measurement are Goniometer and Inclinometer which allows a practitioner to analyse and review the levels of treatment and its impact on a patient. Clinimetrics and ROM This includes the evaluation of the mechanical competencies of a given patient who has undertaken some kind of rehabilitation treatments. This measures three primary competencies and abilities of patients which includes amongst others; 1. Joint Range of Motion; 2. Muscle Strength; 3. Physical Evidence (Reed & Sanderson, 2013) This process provides information about the levels of flexibility of a given patient and the ability of the individual to move within a given extent of a potential range (Holt, Pelham, & Holt, 2013). In this process, flexibility is defined as “the disposition of body tissues to allow without injury, excursions at a joint or set of joints” (Holt, Pelham, & Holt, 2013, p. 4). To be used as an outcome measure, ROM will require the proper definition and review of the following pointers: 1. A documentation of pre-injury levels which is used as the standard for absolute measure; 2. A documentation of the extent of injury that requires rehabilitation; 3. An evaluation of the pre-treatment level of possible movement around the joint; 4. Documentation of post-treatment levels of motion 5. An observation of important movements during the treatment and an assessment of the levels of progression (McLaughlin, 2014) As identified above, observation, testing and comparison of records is important and vital in order to establish the levels of a given treatment. This is because it allows a physiotherapist to get relevant records to evaluate trends and processes to measure the outcome of a given treatment process or rehabilitation procedure. Validity and Reliability of ROM in Musculoskeletal Rehabilitation In order to evaluate the worth of a given treatment measure or process, there is the need to measure the validity of its utilisation and from there, a researcher can deduce the reliability of the results attained from the study in question. Therefore, in this critical review of literature, this section will analyse and review previous studies and analysis that have been conducted in the past in order to provide information about ROM and its validity and reliability in its application as a clinical outcome measure. Validity of ROM Validity is about the extent to which the results of a given study presents the true and fair view of what is actually being measured (Nussbaumer, Leunig, Glatthorn, Stauffacher, Gerber, & Maffiuletti, 2010). Studies indicate that the use of the Goniometer and other instruments in ROM comes with many inherent challenges including the variation of the extent of injuries. This affects face validity which measures the appropriateness of instruments used to measure a given clinical outcome. Hence, it is difficult to establish a one-size-fits-all approach that measures all forms of injuries. Hence, some approaches and processes yield very poor and potentially misleading results (Nussbaumer, Leunig, Glatthorn, Stauffacher, Gerber, & Maffiuletti, 2010). This implies that the approach for examining and critiquing such measures as ROM provides some levels of doubt that can lead to major problems and challenges in processing. However, the use of photographic records provides some degree of complementarity that improves validity of ROM as a clinical outcome measure (Naylor, et al., 2011). This shows that the use of ROM does not in itself guarantee validity, but rather, the application of other methods, approaches and measures helps to provide a better view of musculoskeletal studies and reviews. In terms of intra-tester validity, ROM is said to be a weak option because it fails to establish an appropriate measure for examining the extent of healing at different stages in a given patient (Wilken, Rao, Estin, Saltzman, & Yack, 2011). This is because the healing process comes with various levels of care and attention. Hence, a physiotherapist will have to ensure that the approaches and measures are changed in order to deal with issues in the best ways and manner possible. Reliability of ROM According to various research works, the level of reliability varies from case to case and this include the integration of important variables like flexion and other matters like the experience of the tester (Kafer, Freitz, & Kinkel, 2005). Where a tester is more learned and understands the scope of work, then the reliability of a given measure will be guaranteed to a high extent. This helps to reduce the systematic and random errors and enables the results to come with important traits and trends that have higher degrees of accuracy. Experience also affects the reliability of the results because it helps in the design and the interpretation of findings and results (Jakobsen, Christensen, Christensen, Olsen, & Bandholm, 2010). Other indices include Osteoarthritis Index, Pain and Function Questionnaire Scores, Patient Satisfaction and Perceived Improvement of Quality of Life are used as a technique to examine and evaluate the level of reliability that can be placed on ROM as a measure and this varies from case to case (Miner, Lingarat, Wright, Sledge, & Katz, 2003) Sensitivity Sensitivity is a measure of the specificity and localisation of dysfunctions or other injuries (Dvorak & Gilliar, 2011). This enables a physiotherapist to define the areas for improvement and the modification of the training and rehabilitation process in order to attain the best results. Range of motion and gonimeter measures do not really focus on sensitivity to touch and other exercises (McClain & Suresh, 2011). What ROM does is that it provides a partial direction and view of how much the training has impacted on the patient. This can help to show other measures and other approaches that could potentially be utilised to get the patient to respond to certain forms of treatments and processes for musculoskeletal rehabilitation themes. Other authorities assert that ROM is a very poor technique that can be used as an outcome measure for sensitivity related matters (Pope, Bloem, Beltran, Morrison, & Wilson, 2010). This therefore shows that ROM might not be the most ideal tool to use in dealing with the sensitivity of patients who are recovering from various kinds of muscle strains and similar challenges. The responsiveness to change is quite difficult to measure because there is a major challenge in the utilisation of ROM at the different stages of the training of a given patient (McClain & Suresh, 2011). This is because the patients’ progression and changes in conditions come with major problems and major issues that might not be apparent if ROM is used alone. Rather, the experience of a physiotherapist and the use of various carefully presented chats can cause a physiotherapist to identify the best way to improve the treatment of a given type in order to enhance and improve the methods and approaches that are available for training and rehabilitating a given individual. This helps to guarantee a better and a more reliable approach for monitoring the changes that occur in a given patient. Standardisation and ROM The standardisation of ROM is on a higher level than most other methods because there have been numerous historical changes that have occurred in the process of using ROM and this has led to many changes in the use of the gonimeter and other instruments to provide absolute rather than relativist results that can be used in the interpretation of the status quo of a given patient due to the changes in the patient’s conditions over the timeframe of a given treatment (Eston & Thompson, 2010). The standardisation of ROM implies that a physiotherapist has important tools and other techniques that are laid down in practice and this has evolved over the years to become an important set of rules and regulations that guide the use of ROM in dealing with issues and matters. Therefore, ROM is an important tool that can provide absolute measures that are universal in interpretation. This includes scales and measures that are known throughout the industry and can be used to help to provide a continuous scale and approach for dealing with matters and also aid comparison from a year-to-year basis and from practitioner to practitioner. This is because the information and data that is available for a practitioner varies over the years and it can be improved and enhanced to meet specific needs and objectives of practitioners at all times and in all circumstances in order to provide a guaranteed and improved method and approach for dealing with matters for the best and most optimal results. Issues Relating to the Application of ROM There are several problems and challenges identified to be connected to ROM as an approach to measuring clinical outcome. One of the topmost issues is the issue of measurement and scales. This comes with a major challenge of using the right measures for each individual case. This is because some measures comes with variations that might prove detrimental to certain cases and situations. Therefore, there is the need for tact and expertise in defining the measures and the scales for measurement if ROM is to be used as an outcome measure in physiotherapy. Technological systems could be used to promote better observations, 3D measurements and the examination of more details into more critical depths (Brashear & Elovic, 2011). These devices are expensive and setting them up as a physiotherapist can be a little demanding in terms of investments. In relation to the set up and operations, there are important training costs that could also come at a cost that a private practitioner might find it difficult to justify and work within. Other experience requirements could be very extreme because in cases where a practitioner is not very well experienced, the interpretation of the results, assessment of validity and other factors might prove to be difficult. Hence, there is an important need and demand for a practitioner to be sufficiently experienced in order to achieve the relevant results and relevant ends. PART B This study has provided a lot of insight into the concept of Range of Motion as an outcome measurement technique for musculoskeletal themes of training and rehabilitation. This is clearly going to influence the writer’s future practice as a physiotherapist. This is because it has provided me the opportunity to critically reflect on the concept of ROM. In the past, ROM appeared to be just a part of the utilisation of measures for the evaluation of important processes and techniques for patients who had joint issues and problems. However, this literature review has enabled me to get a scholarly exposition and insight into the issue and also apply it in the right context for the best and most appropriate forms of results. In future, I am going to find ways of learning more about ROM and its application in my field of work because it seems there is more levels of experience that one needs to be able to utilise it as an outcome measure and operate above the standardized limitations in its usage. Therefore, I need to practice more and pay more attention on the main areas of limitation like the measurement scales and ensuring validity and reliability of each case and situation within which it is applied. My personal line of interest can be summed into the following pointers: 1. To build a major understanding of rehabilitation of persons involved in sports; 2. Create the fastest and quickest method of evaluating patients and providing them with musculoskeletal rehabilitation; 3. Blending the best clinical approaches within the most appropriate framework of providing health services and processes to sports professionals 4. Ensure that the best combination of factors relevant to the rehabilitation of patients form the sports sector. These objectives lead me on to get a strong understanding of one of the most popular and the most widely used methods in measuring clinical outcomes in physiotherapy, range of motion (ROM). Although ROM is a basic techniques that is highly specialised, it seems to be the most appropriate for injuries related to sports management and related matters. Therefore, this literature review gave me an opportunity to thoroughly review and understand how ROM operates and how it can affect the attainment of better results in achievement of my personal career development plans and agendas. This will help me to achieve the best results in clinical practice and allow me to understand how rehabilitations occur. From the literature review, I understood that ROM is a central and an important outcome measure and it can be done through the design of appropriate measurement scales that can be invoked based on a practitioner’s needs and requirements in a given case. This typically includes important trends and issues relating to a standardised form and system that can be modified and streamlined in order to be used as a default process and system. In course of operations, where complicated matters come up, a physiotherapist will have to vary his systems and approaches in order to use important measures and other situations relevant to the case at hand to redesign and create a new and improved method of dealing with issues and matters in the context at hand. The creation of faster and enhanced systems of evaluation relates to the definition of a standardised procedural code that can be established within the practice. These systems will have to be of a form that meets the best interest of the highest numbers of cases that are typically reported within the area of specialisation of the practitioner. This must be conditioned in such a way that the most relevant activities and processes necessary to ensure that the ROM system works appropriately is put in place. This will help to identify the best ways and means through which the firm can be ran. In cases of departures from the important processes, a firm will have to find other ways of integrating important measures that will ensure reliability and variability is attained in the best way and manner possible. The procedure will also include the integration of important measures and important processes that will ensure that the patients are treated according to their entire needs and expectations relating to their jobs and their current practice as professionals. In this process, there is the need for the ethics of scientific measurement, objectivity and a strong duty of care to be put in place to ensure that the best interest of the client is sought at all times and the system is changed in order to meet the needs of the client. This will mean that the case history of every client and the facts of every client’s case must give rise to the implementation of ROM in a way and manner that will employ other related measures and standards that can be imposed to achieve the best knowledge and the best level of results. The level of results must also be monitored closely and where other outcome measures must be applied to complement ROM, I believe it should be done quickly. This is because ROM is not always a good stand-alone measure that can be relied upon by a practitioner. Hence, I have come to the realisation that a physiotherapist will have to review every patient’s case and identify where there is the need to make changes and include other approaches and methods of dealing with outcome measurement. This must be altered immediately the need arises and this must be done to prevent monotony and the many challenges that could potentially prevent the ROM from being an appropriate solution to the measurement of outcomes. Finally, I have learnt from this literature review that data measures are important and must be defined in a way and manner that the scales are best and appropriate for the patient. Therefore, the design of questionnaires must be done in a way that all technical requirements and components are put in place to ensure the measurement is coherent with the most important needs for the patient. Bibliography Brashear, E., & Elovic, E. (2011). Spasticity: Diagnosis and Management. New York: Demos Medical Publishing. Delisa, J. A., Gans, B. M., & Walsh, N. E. (2010). Physical Medicine and Rehabilitation: Preferences and Practice. Amsterdam: Wolters Kluwer Health. Dvorak, J., & Gilliar, W. G. (2011). Musculoskeletal Manual Medicine: Diagnosis and Treatment. London: Thieme Medical Publishing. Eston, R., & Thompson, R. (2010). Kinanthropometry and Exercise Physiology Laboratory Manual: Tests. London: Routledge. Frontera, W. R., Silver, J. C., & Rizzo, T. D. (2012). Essentials of Physical Medicine and Rehabilitation. London: Elsevier Health Science. Holt, L. E., Pelham, T. E., & Holt, J. (2013). Flexibilithy: A Concise Guide to Conditioning Performance Enhancement. New York: Springer. Jakobsen, T. L., Christensen, M., Christensen, S. S., Olsen, M., & Bandholm, T. (2010). Reliability of Knee Joint Range of Motion and Circumference Measurements after Total Knee Anthroplastry: Does Tester Experience Matter? Psychotherapy Research Journal , 126-134. Kafer, W., Freitz, l. C., & Kinkel, S. (2005). Outcome Assessment in Total Knee Arthroplastry: Is the Clinical Measurement of ROM and Reliable Measurable Outcome Variable. Z Orthop Ihre Grenzgeb , 25-29. McClain, B. C., & Suresh, S. (2011). Handbook of Pediatric Chronic Pain: Current Science and Integrative Practice. London: Springer. McLaughlin, E. (2014). What is Range of M otion (ROM)? Definition, Types and Exercises. Educational Portal , 234-239. Miner, A. L., Lingarat, E. A., Wright, E. A., Sledge, C. B., & Katz, J. N. (2003). Jnee Range of Motion After Total Knee Arthroplastry: How Influential is this as an Outcome Measure. Journal of Arthroplastry , 286-294. Naylor, J., Ko, V., Sam Adie, S., Gaskin, C., Walker, R., Harris, I. A., et al. (2011). Validity and reliability of using photography for measuring knee range of motion: a methodological study. BMC Musculoskeletal Disorders , 77-84]. Nussbaumer, S., Leunig, M., Glatthorn, J. F., Stauffacher, S., Gerber, H., & Maffiuletti, N. A. (2010). Validity and test-retest reliability of manual goniometers for measuring passive hip range of motion in femoroacetabular impingement patients. BMC Musculoskeletal Disorders , 194-209. Pope, T., Bloem, H. L., Beltran, J., Morrison, W. B., & Wilson, D. J. (2010). Musculoskeletal Imaging. London: Elsevier. Reed, K. L., & Sanderson, S. N. (2013). Concepts of Occupational Therapy. Amsterdam: Wolters Kluwer Health. Wilken, J., Rao, S., Estin, M., Saltzman, D., & Yack, H. J. (2011). A New Device for Assessing Ankle Dorsiflexion Motion: Reliability and Validity. Journal of Orthopedic and Sports Physical Therapy , 274-283. Read More