Jakobsen Thomas Linding, Christensen Malene, Christensen Stine Sommer, Olsen Marie, Bandholm Thomas
Department of Physiotherapy, Copenhagen University Hospital at Hvidovre, Copenhagen, Denmark.
Physiother Res Int. 2010 Sep;15(3):126-34. doi: 10.1002/pri.450.
Two of the most utilized outcome measures to assess knee joint range of motion (ROM) and intra-articular effusion are goniometry and circumference, respectively. Neither goniometry nor circumference of the knee joint have been examined for both intra-tester and inter-tester in patients with total knee arthroplasty (TKA). The purpose of this study was to determine the intra-tester and inter-tester reliability of active and passive knee joint ROM and circumference in patients with TKA when administered by physiotherapists (testers) with different clinical experience.
The design was an intra-tester, inter-tester and intra-day reliability study. Nineteen outpatients (10 females) having received a TKA were examined by an inexperienced and an experienced physiotherapist. Following a standardized protocol, active and passive knee joint ROM and circumference measurements were obtained using a universal goniometer and a tape measure, respectively. To establish reliability, intraclass correlation coefficients (ICC(2,1)) and smallest real difference (SRD) were calculated.
The knee joint ROM and circumference measurements were generally reliable (ICC > 0.8) within and between physiotherapists (except passive knee extension). Changes in knee joint ROM of more than 6.6 degrees and 10 degrees (except active knee flexion) and knee joint circumference of more than 1.0 cm and 1.63 cm represent a real clinical improvement (SRD) or deterioration for a single individual within and between physiotherapists, respectively. Generally, the experienced tester recorded larger knee joint ROM and lower circumference values than that of the inexperienced tester.
In clinical practice, we suggest that repeated knee goniometric and circumferential measurements should be recorded by the same physiotherapist in individual patients with TKA. Tester experience appears not to influence the degree of reliability.
评估膝关节活动范围（ROM）和关节内积液时，最常用的两项结果指标分别是角度测量法和周长测量法。对于全膝关节置换术（TKA）患者，角度测量法和膝关节周长测量法在测试者内和测试者间的情况均未得到研究。本研究的目的是确定由具有不同临床经验的物理治疗师（测试者）对TKA患者进行主动和被动膝关节ROM及周长测量时，测试者内和测试者间的可靠性。
本研究设计为测试者内、测试者间及日内可靠性研究。19例接受TKA的门诊患者（10名女性）由一名经验不足的和一名经验丰富的物理治疗师进行检查。按照标准化方案，分别使用通用角度计和卷尺获取主动和被动膝关节ROM及周长测量值。为确定可靠性，计算组内相关系数（ICC(2,1)）和最小真实差异（SRD）。
膝关节ROM和周长测量值在物理治疗师内部和之间总体上是可靠的（ICC>0.8）（被动膝关节伸展除外）。膝关节ROM变化超过6.6度和10度（主动膝关节屈曲除外），以及膝关节周长变化超过1.0厘米和1.63厘米，分别代表物理治疗师内部和之间单个个体的真实临床改善（SRD）或恶化。一般来说，经验丰富的测试者记录的膝关节ROM值较大，周长值较低，而经验不足的测试者记录的值则相反。
在临床实践中，我们建议应由同一名物理治疗师对个体TKA患者进行重复的膝关节角度测量和周长测量。测试者的经验似乎不会影响可靠性程度。
