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Intra- and intertester reliability and criterion validity of the parallelogram and universal goniometers for measuring maximum active knee flexion and extension of patients with knee restrictions,☆☆,,★★

Presented in part at the 67th Annual Congress of ACFAS in Ottawa, Ont, May 12, 1999.
https://doi.org/10.1053/apmr.2001.19250Get rights and content

Abstract

Brosseau L, Balmer S, Tousignant M, O'Sullivan JP, Goudreault C, Goudreault M, Gringras S. Intra- and intertester reliability and criterion validity of the parallelogram and universal goniometers for measuring maximum active knee flexion and extension of patients with knee restrictions. Arch Phys Med Rehabil 2001;82:396-02. Objective: To examine the intra- and intertester reliability of the universal goniometer (UG) and parallelogram goniometer (PG), and to assess the criterion validity of the same instruments on subjects with knee restrictions. Design: Reliability and validation study. Setting: Radiology department at university hospital. Participants: Sixty subjects (34 men, 26 women; mean age, 52yr) with various knee restrictions. Interventions: Sixteen goniometric measurements were collected per patient by 2 physical therapists. Subjects were evaluated in knee flexion and knee extension positions. To serve as a gold standard, radiographs were taken in both positions. Main Outcome Measures: Active knee flexion and knee extension on 2 goniometers, radiographs. Maximum active range of motion (AROM). Results: The UG intratester reliability (intraclass correlation coefficients [ICCs]) was.997 in flexion and.972 to.985 in extension. The results were also high with the PG (ICC =.996,.953-.955) for flexion and extension, respectively. The intertester reliability was high for flexion (ICC =.977-.982) and for extension (ICC =.893-.926) when using the UG. For the PG, ICC results ranged from.959 to.970 for flexion and from.856 to.898 for extension. Criterion validity (r) varied from.975 to.987 for flexion and from.390 to.442 for extension with the UG, and from.976 to.985 for flexion and.423 to.514 for extension with the PG. Conclusion: Intra- and intertester reliability were high for both goniometers. The results for the criterion validity varied. Our study also revealed that it is preferable to use goniometry rather than visual estimations when measuring AROM. It is recommended that the same therapist take all the measurements when assessing AROM for UG and PG goniometric measurements on patients with knee restrictions.

Section snippets

Literature review

Over the years, several published studies have addressed the reliability and validity of goniometric measurements. Studies6, 7, 8 have shown that goniometric measurements are more reliable than visual estimates. In addition, research studies have found the UG to have a good overall intra- and intertester reliability. However, most studies found the intratester reliability to be better than the intertester reliability.5, 8, 9, 10, 11, 12 Overall reliability of the UG was found to be high, though

Subjects

Sixty subjects (34 men, 26 women; mean age, 52yr) with a residual musculoskeletal impairment at the right or left knee were recruited from discharged patient lists obtained from the physiotherapy departments of different institutions: the Ottawa Hospital, General Campus; The Rehabilitation Centre (Ottawa); the Health Care Center of the Canadian Forces Support Unit of Ottawa; the Clinique de physiothérapie l'Envolée; the Physio Sports Care Centre; and the Centre Hospitalier des Vallées de

Results

Table 1 presents descriptive results obtained from the goniometric measurements for active knee flexion and extension.In addition, radiographic measurements and visual estimations are presented (table 1).

The intratester reliability of goniometric measurements was high for the UG and PG when measuring active knee flexion with ICCs of.997 and.996, respectively (table 2).The ICCs for intratester reliability of active knee extension were.972 and.985 for the UG and.953 and.955 for the PG (table 2).

Intratester reliability

The intratester reliability obtained in this study was high for the PG and the UG when measuring active knee flexion and extension on subjects with knee restrictions. The high intratester reliability of the UG supports findings of previous studies.5, 8, 9, 10, 11 The results for the PG correlate with those of a recent study, assessing the reliability of the PG on the knee joint. The differences between the ICCs for the UG and the PG, between testers and positions, were minimal. As previously

Conclusion

Goniometric measurements taken on subjects with impaired knee ROM were found to be very reliable when using either the PG or the UG. However, it is recommended that the same therapist take all the measurements when assessing AROM on a pathologic knee. The PG has been found to be as reliable and valid as the UG, especially when assessing active knee flexion compared with active knee extension. The current study also revealed that it is preferable to use goniometry rather than visual estimations

Acknowledgements

The authors thank Lynn Moore and Marie-Josée Trudel from the Ottawa Hospital, General Site, Department of Radiology, for their dedication to the project. Special thanks to Julie Budd, Simon Bougie, and Shayne O'Donoghue, the therapists involved in the data collection. Finally, we thank Sarah Milne and Mélanie Farmer for their editing and technical support.

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  • Cited by (0)

    Supported by the Institute of Rehabilitation Research and Development of The Rehabilitation Centre (Ottawa), by the Institute of Functional and Active Rehabilitation, and by the Physiotherapy and the Radiology Departments of the Ottawa Hospital.

    ☆☆

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the author(s) is/are associated.

    Reprint requests to Lucie Brosseau, PhD, Physiotherapy Program, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, 451 Smyth Rd, Ottawa, Ont K1H 8M5, Canada, e-mail: [email protected].

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