No abstract

Reliability of goniometric measurements has been examined only under standardized conditions and usually with healthy subjects. The purpose of this study was to assess goniometric reliability in a clinical setting. The reliability of goniometric measurements of passive elbow and knee positions was assessed using patients as subjects. The effect of using the means of repeated measurements and the interdevice reliability of three common goniometers were also examined. Results showed that intratester reliability for flexion and extension of the knee and the elbow joints was high (r = .91 to .99). Intertester reliability was also high (r = .88 to .97) for these measurements except for measurements of knee extension (r = .63 to .70). Although previous investigators have suggested that using the means of multiple measurements improves reliability, our data indicate that this procedure never improves the correlation coefficient more than .12. The reliability was similar for all three devices. The results of this study indicate that for the knee and elbow joints, goniometric measurements performed in a clinical setting can be highly reliable. The method described in this study provides a simple protocol that can be used clinically to investigate goniometric reliability.

During a five‐year period, 90 patients who had undergone lower‐extremity amputations when aged 60 or older were treated at the Amputee Clinic of the Jewish Hospital of St. Louis. Seventeen of the 90 were not fitted with prostheses because of various medical contraindications. Thirteen of the remaining 73 patients who were fitted with prostheses had died by the time of follow‐up, and 23 others could not be located. Of the 37 known survivors, 23 wore their prosthesis for more than six hours daily and used it as their main mode of locomotion; 14 used it only occasionally or not at all. Sex and age at the time of amputation were of little value in predicting the success of prosthetic rehabilitation. Patients with below‐knee amputations fared much better than those with above‐knee amputations. Contraindications to fitting an aged amputee with a prosthesis are mental deterioration, congestive heart failure, severe angina pectoris, and advanced chronic obstructive pulmonary disease. Neurologic disorders such as parkinsonism or stroke with a significant neurologic residual are additional contraindications. Patients who have ulcerations or infections of the remaining extremity or who have severe contractures of the stump usually cannot be fitted with a prosthesis. The ability to use axillary crutches is not a realistic prerequisite for supplying an aged amputee with a prosthesis. A patient who has walked before the amputation and who afterward can walk with a walker, usually will be able to use an artificial limb. Amputees who cannot be expected to use a prosthesis can still be rehabilitated to an independent wheelchair existence.