INTRA- AND INTER-RATER RELIABILITY OF MAXIMUM TORQUE APPLIED DURING PASSIVE ELBOW RANGE OF MOTION TESTING POST-CASTING OF SUPRACONDYLAR AND LATERAL CONDYLAR FRACTURES IN CHILDREN
Elbow fractures account for a significant number of pediatric orthopedic injuries. The most common of these are the supracondylar and lateral condylar humeral fractures. When surgical repair is necessary casting and pinning of the elbow can affect the elbow’s range of motion (ROM), so recovery is monitored. Practices for measuring recovery are not standardized so measures may not be consistent. A possible novel measure to help account for different clinicians participating in the same study is maximum torque applied during elbow end ROM testing. This study uses several comparisons of maximum torque applied by three different clinicians during end ROM testing on a sample of twenty-seven pediatric patients. Multiple mixed ANCOVAs and pairwise comparison models of maximum torque applied to assess the reliability of applied torque. Significant differences were only detected during six-month follow up appointments, and the twelve-month post-cast removal follow-up appointment. Significant differences in torque applied during tests of both flexion and extension end ROM of both the involved and uninvolved limb were seen mostly attributed to one participating rater. A paired t-test was conducted between the maximum torque measures taken during tests of both the involved and uninvolved limb. No significant difference was found in maximum applied torque. In addition, a two-sample t-test comparing the mean differences in maximum torque applied during the end ROM tests by the same or by different clinicians found no significant difference. While differences were noted in the pairwise comparisons between rater one and the other two during later appointments this could be because of the experience of this one rater with the test and their level of comfort performing it when further removed from incident of injury. If future studies on maximum torque in passive elbow ROM testing are carried out a larger group of patients will be needed to make comparisons between raters and visits. Other studies could also use multiple raters at one visit allowing for a direct comparison of maximum torque.