A/B Testing: When To Test Arom Vs Prom

Range of motion (ROM) is the extent to which a body part can move around a joint or fixed point. ROM is crucial for functional mobility and adequate joint movement. There are two main types of ROM: active range of motion (AROM) and passive range of motion (PROM). AROM is the movement achieved when opposing muscles contract and relax, resulting in joint movement. PROM, on the other hand, is the movement achieved when an outside force, such as a therapist, exclusively causes joint movement. The choice between testing AROM vs PROM depends on the specific condition and goals of the patient. AROM promotes fluid movement and decreased edema, while preserving movement. PROM is used to increase ROM or prevent contractures and is safer for certain injuries. Understanding the underlying problem and potential risks is crucial for determining the appropriate type of ROM to test and treat.

When to use AROM for injuries

Active Range of Motion (AROM) exercises are used to improve joint function, strength, and flexibility. They are often used in physical therapy to help people recover from injuries or surgery. AROM exercises are also used to improve athletic performance or prevent injuries.

AROM exercises can be performed on any joint in the body, including the shoulders, elbows, wrists, hips, knees, and ankles. They are typically done by the patient without any assistance, using their own muscles to move the joint through its full range of motion.

• Post-surgical rehabilitation: AROM exercises are often used after surgery to help restore normal joint function and improve range of motion. For example, after rotator cuff surgery on the shoulder, AROM exercises can be performed to regain shoulder flexibility and strength.
• Accident recovery: AROM exercises are beneficial for individuals who have experienced accidents that have impaired their joint mobility. These exercises help improve joint function and reduce stiffness.
• Orthopedic injuries: AROM exercises are commonly used to treat orthopedic injuries, such as joint dislocations or tendon injuries. They help improve joint flexibility and strengthen the muscles surrounding the joint.
• Neurological problems: AROM exercises can be applied in cases of neurological issues, such as movement and muscle control impairments caused by cerebral palsy. These exercises can help improve sensory awareness and enhance balance and coordination.
• Joint infections: Infections in joints, such as sepsis of the hip joint, can benefit from AROM exercises. These exercises aid in maintaining joint mobility and reducing inflammation.
• Age-related arthritis: For individuals with osteoarthritis, AROM exercises can help improve joint flexibility and reduce pain. They also contribute to maintaining structural integrity and preventing further complications.

It is important to note that AROM exercises should be performed slowly and carefully to avoid causing pain. Warming up before starting the exercises is crucial, and individuals should listen to their bodies and stop if they experience any discomfort.

When to use PROM for injuries

The Patient-Reported Outcome Measurement Information System (PROMIS) is a useful tool for quantifying outcomes in orthopedic trauma. PROMIS can be administered in two formats: short form and computerized adaptive testing (CAT). The short-form surveys consist of distinct, predetermined sets of questions administered electronically or by hand. The alternative to short-form, CAT, produces precise measurements using the minimum number of questions.

PROMIS has eight main adult domains split across three profiles: physical health, mental health, and social health. These domains include fatigue, pain intensity, pain interference, physical function, sleep disturbance, anxiety, and depression.

PROMIS has been validated for different orthopaedic trauma patient populations. PROMIS Physical Function has been validated for use in both upper and lower extremity orthopaedic trauma research. PROMIS has also been used to study injuries in geriatric patients.

PROMIS has several advantages, including quick administration, reduced floor and ceiling effects, and a computer-adaptive model for testing. However, it also has some weaknesses, such as a lack of specificity for certain body parts, a lack of validation for mental health outcomes, and a ceiling effect in certain active patient populations.

When to use AROM for rehabilitation

Active Range of Motion (AROM) is a key indicator used in rehabilitation by physical therapists. It is used to gauge recovery from an injury, surgery, or serious condition such as a stroke. AROM is one of the factors used to measure a patient's strength and control over their joints.

AROM is used to determine how far a patient can voluntarily move a joint. For example, the AROM of the shoulder is determined by how far one can move their arm in a circular motion above their head. AROM is controlled by muscle contraction and flexion, but also depends on joint flexibility and other factors.

AROM is particularly useful in rehabilitation as it helps to increase local circulation, increase sensory awareness, and prevent complications in the cardiovascular system. It is also used to maintain the structural integrity of joints and improve muscle strength.

For instance, if a patient is having difficulty moving their affected limb against gravity, AROM exercises can help to enhance their muscle strength. AROM is also used to maintain the physiologic elasticity and contractile endurance of muscles.

Additionally, AROM can be used to prevent blood clots in the lower extremities, which may be caused by deconditioning or a post-operative state.

When using AROM for rehabilitation, it is important to be careful not to push the joints too far. While increasing the AROM is beneficial, attempting to move beyond it can result in injury. Therefore, increasing the strength and flexibility of joints should be done in controlled, smaller movements to avoid any damage to the joint or soft tissues.

When to use PROM for rehabilitation

Patient-reported outcome measures (PROMs) are an essential tool in modern healthcare, particularly in physiotherapy. PROMs are defined as reports of a patient's health condition that come directly from the patient and are not influenced by a health professional's interpretation. They are typically administered as questionnaires, either on paper or electronically, and are completed by the patient independently. PROMs are used in three main areas: service evaluation for policymakers, clinical practice, and research.

When it comes to rehabilitation, PROMs play a crucial role in informing clinical practice, enhancing patient-centred care, supporting health service programming, directing performance measurement, and contributing to quality improvement. By capturing patients' perceptions of their health and health outcomes, PROMs promote patient-centred care and empower patients to have a voice in their treatment.

PROMs are particularly useful in rehabilitation for several reasons. Firstly, they provide additional "patient-centred" data, which captures the patient's own perspective on the impact of their disease or disorder and its treatment on their life. This information is unique and cannot be obtained from medical records or clinician observations alone. Secondly, PROMs facilitate shared decision-making and collaborative goal-setting between patients and providers. They provide a structured framework for discussing current health status, rehabilitation goals, and treatment planning. Thirdly, PROMs enable clinicians to monitor the progress and effectiveness of treatment. By collecting PROMs at intake and the end of the episode of care, rehabilitation professionals can track changes in the patient's health status and use this information to adjust treatment plans as needed. Fourthly, PROMs contribute to quality improvement initiatives at both the organisational and system levels. Aggregate PROM data can be used to compare the performance of rehabilitation teams across different sites and health zones, driving improvements in rehabilitation services.

In conclusion, PROMs are valuable tools in rehabilitation as they provide patient-centred data, enhance shared decision-making, facilitate progress monitoring, and contribute to quality improvement at multiple levels of the healthcare system. By capturing the patient's voice and incorporating it into outcome measurement, PROMs help to ensure that rehabilitation interventions are tailored to the individual's needs and goals.

Differences between AROM and PROM

Range of motion (ROM) is the extent to which a body part can be moved around a joint or fixed point. ROM is usually assessed during physical therapy, with normal values depending on the body part and individual variations.

There are three types of ROM exercises:

Passive Range of Motion (PROM)

PROM is the ROM achieved when an outside force, such as a therapist or machine, causes movement of a joint. This is usually the maximum range of motion that a joint can move and is performed when the patient is unable or not permitted to move the body part themselves. PROM is typically greater than AROM due to the stretch of tissues surrounding the joint and the reduced bulk of relaxed muscles.

Active-Assisted Range of Motion (AAROM)

AAROM is when the joint receives partial assistance from an outside force, such as a therapist or machine. This is usually performed when the patient needs assistance due to weakness, pain, or changes in muscle tone.

Active Range of Motion (AROM)

AROM is the ROM achieved when opposing muscles contract and relax, resulting in joint movement. For example, to bend the elbow, the bicep contracts while the tricep relaxes. AROM is usually performed independently by the patient and is typically less than PROM as each joint has a small amount of movement that is not under voluntary control.

AROM is generally chosen over PROM when there is a risk of causing more damage by going too far in the ROM. For instance, with some arm injuries, AROM is recommended within a pain-free range. PROM, on the other hand, is used when the goal is to increase ROM or prevent contractures.

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