The Colorado Haemophilia Paediatric Joint Physical Examination Scale: normal values and interrater reliability

Abstract

Persons with haemophilia often experience their first joint haemorrhage in early childhood. Recurrent bleeding into a joint may lead to significant morbidity, specifically haemophilic arthropathy. Early identification of the onset and progression of joint damage is critical to preserving joint structure and function. Physical examination is the most feasible approach to monitor joint health. Our group developed the Colorado Haemophilia Paediatric Joint Physical Examination Scale to identify earlier signs of joint degeneration and incorporate developmentally appropriate tasks for assessing joint function in young children. This study's objectives were to establish normal ranges for this scale and assess interrater reliability. The ankles, knees and elbows of 72 healthy boys aged 1 through 7 years were evaluated by a physical therapist to establish normal ranges. Exactly 10 boys in each age category from 2 to 7 years were evaluated by a second physical therapist to determine interrater reliability. The original scale was modified to account for the finding that mild angulation in the weight-bearing joints is developmentally normal. The interrater reliability of the scale ranged from fair to good, underscoring the need for physical therapists to have specific training in the orthopaedic assessment of very young children and the measurement error inherent in the goniometer. Modifications to axial alignment scoring will allow the scale to distinguish healthy joints from those suffering frequent haemarthroses.

Evaluation of early musculoskeletal disease in patients with haemophilia

“…The HJHS has demonstrated excellent inter-rater and intra-rater reliability, even in inexperienced assessors in a country with limited access to haemophilia services [21,22]. The HJHS is designed to detect mild stage arthropathy in 4–18-year-olds, whereas the Colorado scale is designed to identify earlier signs of joint degeneration and function in young children [17,23]. …”

Functional independence score in hemophilia: A cross‐sectional study assessment of Mexican children

“…The World Federation of Hemophilia (WFH) score [8] and the Colorado score [9] are instruments to be used in children, but these tools have to be assessed by experienced physicians. Poonnoose et al [10] developed the Functional Independence Score in Hemophilia (FISH), a performance-based assessment tool to objectively measure the patient's functional ability that can be easily administered by a trained nurse, doctor, or therapist.…”

Measurement of joint health in persons with haemophilia: A systematic review of the measurement properties of haemophilia‐specific instruments

“…Reliability of the CPE has not been studied in persons with haemophilia. In a study among 62 healthy boys, the interrater intraclass correlations (ICCs) were unsatisfactory, 0.34 for ankles, 0.67 for knees and 0.46 for elbows . This study established normal values in 72 healthy boys, aged between 1 and 7 years (left ankle 1.14 ± 0.42, right ankle 1.10 ± 0.30, left knee 0.46 ± 0.69, right knee 0.50 ± 0.77 and left elbow 0.24 ± 0.72, right elbow 0.22 ± 0.65).…”