title: Pediatric Escola Paulista de Medicina Range of Motion Scale: a reduced joint count scale for general use in juvenile rheumatoid arthritis.
abstract: OBJECTIVE
  Different instruments are available to measure functional status in juvenile rheumatoid arthritis (JRA); however, none is based on the evaluation of joint range of motion (ROM). We designed and evaluated a ROM scale to be used as a complementary instrument in daily practice with JRA as well as in trials.
  
  
  METHODS
  The 10 joint movements of the Pediatric Escola Paulista de Medicina Range of Motion scale (Pediatric EPM-ROM) were derived from 25 initial movements. The selection was based on 2 criteria: (1) consensus among 3 pediatric rheumatologists, one physical therapist, and one occupational therapist; and (2) choice of movements that presented the highest scores in a pilot study involving patients with JRA. The score for each joint ranges from 0 (full movement) to 3 (severe limitation) and the cutoff degrees of motion are, in general, based on the lack of ability to perform some activities of daily living. The test-retest reliability was assessed by administering the scale twice by the same observer, 4 to 10 days apart, always in the morning. The interobserver reliability was evaluated on the same day by 2 independent observers. Cross sectional construct validity was also assessed by correlating the values of some clinical variables with the scores of the Pediatric EPM-ROM scale.
  
  
  RESULTS
  The instrument was applied to 34 patients with JRA, 11 systemic, 11 polyarticular, and 12 pauciarticular. The mean EPM-ROM score was 0.57 (SD 0.54, min 0, max 2.05). The test-retest and interobserver correlation coefficients were 0.96 and 0.98, respectively. The Pearson correlation coefficients comparing scores of the Pediatric EPM-ROM scale and other variables were satisfactory: Childhood Health Assessment Questionnaire, r=0.55 (p<0.001); American College of Rheumatology global functional class, r=0.56 (p<0.001); and number of limited joints, r=0.65 (p<0.001).
  
  
  CONCLUSIONS
  Our results provide evidence that the Pediatric EPM-ROM scale is a valid instrument to measure joint ROM in JRA.
authors.affiliation: Department of Pediatrics, Sao Paulo Federal University-Escola Paulista de Medicina, Brazil.
authors.forename: C
authors.initials: C
authors.lastname: Len
authors.forename: M B
authors.initials: MB
authors.lastname: Ferraz
authors.forename: J
authors.initials: J
authors.lastname: Goldenberg
authors.forename: L M
authors.initials: LM
authors.lastname: Oliveira
authors.forename: P P
authors.initials: PP
authors.lastname: Araujo
authors.forename: M R
authors.initials: MR
authors.lastname: Quaresma
authors.forename: M T
authors.initials: MT
authors.lastname: Terreri
authors.forename: M O
authors.initials: MO
authors.lastname: Hilário
mesh_terms: D000293:Adolescent; D001171:Arthritis, Juvenile / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007596:Joints / Q000503:physiopathology*; D008297:Male; D015588:Observer Variation; D010865:Pilot Projects; D016059:Range of Motion, Articular / Q000502:physiology*; D015203:Reproducibility of Results; D017678:Sex Distribution; D016896:Treatment Outcome