Best Practices for Measuring Joint Range of Motion

Best Practices for Measuring Joint Range of Motion. Getty Images

Range of motion refers to the degree to which each joint of your body can move. For each joint, there is a considered to be a normal range of movement. Whether your joint’s movements fall into this category is a good indicator of joint health.

Assessing range of motion is a common practice in occupational therapy evaluations. Your therapist wants to know if the impairment in your joint health is impacting your ability to participate in daily life.

This article is intended to help you understand the range of motion portion of your evaluation and advocate that best practices be used.

Scanning for active range of motion

In most evaluations (especially in the nursing home and hospital settings), assessing the range of motion will begin with a visual scan. Your therapist will have you raise your arm, flex your elbows, rotate your forearms, etc., systematically checking each joint. When you are moving the joint without assistance, this is referred to as the active range of motion (AROM).

According to the book Occupational Therapy for Physical Dysfunction, 6, here are the best practices for this scan:

  • You should be seated or standing (as these are the most common positions for functionally use these joints.)
  • You should perform the movements on the right and left side at the same time (comparing the right to the left is the easiest way to identify a possible deficit.)
  • Timing and symmetry of motions should also be attended to by your therapist (as this also assists in screening for neurological deficits).

If no limitations are observed, your therapist will either document within normal limits (WNL) or within functional limits (WFL).

Measuring limitations in range of motion

If a deficit is identified in the scan or if you are seeing an occupational therapist or physical therapist for an issue related specifically to joint health, your therapist should physically measure the degree to which those joints can move. This is often done using a protractor-like device called a goniometer (or a goniometer app).

Your therapist may want to measure both active range of motion and passive range of motion (PROM), meaning how much the joint can be moved with assistance from the therapist. If AROM of motion is less than PROM, this can indicate an issue at the muscular level, versus with the joint itself.

Minimizing inconsistency in range of motion measurements

There is plenty of room for inconsistency in measuring a range of motion. As a client, you may be tired or in pain, which might impact your participation. Your therapists may use slightly different landmarks for their measurement or different documentation for recording the data, leading to confusion.

The range of motion measurements are an important indicator of progress in therapy. It is, therefore, prudent to advocate for best practices in gathering the date. Research has yielded the following best practices:

Results are most consistent when performed by the same person. A 2002 study found this to be true in shoulder measurements. A second study, also released in 2002, found measurements of the finger joint to be more reliable when one therapist was involved.

Active measurements are more reliable than passive ones according to a 1998 study of shoulder movements.

The client should be in the same position when repeat measurements are taken. The same 1998 study found there was only a moderate level of agreement when the client was lying down versus sitting.

Emerging technologies to decrease inconsistency

The inconsistencies of joint measurements and time-consuming nature of documenting each joint have lead to the development of technologies, such as Kinetisense, to capture digitally this data. These technologies show promise from early research. However, the use of these devices has yet gained wide distribution. 

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