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Assessing Shoulder Motion in Children: Age Limitations to Mallet and ABC Loops

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

A CORR Insights to this article was published on 06 November 2013

Abstract

Background

Shoulder ROM and function of the shoulder are difficult to evaluate in young children. There has been no determination of the age at which children can comply with the current assessment tools in use, but doing so would be important, because it gives us more accurate insight into the development and assessment of shoulder functional ROM in young children.

Questions/purposes

We (1) determined whether age would limit the use of two different observational scales used to assess shoulder ROM and function in young children (the Mallet scale and the ABC Loops protocol); and (2) compared the two scales in terms of intra- and interobserver reliabilities.

Methods

Sixty-five able-bodied children (32 boys, 33 girls; mean age, 3.9 years; range, 0.5–7.0 years) were recruited from local preschools and evaluated using the Mallet scale and ABC Loops protocol. Children were assessed on their ability to complete the examinations and time to completion for each measurement protocol. Intra- and interobserver reliability was tested by percentage agreement. Forty-eight children (mean age, 4.4 years; SD, 1.3 years) were able to complete the Mallet and ABC Loops measurement protocols; 17 children (mean age, 2.3 years; SD, 1.1 years) failed to complete either test.

Results

Younger children had more difficulty completing the examinations; there was a strong negative correlation between age and failure: probability of failure increased with decreasing age (Pearson r = −0.601, p < 0.001). Children who were able to complete one test were able to complete the other. Interobserver and intraobserver agreement was very high for both scales (in excess of 95% for all comparisons), and with the numbers available, there were no differences between the scales.

Conclusions

The Mallet scale and ABC Loops protocol have high reliability metrics in children younger than 6 years, but very young children (those younger than 3 years) generally will not be able to complete the examinations. The ABC Loops test took longer to perform than the Mallet scale but may more comprehensively evaluate a child’s functional capabilities. We therefore state that both assessment tools can be reliably used in children older than 3 years; we believe the ABC Loops gives a more accurate assessment of shoulder ROM.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Kaiser Permanente Medical Center Los Angeles, Los Angeles, CA, USA

    Michael L. Pearl MD & Michaela Pearl BS

  2. Vrije Universiteit Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands

    Fabian van de Bunt BS

  3. Department of Orthopedic Surgery, Children’s Hospital Los Angeles, Los Angeles, CA, USA

    Nina Lightdale-Miric MD, Susan Rethlefsen PT, DPT & Jennifer Loiselle OTRL

Authors
  1. Michael L. Pearl MD
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  2. Fabian van de Bunt BS
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  3. Michaela Pearl BS
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  4. Nina Lightdale-Miric MD
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  5. Susan Rethlefsen PT, DPT
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  6. Jennifer Loiselle OTRL
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Corresponding author

Correspondence to Fabian van de Bunt BS.

Additional information

Each author certifies that he or she, or a member of his or her immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Kaiser Permanente Medical Center Los Angeles, Los Angeles, CA, USA.

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Pearl, M.L., van de Bunt, F., Pearl, M. et al. Assessing Shoulder Motion in Children: Age Limitations to Mallet and ABC Loops. Clin Orthop Relat Res 472, 740–748 (2014). https://doi.org/10.1007/s11999-013-3324-9

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  • DOI: https://doi.org/10.1007/s11999-013-3324-9

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