Implementing a Protocol of Ankle ROM Goniometry Measurement in the Neuroscience ICU

Abstract

Background/Purpose: Prolonged intensive care unit (ICU) admission and symptoms of neurologic injury may increase the risk for joint contracture, negatively affecting function. Clear recommendations for assessing, monitoring, and providing interventions for contractures are limited. The purpose of our study was to determine the effect of implementing an ankle dorsiflexion (DF) measurement protocol in a patient population at risk for ankle contractures. We examined the effect of the measurement protocol on the frequency of measurement, ankle DF range of motion (ROM) from physical therapy (PT) evaluation to hospital discharge, and interventions provided. Methods: A measurement protocol of ankle DF ROM was implemented for patients admitted to the neuroscience ICU. A retrospective analysis was conducted of all patients who met eligibility criteria with a total hospital length of stay of more than 15 days and revealed 2 groups. A measurement group (MG) was evaluated by a physical therapist within 72 hours and included in the measurement protocol. A comparison group (CG) was not successfully evaluated per the measurement protocol and not included in the measurement protocol. Results: A total of 58 patients were analyzed. The MG (n = 27) received more measurements per week (P < .001) and more total sessions with measurements (P < .001); the CG (n = 31) received more estimated measurements (P = .005). More MG patients were assessed for the need for ROM intervention (P = .02). The CG received more interventions (mean [SD] = 0.94 [2.02]) than the MG (mean [SD] = 0.67 (1.00)], though not statistically significant. A subset of each group had analyzable ROM measurements. The MG subgroup (MGs) ROM change was positive (mean [SD] = 2.88°[8.55°]). The CG subgroup (CGs) was negative (mean [SD] = 4.50° [16.58°]); no significant difference was found. Discussion/Conclusion: The protocol increased the number of measurements performed. Ankle DF ROM was more frequently estimated in the CG. More MG patients were assessed for the need for ROM interventions; however, the number of interventions provided did not differ between groups. Ankle DF ROM goniometric measurements taken at a consistent frequency may affect the number of interventions provided. We were unable to determine the effect of the protocol on ROM measurements due to inconsistent measurement frequency and small sample size. Further studies are needed to assess barriers to consistent ROM measurement, assess the effects of increased measurement on ROM and functional outcomes, and the effect on the provision of intervention and allotment of resources.