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John D. Loeser, MD, Department Editor
Reviewed by James P. Robinson, MD PhD
J. Gerhardt, L. Cocchiarella, F. Lea, Chicago, American Medical Association (800/621-8335, item # OP120902), 2002, 128 pages, $69.95 (hard cover), ISBN 157947263X
As the title indicates, “The Practical Guide to Range of Motion Assessment” provides practical, systematic information about how to measure range of motion (ROM) in the spine and extremities. Although the book is brief, its coverage of ROM testing is comprehensive. The measurement system it introduces starts with nomenclature for describing joint motion—the zero neutral system. This system of nomenclature allows an examiner to describe motion unambiguously, even for joints with motion in multiple planes, such as the thumb and the shoulder. The book goes on to review instrumentation that may be used to measure ROM, and describes a number of practical issues an examiner should address to maximize the reliability of the measures of joint motion he or she obtains. For example, it considers the type of warm-up exercises an examinee should do prior to ROM testing.
After this general information has been presented in Chapter 1, the next three chapters address the specifics of ROM testing for the spine and the upper and lower extremities. The text proceeds joint by joint (or region by region for the spine) in a very systematic way. The discussion for each joint motion includes the starting position for the examinee, the initial position of the measuring devices (usually one or more inclinometers), the instructions given to the examinee, the measurements made by the examiner, the number of repetitions to be performed, criteria for acceptable reliability (described as “validity” in the book), and the manner in which data should be recorded. These descriptions are generally clear, and are supplemented by photographs and diagrams.
The descriptions are informative at multiple levels. In some instances, they describe motions—such as pronation/ supination of the foot, with which many clinicians are unfamiliar. In other instances, they include ingenious ways to use inclinometers, such as for the evaluation of pronation/supination of the forearm. In all instances, they force the reader to think more clearly about the definitions of various kinds of motion, and the factors that influence these motions. In fact, the book is full of insights that reflect Dr. Gerhardt’s nearly 50 years of attention to the problem of assessing musculoskeletal function.
It is plausible to expect the attention to detail in “The Practical Guide to Range of Motion Assessment” would translate into greater reliability in the assessment of ROM. However, although the book is well referenced, it does not contain research data that establish the scientific value of the system described. This is understandable, since it would take a monumental research effort to determine the reliability of the roughly 80 joint motions described here. Rather than considering the system described in the book as proven, readers should chip away at the problem of inter-rater reliability by suggesting sensible ways to reduce obvious sources of unreliability.
I believe most physicians, physical therapists, and occupational therapists who treat musculoskeletal problems will find the book valuable, although the extent to which they incorporate it into their practices will vary. For some, it will simply reinforce the general point that ROM assessment is a complex endeavor, and that data obtained from physical therapists should be viewed with some skepticism. Others may want to incorporate selected portions of the book into their assessment procedures—e.g., ideas about warm-up or initial position of an assessed joint. A more ambitious project would be for a clinician to become familiar with the nomenclature used in the book to describe joint motions. This nomenclature appears to have great intrinsic appeal because it is unambiguous; however, my impression is it is not used widely. This limits its value for unambiguous communication among health professionals.
Physicians who perform independent medical evaluations should examine this book with great care because it describes numerous procedures that should increase the objectivity and reliability of assessing ROM. But they need to adopt the methods described in the book selectively, as they are constrained by legal requirements in the jurisdictions in which they perform examinations.
Two groups that might want to incorporate the system in toto are physical therapists who perform physical capacities examinations, and individuals who perform research on musculoskeletal conditions. In both settings, there is a premium on obtaining results that are reproducible and based on unambiguous methods.
As a physiatrist who is involved in musculoskeletal research and performs independent medical examinations, I found The Practical Guide to Range of Motion Assessment informative. In the absence of definitive research about the best methods for assessing ROM, the methods described in the book are sensible and cogent enough to warrant serious consideration by any clinician with a strong interest in this area.
Review content represents the opinion of the reviewer, not APS.
Dr. Robinson is assistant professor of rehabilitation medicine at the University of Washington in Seattle.
Please direct your suggestions for future Resource Reviews to John D. Loeser, MD, Department Editor, at jdloeser@u.washington.edu.
