C. Len et al., Pediatric Escola Paulista de Medicina Range of Motion scale: A reduced joint count scale for general use in juvenile rheumatoid arthritis, J RHEUMATOL, 26(4), 1999, pp. 909-913
Objective, Different instruments are available to measure functional status
in juvenile rheumatoid arthritis (JRA); however, none is based on the eval
uation of joint range of motion (ROM). We designed and evaluated a ROM scal
e to be used as a complementary instrument in daily practice with JRA as we
ll as in trials.
Methods. The 10 joint movements of the Pediatric Escola Paulista de Medicin
a Range of Motion scale (Pediatric EPM-ROM) were derived from 25 initial mo
vements. The selection was based on 2 criteria: (I) consensus among 3 pedia
tric rheumatologists, one physical therapist, and one occupational therapis
t; and (2) choice of movements that presented the highest scores in a pilot
study involving patients with JRA. The score for each joint ranges from 0
(full movement) to 3 (severe limitation) and the cutoff degrees of motion a
re, in general, based on the lack of ability to perform some activities of
daily living. The test-retest reliability was assessed by administering the
scale twice by the same observer, 4 to 10 days apart, always in the mornin
g, The interobserver reliability was evaluated on the same day by 2 indepen
dent observers. Cross sectional construct validity was also assessed by cor
relating the values of some clinical variables with the scores of the Pedia
tric EPM-ROM scale.
Results. The instrument was applied to 34 patients with JRA, 11 systemic, 1
1 polyarticular, and 12 pauciarticular. The mean EPM-ROM score was 0.57 (SD
0.54, min 0, max 2.05). The test-retest and interobserver correlation coef
ficients were 0.96 and 0.98, respectively. The Pearson correlation coeffici
ents comparing scores of the Pediatric EPM-ROM scale and other variables we
re satisfactory: Childhood Health Assessment Questionnaire, r = 0.55 (p < 0
.001); American College of Rheumatology global functional class, r = 0.56 (
p < 0.001); and number of limited joints, r = 0.65 (p < 0.001).
Conclusion. Our results provide evidence that the Pediatric EPM-ROM scale i
s a valid instrument to measure joint ROM in JRA.