Range of Motion in Older Women

Long-Term Outcomes in Patients Surviving Large Burns: The Musculoskeletal System

The authors have previously described long-term outcomes related to the skin in patients surviving large burns. The objective of this study was to describe the long-term musculoskeletal complications following major burn injury. This is a cross-sectional descriptive study that includes a one-time evaluation of 98 burn survivors (mean age = 47 years; mean TBSA = 57%; and mean time from injury = 17 years), who consented to participate in the study. A comprehensive history and physical examination was conducted by a senior and experienced Physical Medicine and Rehabilitation physician. In addition to completing a Medical Problem Checklist, subjects also completed the Burn-Specific Health Scale (Abbreviated 80 item), a self-report measure used to review the level of functional adaptation. Joint pain, joint stiffness, problems walking or running, fatigue, and weak arms and hands are conditions that continue to be reported at an average of 17 years from the time of burn injury. Seventy-three percent (68 of 93) of the study sample were found to have a limitation of motion and areas most affected were the neck (47%), hands (45%), and axilla (38%). The global (Burn-Specific Health Scale-total) score for the overall sample was 0.78. Subjects with limitation of motion had significant difficulty in areas of mobility, self-care, hand function, and role activities. This study underscores the importance of long-term follow-up care and therapeutic interventions for survivors of major burn injury, as they continue to have significant and persistent burn-related impairments even several years following injury.

Shoulder Joint Range of Motion in Healthy Adults Aged 20 to 49 Years

Studies of adults aged 50 years and older have shown that shoulder range of motion (ROM) is significantly less than the norms reported by the American Academy of Orthopaedic Surgeons (AAOS) and decreases with age. However, there has been little investigation of the shoulder ROM of younger adults. The aims of this study were to measure the ROM of healthy younger Australian adults aged 20 to 49 years to (1) pool with data on healthy older Australian adults aged 50 years and older from the study by McIntosh et al (2003) to provide shoulder ROM values across the adult life span; (2) compare their shoulder ROM with AAOS norms; and (3) determine the effect of background factors (age, gender, body mass index [BMI] and current activity level) on active shoulder ROM.

Goniometric measurement of bilateral passive and active shoulder flexion, abduction, internal rotation and external rotation of 72 participants was compared with the AAOS norms using one-sample t-tests. The effect of the background factors on shoulder ROM was analysed using univariate General Linear Models.

Significantly lower active and passive ROM (p≤0.001) for all movements compared with AAOS norms was found. Active shoulder flexion, abduction and internal rotation were not significantly affected by any of the background factors. Decreased active external rotation was found for males (p = 0.020) and for older (p = 0.048) and less active (p = 0.048) participants. This study highlights the inaccuracies of the AAOS norms for younger adults aged 20 to 49 years and shows that age, gender, BMI and current activity level do not consistently have an impact on active shoulder ROM in this age group. The relevance of the AAOS norms to other joints needs investigation.

Active and Passive Shoulder Range of Motion in Healthy Older People

This study was conducted to determine the effect of increasing age on four shoulder movements and to explore the need for normative data for shoulder range of motion (ROM) in people aged 50 years and older. Forty-one participants were conveniently recruited according to four age categories: 50–59 years, 60–69 years, 70–79 years and 80 years and over. Goniometric measurement of bilateral active and passive ROM for flexion, abduction, internal rotation and external rotation was analysed using paired sample t-tests and compared with the norms of the American Academy of Orthopaedic Surgeons (AAOS) using one sample t-tests.

Passive ROM was greater than active ROM for all movements (p<0.001). Active and passive ROM were significantly (p<0.01) lower than the AAOS norms, except for passive external rotation (p = 0.07). The General Linear Model procedure was used to determine the effect of age, gender, activity level, work history and body mass index on active ROM. The results showed that age (p = 0.001) and work history (p = 0.012) significantly influenced flexion, work history (p = 0.008) significantly influenced abduction and gender (p = 0.018) significantly influenced internal rotation. None of the independent variables influenced active external rotation.

Preliminary normative data are presented as percentiles by age and work history for clinical reference. Comparing patients' ROM measurements with age-related and activity-related norms will assist occupational therapists in establishing realistic goals during rehabilitation.

Effects of age on passive range of motion of selected peripheral joints in healthy adult females

The purposes of this study were to investigate whether age influences passive range of motion (PROM) in women and to compare obtained values with other available data. Ninety healthy Caucasian women from 18 to 59 years of age had the PROM of their ankle, knee, hip, shoulder, elbow, and wrist measured by using a standard goniometer. Data were analyzed by using descriptive statistics (mean/SD) and linear regression (to analyze the effect of age on ROM). Age did not significantly influence PROM for the majority of movements tested. For 11 of the tested movements (knee flexion, hip flexion, hip external rotation, glenohumeral and shoulder complex flexion, glenohumeral and shoulder complex external rotation, shoulder complex abduction, shoulder complex extension, and elbow extension), increasing age was associated with a statistically significant decrease in PROM, whereas for ankle dorsiflexion, ankle plantarflexion, ankle inversion, and hip abduction, increasing age was associated with an increase in PROM. The change in PROM associated with age was typically small and ranged from -0.420 to 0.207 degrees per year. The difference in mean PROM between this study and published normative values ranged from -16.6 to +25.9 degrees. For women aged 18 to 59, PROM of the extremities is relatively constant, suggesting that a single table of reference values for adult females is an appropriate approximation for clinical practice except for glenohumeral and shoulder complex external rotation, which were found to clinically significantly decrease with age.