Intrarater Reliability of Goniometry to Measure Scapular Protraction and Retraction

PURPOSE: Scapular mobility is essential for motion of the upper extremity and completion of activities of daily living (ADLs). However, no reliable goniometric technique to measure scapular protraction and retraction is established in clinical practice for occupational therapy practitioners. In the current study, an expert occupational therapy clinician and student measured scapular protraction and retraction of a sample of healthy adults and the results were used to examine the intra-rater reliability of a proposed goniometric technique.

STUDY DESIGN: This quantitative, observational, descriptive study sought out a purposive, convenience sample of 18- to 40-year-old healthcare graduate students with no known upper extremity injuries.

METHOD: Participant’s age, gender, arm dominance, and potential upper extremity injuries were captured through a self-developed demographic questionnaire. The degree of active range of motion at the shoulder was measured using surface anatomy of the scapula and a 12’’ plastic goniometer. The right and left scapulae of a sample of healthy young adults were measured by a certified hand therapist (CHT) and an occupational therapy student in natural (resting), protracted, and retracted positions (n = 54; total of 108 data points for each measurement) to analyze intra-rater reliability. Standard error of measure (SEM) for each evaluator was calculated using Statistical Package for the Social Sciences (SPSS) and compared to a predetermined threshold for clinical significance based on current literature (<8° SEM).

RESULTS: The proposed goniometric technique for measuring scapular protraction and retraction demonstrated clinically significant intra-rater reliability as evidenced by a standard error of measure (SEM) well below the predetermined threshold for clinical significance. For measurements of scapular neutral, protracted, and retracted positions, the SEM for the expert evaluator was < 4.10° and the SEM for the novice evaluator was < 3.91°. Furthermore, inter-rater reliability was also determined to be clinically significant with a SEM of < 4.87°. The results of the current study support the proposed goniometric technique as a reliable means of assessment for measuring scapular mobility in relation to occupational performance.

CONCLUSION: The results support the use of the goniometric method as a reliable technique to record scapular measurements of protraction and retraction within a clinical setting. The lower SEM of the novice evaluator compared to the expert evaluator suggests that with supervised practice the technique can be effectively implemented by a student, novice, or experienced clinician. Therefore, all levels of occupational therapy clinicians would be able to apply this simple and reliable technique to evaluate scapular mobility for meaningful activities. The results of the study expand clinical practice by providing a reliable method to accurately document between treatment sessions, formulate effective intervention plans, monitor progress and modify client goals, and provide client-centered care by comparing individualized scapular measurements for functional range of motion. The results of the current study may exert a powerful influence on the profession of occupational therapy as it provides practitioners with a means to justify services for reimbursement while using an evidenced-based method to further justify the utility of the profession.

References

Short, N., Mays, M., Ford, R., & Fahrney, E. (2019). Proposed method for goniometric measurement of scapular protraction and retraction. Journal of Hand Therapy: Official Journal of the American Society of Hand Therapists, 24(1),148-150. https://doi.org/10.1016/j.jht.2019.02.002

Short, N., Almonreoder, T., Mays, M., Baist, A., Clifton, T., Horty, A., Kosty, M., Olson, C., & Patel, R. (in press). Inter-rater reliability of a novel goniometric technique to measure scapular protraction and retraction.

MacDermid, J. C., Chesworth, B. M., Patterson, S., & Roth, J. H. (1999). Intratester and intertester reliability of goniometric measurement of passive lateral shoulder rotation. Journal of Hand Therapy,12(3),187-192. https://doi.org/10.1016/s0894-1130(99)80045-3