What is the recommended method for documenting range of motion (ROM) in a 91-year-old patient?

Documenting Range of Motion in a 91-Year-Old Patient

For a 91-year-old patient, range of motion (ROM) should be documented using standardized goniometric measurements with specific attention to pain limitations, functional impact, and comparison to age-appropriate norms rather than standard adult values. 1

Recommended Documentation Method

Measurement Approach

• Use a universal goniometer for objective measurements
• Document both active and passive ROM for each joint
• Record measurements in degrees
• Note the specific position in which measurements were taken (sitting, supine, etc.)
• Compare bilateral measurements when appropriate

Essential Components to Document

1. Quantitative Measurements:

   • Record exact degrees of motion using standardized positions
   • Document starting position (zero position) and end range
   • Note whether measurement is active or passive ROM

2. Qualitative Assessment:

   • Document quality of movement (smooth, jerky, guarded)
   • Record end-feel characteristics (firm, soft, empty, springy)
   • Note any pain during movement (location, intensity, point in range)

3. Functional Context:

   • Document how ROM limitations affect specific daily activities
   • Note any compensatory movements used
   • Record use of assistive devices required due to ROM limitations

4. Pain Assessment:

   • Document if ROM is limited by pain rather than mechanical restriction 1
   • Note if pain occurs throughout range or only at end-range
   • Record if patient demonstrates anticipatory pain avoidance

Special Considerations for Geriatric Patients

Age-Appropriate Expectations

• ROM naturally decreases with age, but substantial loss should not be attributed solely to aging 2
• Most joint motions show only 3-5° decrease in the oldest age groups compared to younger adults 2
• Only hip extension typically shows >20% decline with age 2

Pain vs. Mechanical Limitation

• Differentiate between true mechanical restrictions (firm end-feel) and pain-limited ROM (softer end-feel with patient resistance) 1
• Document muscle guarding or protective spasms that may limit motion
• Note if neuromuscular inhibition appears to be affecting normal movement patterns

Functional Assessment Integration

• Incorporate mobility assessment tools appropriate for geriatric patients:
  • Timed Up and Go (TUG) test (>12 seconds indicates increased fall risk) 3
  • 4-Stage Balance Test (inability to hold tandem stand for 10 seconds indicates fall risk) 3

Documentation Template Example

Joint: [specific joint]
Position: [patient position during measurement]
Active ROM: [degrees] [note any pain, quality issues]
Passive ROM: [degrees] [note any pain, quality issues]
End-feel: [firm, soft, empty, springy]
Pain: [location, intensity (0-10), point in range]
Functional impact: [specific ADLs affected]
Comparison to previous: [change from baseline if available]

Common Pitfalls to Avoid

• Misattributing ROM limitations: Don't assume limitations are solely due to age when they may be due to pain, pathology, or disuse 1
• Overlooking pain as primary limiter: Address pain first when it's the primary limiting factor rather than mechanical restriction 1
• Neglecting functional context: ROM measurements alone provide incomplete information without functional task assessment 1
• Using inappropriate norms: Don't compare elderly ROM to standard adult norms; use age-appropriate references 2

By following these guidelines, clinicians can accurately document ROM in elderly patients while providing meaningful context for clinical decision-making and monitoring changes over time.