Aslam et al Int. j. med. appl. health. Vol. 4, No.

2, 2016

TO INVESTIGATE THE FACILITATORS AND BARRIERS OF GONIOMETRY IN PHYSICAL THERAPY PRACTICE IN

PUNJAB, PAKISTAN
Zahra Aslam*, Mariam Naeem, Rabia Saeed, Misbah Javed, Sana Abid, NaimaI ftikhar, Madiha yousafi,
Munaza Tabassum, Saira komal,Sharka Iqbal, Farjad Afzal, Muhammad Ramzan, Akhtar Rasul, Asif Islam,
Tehreem Saif
Department of physical therapy, Sargodha Medical College, University Of Sargodha
*Correspondence author email: zahradpt17@gmail.com

ABSTRACT
Use of instrument and measurement tools in every field of medicine has prime importance in examination,
evaluation, making the diagnosis and prognosis. Moreover in documentation, outcome measurement tools are
most frequently used. Goniometry is technique to measure the joint range of motion in degree. Objective of
this study was to investigate the facilitator and barrier in current use of goniometry in routine physical therapy
clinical practice in clinics, hospitals and rehabilitation centres among the physical therapists working in the
province Punjab. Two methods were used in the collection of data. Physical therapists working in different
hospitals and clinics were accessed by email contact. We send them the link of questionnaire with consent for
the participation in this survey in their email addresses. Another method to collect data was semi structured
interview from 20 physical therapists. Descriptive statistical tools were used to analyze data with the help of
excel. Results of this study show that 40% physiotherapist disagree that they do not used goniometer in their
clinical practice and 23% strongly agree that they used goniometer in their clinical practice. 49% are agree that
they have sufficient knowledge how to use the goniometer in practice 18%are strongly agree about having
knowledge. 47% use goniometers for evaluation purpose. 29% use goniometer for prognostic purpose and
only 24% use goniometer for diagnostic purpose. 42% are agreeing that it is time consuming treatment. 27%
are strongly agreed with this statement.Main barrier that we identified in this study were lack of time
requirement, lack of skills level, lack of resources, lack of documentation, lack of patience from patients,
negative attitude within society or lack of awareness in the society and patient’s satisfaction towards existing
assessment methods and resistance towards change.
KEYWORDS: goniometry, barrier and facilitator, outcome measurement tools

INTRODUCTION
The word goniometer originates from the Greek
“gonia and metron”, which means angles and
measures respectively It is a simple instrument
that is used to measure the range of
motion(Gajdosik and Bohannon 1987). There is a
verity of tools for measurement of range of
motion but goniometer is dominant in the
measurement of joint range of motion(Rothstein
et al. 1987). It is based upon the technique of the
comparing the degree of joint motion to a full
circle. It is used as a diagnostic tool to determine
the functional status of patient with
musculoskeletal and neurological disability( Carey
et al. 1991). In this technique the axis of the
goniometer is placed in alignment with axis of
joint(Miller-Keane and O'Toole 2003).Correct
measurement of range of range of motion has a
substantial effect in the development of
therapeutic intervention(Kisner and Colby
2012).Different instrument are used for the
assessment and measurement for patient base line
evaluation(Rothstein and Echternach 1993). The
use of measurement instruments in clinical
practice is relevant from four points of view
namely those of health professionals/doctors,
colleagues, patients and medical insurance
companies(Fish and Wingate 1985). For measuring
ROM, goniometer is used by many
physiotherapists worldwide. It is the best
standardized method to find out the ROM of joint.
It gives proper and accurate results and the
diagnosis is made according to it( Braatz et al.
1987). We tried to find the facilitators and barriers
of using goniometer in Punjab. The objective of
our studywas to find out the facilitators n barriers
in use of goniometer by physiotherapists in clinical
practice whether government, private or home
nursing in all over Punjab.
MATERIALS AND METHODS
Two methods were used in the collection of data.
Information of the physical therapist working on
different hospitals and clinics in the Punjab are
retrieved from online source the
pakistanphysiotherapist.com.We send them the
link of questionnaire with consent for the
participation in this survey in their email
addresses. Social Medias were also used to
request physiotherapist to fill online
questionnaire. Another method to collect data was
semi structured interview from 20 physical
therapists.In this work, we have used multiple
choice questions to collect data from physical
therapists of Punjab. To compose the

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questionnaire, we made different questions
according to our requirement of research. We sent
questionnaire to different physiotherapists in
Punjab by email and requested them to fill it
accordingly.We collected 200 responses out of 400
candidates. Descriptive statistical tools were used
to analyze the data in the form of percentages.
Five point liker scales was used.
RESULTS AND DISCUSSION
Study was conducted with 200 people working as a
physiotherapist in private and government
institutes in the form of online survey. Total 22
questions were asked. According to the survey,
main barriers towards this methodology are time
requirement, lengthy and slow treatment method,
lack of resources, lack of expertise, and most
importantly lack of patience in patient and
resistance towards change. A physiotherapist are
much more satisfied with current practice and are
usually resistant towards change as patients are
satisfied with existing treatment methods.The
main results summarized by survey are below.
Sufficient numbers of participants have knowledge
about goniometry that indicates its importance in
physiotherapy treatment.
Most of the participants liked to use this
treatment method for evaluation purposes.
Diagnostic usage is found less and it may be
because of the reason that participants think that
goniometry is a time consuming treatment
method.
Also patients wanted to shorten the treatment
time therefore they are not using this treatment
method occasionally.
It can be concluded from survey that main
barriertowards the use of goniometry includ
Time requirement
Skills level
Lack of resources
Lack of patience from patients
Negative attitude within society or lack of
awareness in the society
Patient’s satisfaction towards existing treatment
methods and resistance towards change.
CONCLUSIONS
Charts and graphs:
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Int. j. med. appl. health. Vol. 4, No. 2, 2016
According to the survey, main barriers towards
this methodology are time requirement, lengthy
and slow treatment method, lack of resources,
lack of expertise, and most importantly lack of
patience in patient and resistance towards
change.Additionally, aphysiotherapist are much
more satisfied with evidence based practice and
are usually resistant towards change as patients
are satisfied with existing treatment
methods.However, it can be improved by creating
awareness in the society due to its reliability and
strengthening the expertise among
physiotherapists with the aid of Government.
REFERENCES
Fish, D. R. and L. Wingate 1985. "Sources of
goniometric error at the elbow." Physical
Therapy 65(11): 1666-1670.
Gajdosik, R. L. and R. W. Bohannon 1987. "Clinical
measurement of range of motion."
Physical Therapy 67(12): 1867-1872.
Gogia, P. P., J. H. Braatz, S. J. Rose and B. J. Norton
1987. "Reliability and validity of
goniometric measurements at the knee."
Physical therapy 67(2): 192-195.
Kisner, C. and L. A. Colby (2012). Therapeutic
Exercise: Foundations and Techniques,
F.A. Davis.
Miller-Keane and O'Toole 2003. Encyclopedia and
Dictionary of Medicine, Nursing, and
Allied Health, Saunders.
Riddle, D. L., J. M. Rothstein and R. L. Lamb 1987.
"Goniometric reliability in a clinical
setting." Physical therapy 67(5): 668-673.
Rothstein, J. M. and J. L. Echternach 1993. Primer
on measurement: an introductory guide
to measurement issues, featuring the
American Physical Therapy Association's
standards for tests and measurements in
physical therapy practice, Amer Physical
Therapy Assn.
Youdas, J. W., J. R. Carey and T. R. Garrett 1991.
"Reliability of measurements of cervical
spine range of motion—comparison of
three methods." Physical therapy 71(2):
98-104.
Aslam et al Int. j. med. appl. health. Vol. 4, No. 2, 2016

Figure 1: Working experience of participants

Figure 2: Working hours per week of participants

Figure 3: Average no. of patients treated per week

Figure 4: Usage of goniometry in clinical practice

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 Aslam et al Int. j. med. appl. health. Vol. 4, No. 2, 2016

Figure 5: Participants having knowledge about goniometry

Figure 6: Participants having sufficient skills to apply goniometry

Figure 7: Purpose of goniometry usage

Figure 8: goniometry as a time consuming treatment

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Figure 9: goniometry is considered to be lengthy treatment

Figure 10: Ratio of participants thinking Co-workers support goniometry

Figure 11: Ratio of participants thinking Co-workers support goniometry

Figure 12: Participants taking goniometry to improve treatment quality

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Figure 13: ratio of participants thinking patients want results evaluation

Figure 14: Ratio of participants thinking diagnostic process mainly directed at impairments

Figure 15: Ratio of participants thinking patient does not want measurement, just treatment

Figure 16: Participants about society’s negative attitude regarding usage of goniometry

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Figure 17: Participant’s excitement about evidence based practice

Figure 18: Participant’s satisfaction with current practice and resistance towards change

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