Department of Orthopedic Surgery, Kaiser Permanente Medical Center Los Angeles, Los Angeles, CA, USA.
Clin Orthop Relat Res. 2014 Feb;472(2):740-8. doi: 10.1007/s11999-013-3324-9. Epub 2013 Oct 18.
Shoulder ROM and function of the shoulder are difficult to evaluate in young children. There has been no determination of the age at which children can comply with the current assessment tools in use, but doing so would be important, because it gives us more accurate insight into the development and assessment of shoulder functional ROM in young children.
QUESTIONS/PURPOSES: We (1) determined whether age would limit the use of two different observational scales used to assess shoulder ROM and function in young children (the Mallet scale and the ABC Loops protocol); and (2) compared the two scales in terms of intra- and interobserver reliabilities.
Sixty-five able-bodied children (32 boys, 33 girls; mean age, 3.9 years; range, 0.5-7.0 years) were recruited from local preschools and evaluated using the Mallet scale and ABC Loops protocol. Children were assessed on their ability to complete the examinations and time to completion for each measurement protocol. Intra- and interobserver reliability was tested by percentage agreement. Forty-eight children (mean age, 4.4 years; SD, 1.3 years) were able to complete the Mallet and ABC Loops measurement protocols; 17 children (mean age, 2.3 years; SD, 1.1 years) failed to complete either test.
Younger children had more difficulty completing the examinations; there was a strong negative correlation between age and failure: probability of failure increased with decreasing age (Pearson r = -0.601, p < 0.001). Children who were able to complete one test were able to complete the other. Interobserver and intraobserver agreement was very high for both scales (in excess of 95% for all comparisons), and with the numbers available, there were no differences between the scales.
The Mallet scale and ABC Loops protocol have high reliability metrics in children younger than 6 years, but very young children (those younger than 3 years) generally will not be able to complete the examinations. The ABC Loops test took longer to perform than the Mallet scale but may more comprehensively evaluate a child's functional capabilities. We therefore state that both assessment tools can be reliably used in children older than 3 years; we believe the ABC Loops gives a more accurate assessment of shoulder ROM.
肩部活动度和功能在幼儿中较难评估。目前还没有确定儿童能够符合现有评估工具的年龄，但这一点很重要，因为它使我们能够更准确地了解幼儿肩部功能活动度的发展和评估。
问题/目的：我们（1）确定年龄是否会限制两种不同的观测量表在幼儿中评估肩部活动度和功能的使用（Mallet 量表和 ABC 环协议）；（2）比较两种量表在观察者内和观察者间的可靠性。
从当地幼儿园招募了 65 名健康儿童（32 名男孩，33 名女孩；平均年龄 3.9 岁；范围，0.5-7.0 岁），并使用 Mallet 量表和 ABC 环协议进行评估。通过评估儿童完成检查的能力以及每个测量方案的完成时间来评估年龄限制。通过百分比一致性测试观察者内和观察者间的可靠性。48 名儿童（平均年龄 4.4 岁；标准差 1.3 岁）能够完成 Mallet 和 ABC 环测量方案；17 名儿童（平均年龄 2.3 岁；标准差 1.1 岁）未能完成任何一项测试。
年幼的儿童完成检查更困难；年龄与失败之间存在强烈的负相关：失败的概率随着年龄的降低而增加（皮尔逊 r = -0.601，p < 0.001）。能够完成一项测试的儿童能够完成另一项测试。两种量表的观察者内和观察者间一致性均非常高（所有比较均超过 95%），并且根据可用的数字，两种量表之间没有差异。
Mallet 量表和 ABC 环协议在 6 岁以下儿童中具有较高的可靠性指标，但非常年幼的儿童（3 岁以下）通常无法完成检查。ABC 环测试的执行时间比 Mallet 量表长，但可能更全面地评估儿童的功能能力。因此，我们表示这两种评估工具都可以在 3 岁以上的儿童中可靠使用；我们认为 ABC 环能更准确地评估肩部活动度。
