Reproducibility of goniometric measurement of the knee in the in-hospital phase following total knee arthroplasty

Anton F Lenssen, Ellen M van Dam, Yvonne H F Crijns, Mark Verhey, Ruud J T Geesink, Piet A van den Brandt, Rob A de Bie, Anton F Lenssen, Ellen M van Dam, Yvonne H F Crijns, Mark Verhey, Ruud J T Geesink, Piet A van den Brandt, Rob A de Bie

Abstract

Background: The objective of the present study was to assess interobserver reproducibility (in terms of reliability and agreement) of active and passive measurements of knee RoM using a long arm goniometer, performed by trained physical therapists in a clinical setting in total knee arthroplasty patients, within the first four days after surgery.

Methods: Test-retest analysis.

Setting: University hospital departments of orthopaedics and physical therapy.

Participants: Two experienced physical therapists assessed 30 patients, three days after total knee arthroplasty.

Main outcome measure: RoM measurement using a long-arm (50 cm) goniometer. Agreement was calculated as the mean difference between observers +/- 95% CI of this mean difference. The intraclass correlation coefficient (ICC) was calculated as a measure of reliability, based on two-way random effects analysis of variance.

Results: The lowest level of agreement was that for measurement of passive flexion with the patient in supine position (mean difference 1.4 degrees ; limits of agreement 16.2 degrees to 19 degrees for the difference between the two observers. The highest levels of agreement were found for measurement of passive flexion with the patient in sitting position and for measurement of passive extension (mean difference 2.7 degrees ; limits of agreement -6.7 to 12.1 and mean difference 2.2 degrees ; limits of agreement -6.2 to 10.6 degrees, respectively). The ability to differentiate between subjects ranged from 0.62 for measurement of passive extension to 0.89 for measurements of active flexion (ICC values).

Conclusion: Interobserver agreement for flexion as well as extension was only fair. When two different observers assess the same patients in the acute phase after total knee arthroplasty using a long arm goniometer, differences in RoM of less than eight degrees cannot be distinguished from measurement error. Reliability was found to be acceptable for comparison on group level, but poor for individual comparisons over time.

Figures

Figure 2
Figure 2
Scatter plot of interobserver reliability of measurement of passive flexion whilst sitting, as indicated by the ICCs.
Figure 3
Figure 3
Differences between observers, plotted against the mean values of both observers for each patient for passive extension. The figure shows the mean difference between observers (solid line at centre) and the limits of agreement (dashed outer lines corresponding to ±1.96 SD of the mean difference between the first and second observers).
Figure 1
Figure 1
Differences between two observers, plotted against the mean values for both observers for each patient for flexion RoM in sitting position. The figure shows the mean difference between observers (solid line at centre) and the limits of agreement (dashed outer lines corresponding to ±1.96 SDs of the mean difference between the first and second observers).
Figure 4
Figure 4
Scatter plot of interobserver reliability of measurement of passive extension.

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