Geertzen J H, Dijkstra P U, Stewart R E, Groothoff J W, Ten Duis H J, Eisma W H
Department of Rehabilitation, University Hospital Groningen, The Netherlands.
Clin Rehabil. 1998 Jun;12(3):254-64. doi: 10.1191/026921598675343181.
To quantify the amount of variation attributed to different sources of variation in measurement results of upper extremity range of motion, and to estimate the smallest detectable difference (SDD) between measurements in reflex sympathetic dystrophy (RSD) patients.
Two observers each measured in two sessions the range of motion of several upper extremity joints of RSD patients participating in an outcome study.
Department of Rehabilitation of a university hospital.
Twenty-nine upper extremity RSD patients.
The range of motion of forward flexion and external rotation of the shoulder, extension, flexion and supination of the elbow, palmar, dorsiflexion and ulnar, radial deviation of the wrist of affected and nonaffected sides, using a two-armed goniometer and an inclinometer. The measurement results were analysed using an analysis of variance according to the generalizability theory.
The results indicate that observer and patient-observer were important sources of variation. The random error was the most important source of variation. Averaged over all ranges of motion the observer contributed 3.9% to the total variation, patient-observer interactions contributed 5.2% and the random error 20.3%. The SDD was smallest for elbow flexion, 7.1 degrees and 9.6 degrees and was largest for external rotation of the shoulder, 24.8 degrees and 28.7 degrees. The SDD was smaller for the nonaffected side as compared to the affected side for the majority of ranges of motion except elbow extension, wrist dorsiflexion, and radial and ulnar deviation.
Clinically, our results indicate that range-of-motion measurements in RSD patients are subject to considerable variation and indicate that results of medical examinations in order to assess disability on the basis of range-of-motion measurements are subject to the same variation.
量化上肢活动范围测量结果中不同变异来源所导致的变异量，并估计反射性交感神经营养不良（RSD）患者测量值之间的最小可检测差异（SDD）。
两名观察者在两个时间段内分别对参与一项结局研究的RSD患者的多个上肢关节活动范围进行测量。
一所大学医院的康复科。
29例上肢RSD患者。
使用双臂角度计和倾角仪测量患侧和非患侧肩部前屈和外旋、肘部伸展、屈曲和旋后、腕部掌屈、背屈以及尺偏、桡偏的活动范围。根据概化理论，采用方差分析对测量结果进行分析。
结果表明观察者和患者 - 观察者是重要的变异来源。随机误差是最重要的变异来源。在所有活动范围内平均计算，观察者对总变异的贡献为3.9%，患者 - 观察者交互作用贡献为5.2%，随机误差贡献为20.3%。肘部屈曲的SDD最小，分别为7.1度和9.6度；肩部外旋的SDD最大，分别为24.8度和28.7度。除肘部伸展、腕部背屈以及桡偏和尺偏外，在大多数活动范围内，非患侧的SDD比患侧小。
临床上，我们的结果表明RSD患者的活动范围测量存在相当大的变异，并且表明基于活动范围测量来评估残疾程度的医学检查结果也存在同样的变异。
