OBJECTIVE VS. SUBJECTIVE: THE CHALLENGE OF CLEAR DOCUMENTATION OF RANGE OF MOTION

Abstract

To the editors of Physiotherapy Canada: After reading the editorial “Objective versus Subjective: Kudzu Terminology” in the Spring 2008 edition of Physiotherapy Canada, we were inspired to share a recent experience with so-called “objective” measurement. At the Winnipeg Children's Hospital, physiotherapists (PTs) and occupational therapists (OTs) work closely together on the Hand and Rheumatology Services. While reviewing our patient documentation practices, we learned that the OTs used a system of recording joint range of motion (ROM) that differed from the practice the PTs were using. After discussing the merits and limitations of both methods, we decided to survey our departmental colleagues regarding whether a standard or preferred method of recording ROM existed in their clinical practice. Interestingly, we found within our Pediatric PT and OT departments that plus (+) and minus (−) signs were used to denote both limitation of extension and joint hyperextension; however, there was no agreement among us regarding which sign should be used to denote each clinical finding! Intrigued, we decided to explore this documentation discordance outside of our department. We consulted textbooks,1–4 emailed PT and OT colleagues across the country, consulted with faculty members at the University of Manitoba, examined the American Society of Hand Therapy guidelines,5 and reviewed protocols from two large multi-centre studies.6,7 We undertook this exercise in an attempt to facilitate consistent and reliable measurement and recording of ROM within our hospital.