脑瘫儿童下肢连续关节活动度测量的稳定性：我们能做得更好吗？

Stability of serial range-of-motion measurements of the lower extremities in children with cerebral palsy: can we do better?

机构信息

J. Darrah, PT, PhD, Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton, Alberta, Canada T6E 2S7.

L. Wiart, PT, PhD, Clinical Support, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada, and Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta.

出版信息

Phys Ther. 2014 Jul;94(7):987-95. doi: 10.2522/ptj.20130378. Epub 2014 Feb 20.

DOI:10.2522/ptj.20130378

PMID:24557653

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4078266/

Abstract

BACKGROUND

Serial joint range-of-motion (ROM) measurements are an important component of assessments for children with cerebral palsy. Most research has studied ROM stability using group data. Examination of longitudinal intraindividual measures may provide more clinically relevant information about measurement variability.

OBJECTIVE

The aim of this study was to examine the stability of intraindividual longitudinal measurements of hip abduction (ABD), popliteal angle (POP), and ankle dorsiflexion (ADF) ROM measures of children with cerebral palsy.

DESIGN

Secondary data analyses were performed.

METHODS

The stability patterns of individual serial measurements of ABD, POP, and ADF from 85 children (mean age=3.8 years, SD=1.4) collected at baseline (T1), 3 months (T2), 6 months (T3), and 9 months (T4) were examined using T1 as the anchor and bandwidths of ±15 degrees (ABD and POP) and ±10 degrees (ADF) as acceptable variability. Frequencies of stability categories (0°-5°, 5.1°-10°, 10.1°-15°, and >15°) were calculated. Patterns of stability across the 4 time periods also were examined. Group means (T1-T4) were compared using repeated-measures analysis of variance.

RESULTS

No significant differences in group means were found except for ABD. Stability patterns revealed that 43.3% to 69.5% of joint measurements were stable with T1 measurements across all 3 subsequent measurements. Stability category frequencies showed that many measurements (ABD=17%, POP=29.9%, and ADF=37.1%) went outside the variability bandwidths even though 39% or more of joint measurements had a change of 5 degrees or less over time.

LIMITATIONS

Measurement error and true measurement variability cannot be disentangled. The results cannot be extrapolated to other joint ROMs.

CONCLUSIONS

Individual ROM serial measurement exhibits more variability than group data. Range-of-motion data must be interpreted with caution clinically and efforts made to ensure standardization of data collection methods.

摘要

背景

连续的关节活动度（ROM）测量是脑瘫儿童评估的重要组成部分。大多数研究都是使用组数据来研究 ROM 稳定性。检查个体内的纵向测量值可能会提供更具临床相关性的测量变异性信息。

目的

本研究旨在探讨脑瘫儿童髋关节外展（ABD）、腘窝角（POP）和踝关节背屈（ADF）ROM 测量的个体内纵向测量值的稳定性。

设计

进行二次数据分析。

方法

使用 T1 作为锚点，将 85 名儿童（平均年龄=3.8 岁，标准差=1.4）在基线（T1）、3 个月（T2）、6 个月（T3）和 9 个月（T4）时 ABD、POP 和 ADF 的个体连续测量值的稳定性模式进行了检查，可接受的变化范围为±15 度（ABD 和 POP）和±10 度（ADF）。计算了稳定性类别（0°-5°、5.1°-10°、10.1°-15°和>15°）的频率。还检查了 4 个时间段的稳定性模式。使用重复测量方差分析比较了组平均值（T1-T4）。

结果

除 ABD 外，组间平均值无显著差异。稳定性模式显示，在所有 3 次后续测量中，43.3%至 69.5%的关节测量值与 T1 测量值稳定。稳定性类别频率显示，即使 39%或更多的关节测量值随时间变化在 5 度以内，许多测量值（ABD=17%、POP=29.9%和 ADF=37.1%）仍超出可变性带宽。