Range of Motion (ROM) is the measure of movement potential around a specific joint, reflecting the distance and direction a joint can move. This assessment provides a fundamental understanding of a patient’s functional mobility and musculoskeletal integrity. In nursing, evaluating ROM establishes a patient’s initial baseline status and monitors changes over time. Observing a patient’s ability to move identifies limitations, potential for injury, or the presence of pain, which informs the care plan and rehabilitation goals. ROM assessment also helps prevent complications like joint contractures and muscle atrophy.
Categorizing Range of Motion
Assessing joint mobility involves three distinct categories. Active Range of Motion (AROM) occurs when the patient uses their own muscle strength to move the joint without external assistance. AROM assessment determines the patient’s voluntary muscle function and coordination. A patient’s ability to perform AROM is often limited by muscle weakness or pain, even if the joint structure is sound.
Passive Range of Motion (PROM) involves a nurse or therapist moving the patient’s joint through its range while the patient remains relaxed. Assessing PROM provides information about joint structure integrity, ligament flexibility, and the presence of mechanical restrictions. PROM is typically slightly greater than AROM because it bypasses the limiting factor of muscle strength and coordination.
The third category is Active-Assistive Range of Motion (AAROM), where the patient initiates the movement, but an external force helps complete it. This assistance can come from the nurse, a piece of equipment, or the patient’s other limb. AAROM is used in rehabilitation when a patient has some muscle strength but needs support to move the joint through its full available arc. This assessment helps strengthen muscles while gently increasing the joint’s movement potential.
Principles of ROM Assessment
ROM assessment requires a standardized and systematic approach to ensure accuracy and patient comfort. Before beginning, the nurse must ensure patient privacy and explain the procedure to gain cooperation. The assessment should begin with the patient in a comfortable, stable position, typically supine, to allow for optimal joint movement.
The nurse should systematically assess joints, often moving from the larger, proximal joints (like the shoulder and hip) to the smaller, distal joints (such as the wrist and fingers). The nurse first observes the patient’s AROM by instructing them to move the joint independently. Any signs of pain, stiffness, or hesitation are noted during this active phase.
If AROM is limited, the nurse assesses PROM by gently supporting the limb and moving the joint without patient exertion. The movement should be slow and deliberate, stopping immediately if the patient reports pain or if resistance is felt. For precise measurement, a goniometer, a handheld device that measures angles, is used to quantify the angular movement in degrees.
The standard reference point for all joint movement is the anatomical position, which is considered zero degrees. The goniometer’s arms are aligned with the bone segments adjacent to the joint, and the reading is taken at the end of the movement. Comparing the measured degrees to established normal values and to the corresponding joint on the opposite side is necessary. The presence of crepitus (a crackling or popping sound felt during joint movement) is an objective finding to document.
Documentation Standards and Format
Effective documentation of ROM is necessary for communicating the patient’s status and ensuring continuity of care. The charting must be accurate, timely, and complete, typically entered into the electronic health record (EHR). Every entry must clearly identify the specific joint assessed and the type of ROM performed (AROM, PROM, or AAROM).
The precise degree of movement measured must be recorded, such as “Right elbow flexion AROM 0-135 degrees.” If a goniometer was not used, a descriptive statement like “AROM full and equal bilaterally” may be acceptable depending on facility policy. When movement is within expected limits, common abbreviations are used for efficiency.
Abbreviations for Normal Movement
- FROM (Full Range of Motion)
- WNL (Within Normal Limits)
Subjective and objective findings accompanying the movement are important to record. Patient complaints of pain must be documented, including the location and the degree of movement at which the pain occurred (e.g., “Complains of sharp pain at 90 degrees shoulder abduction”). Objective findings, such as crepitus, muscle guarding, or joint swelling, must also be included in the note.
Documentation should always include a comparison to the previous assessment or the opposite, unaffected limb to highlight changes or asymmetry. Notes should state whether the movement was performed easily, with difficulty, or was met with resistance. Findings such as an inability to perform AROM, a developing contracture, or severe limitation require immediate communication to the healthcare team and detailed charting to justify subsequent interventions.