A new shoulder range of motion screening measurement: its reliability and application in the assessment of the prevalence of shoulder contractures in patients with impaired consciousness caused by severe brain damage

Abstract

Objectives: To determine the reliability of a new shoulder joint range of motion (ROM) measurement for unconscious patients and to assess the prevalence of shoulder joint contractures in such patients.

Design: Prospective cohort survey.

Setting: An early rehabilitation center for adult persons with neurologic disorders.

Participants: Fifty patients with impaired consciousness caused by severe cerebral damage of various etiologies. In addition, reference values were measured in 60 healthy adults.

Intervention: Shoulder ROM was assessed by measuring the distance between the olecranon and underlay while the patient lay supine on a solid surface and the patient's hands were passively positioned behind the neck. Distances between the olecranon and underlay were measured, first, manually by the rater and, second, for control, digitally by a blinded person from a digital photo taken while a constant force was applied to the elbow.

Main outcome measures: Prevalence of contractures defined as increased distance between the olecranon and underlay or impossibility of positioning the hands passively behind the neck, and intra- and interrater-reliability of the 2 shoulder ROM measurements with the interclass correlation coefficient (ICC).

Results: Measurement of shoulder ROM showed high intra-(ICC range, .78-.91) and interrater reliability (ICC range, .77-.90) for manual measurement, high intra- (ICC range, .91-.95) and interrater reliability (ICC range, .90-.94) for the digital analysis, and a high ICC for both methods (ICC=.87). The prevalence of shoulder contractures was 56% in the patients and 50% of all shoulder joints.

Conclusions: The described method provided a reliable measurement for reduced shoulder ROM and appears to be a useful screening method to show the prevalence of shoulder joint contracture in these patients.