Assessment of Shoulder Range of Motion: Introduction of a Novel Patient Self-Assessment Tool

Purpose: The goal of this study was to show that patient self-assessment of active shoulder range of motion (ROM) by use of a novel, diagram-based questionnaire is accurate when compared with physician-assessed shoulder ROM. Methods: We designed a diagram-based self-assessment tool that enables patients to determine their own active shoulder ROM in 3 planes of motion: forward elevation, external rotation, and internal rotation. This questionnaire was administered to 100 consecutive English-speaking patients presenting to a university-based orthopaedic surgery practice for evaluation of a shoulder-related complaint. After completion of the questionnaire, the patients' actual shoulder ROM in each plane was measured by a single blinded investigator using a standard 12-inch goniometer. Direct comparison of patient and physician ROM assessments was performed, and logistic regression analysis was then applied to identify those factors affecting the patients' ability to accurately complete the questionnaire. Results: Patients were able to properly quantify motion 85% of the time; they were able to qualitatively assess motion as impaired or unimpaired 93% of the time. Patients who were more likely to make errors in self-assessment were significantly older than the error-free subjects and expressed significantly more dissatisfaction with shoulder function. In addition, there was a weak inverse relation between education level and accurate self-assessment. Gender, exposure to physical therapy, and involvement in litigation or Workers' Compensation cases were not significantly correlated with accurate ROM self-assessment. Patients were significantly less accurate in their assessment of internal rotation than in their assessment of both forward elevation and external rotation. Conclusions: Using a diagram-based questionnaire, patients are able to accurately assess their own active shoulder ROM. Level of Evidence: Level II, development of diagnostic criteria based on consecutive patients with universally applied gold standard.