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Perometer (400T) measurement of lower limb volume: development of a standardised protocol Fiona Coutts , Andrew Grainger, Dr Cathy Bulley Queen Margaret University, Edinburgh, UK. Background. Various musculoskeletal, oncological or vascular conditions result in increased limb volume

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  1. Perometer (400T) measurement of lower limb volume: development of a standardised protocol Fiona Coutts, Andrew Grainger, Dr Cathy BulleyQueen Margaret University, Edinburgh, UK

  2. Background • Various musculoskeletal, oncological or vascular conditions result in increased limb volume • Limb volume – outcome measures • Fluid displacement • Geometric calculations from limb circumferences using tape measure • Perometer – optoelectronic imaging device; limb shape and volume (Pero-System GmbH, Wuppertal, Germany)

  3. Purpose • True repeatable measurement important in monitoring treatment efficacy. • Perometer (400T) optoelectronic imaging device used to assess limb volume. No protocol has been published to standardise its use.

  4. Rest Period (A) Leg position (Rotation) (B) Diurnal Variation (A) Speed of frame Movement (C) Standardised protocol Foot position on base plate (B) End point of limb measurement (C) Use of software (D) Study Design Phase 1 Phase 2 Phase 3

  5. Issue: Does limb volume change through a day? Design: n=2, healthy participants. 3 volume measurements @ 3 times per day, between 09.00 and 18.00. Phase 1A: Diurnal Variation • Results:Volumes averaged and % differences to initial volume were calculated. <2% volume change for each participant. Tester1 2 Morning – 1.1% 1.6% Afternoon Morning – 1.8% 1.2% Evening

  6. 1 2 A B D C 4 3 Phase 1B: Foot position • Issue: Does the position of the limb on the base plate alter measurement data? • Design: Cylinder placed in each of the 16 squares marked on the base plate, measured 3 times. • Results:Four centre squares (A,B,C,D) demonstrated the highest repeatability of measurement. Corner squares (1,2,3,4) lowest repeatability.

  7. Issue: Standardised landmarks for measurement of volume? Design: n=4, frame advanced to comfortable maximum vertical height, leg marked. Calculated as % of length Position 1 to 2 (see below) Grt Trochanter (1) 65% Femur Lat Femoral Epicondyle (2) Lateral Malleolus Phase 1C: End point of limb measurement • Results: % leg length= 67.6, 69, 79.1, 81.7; 65% of leg length was max. height for vertical frame advancement

  8. Standardised Protocol 1 • Diurnal variation: keep standardised times for repeat visits • Foot position: maintain foot in the centre of the base plate at all times • End point of measurement: 65% of distance from lateral femoral Epicondyle to Greater Trochanter

  9. Repeatability after phase1 • n= 30 (22F: 8M) (25.9±3.48yrs, 171.02±6.77cm, 67.32±7.68Kg) Dominant leg – tested 9 times by a rater on 2 consecutive occasions LOA= Limits of Agreement (Bland & Altman, 1986)

  10. Concerns after phase 1 • Rest period prior to commencement of measurement • Axial rotation of the limb in the frame • Speed of Perometer frame movement = Phase 2

  11. Issue: Stasis of limb volume prior to assessment with perometer Design: Pre and post rest limb volume at : 2.5, 5,10,12.5,15 mins., n=2 healthy participants Phase 2A: Rest Period • Results: Volume change variable until 10 minutes of rest. After 10 mins. less variable.

  12. Phase 2B: Leg position • Issue: Does axial limb rotation cause measurement error? • Design: Full size mannequin limb positioned 10 increments to internal and external axial rotation (0 - 50°), 3 times. • Results:Mean of 3 tests on 2 occasions shows little variation, CoV <0.1% in all bar 1 position, <1.2% overall

  13. Issue: Does speed of movement affect Perometer measurement? Design: mannequin limb measured 30 times Fast speed = 0.37m/s Slow speed = 0.022m/s Controlled by a motor p<0.00001 Motor Phase 2C: Speed of frame • Results:Significant differences between slow and fast speeds, (p<0.00001)

  14. Results: Session 1 Session 2 Rater 1 9005.53 8993.10 1504.81393.9 (p<0.0001) (p<0.0001) Rater 2 9088.27 9102.10 1417.1 1452.9 (p<0.0001) Intra- & inter-rater reliability, n= 30, 2 raters, 2 occasions Reliability

  15. Issue: Software allows limb measurement length to change in two screens Design:A) reliability study using independent measurement of length B) use of single limb length measures on 2 occasions Phase 3: Use of software • Results:Variability • A): n=30B):n=10 • Rater 1 = 20% Rater 1= 3.8%, • Rater 2 = 16.3% Rater 2 = 5.3%

  16. Conclusions Protocol reliable if: • 10 min rest period before testing with elevated leg • Neutral axial rotation of limb • Foot placed in centre of base plate • Constant slow speed is maintained • Only 1 limb length measurement is taken and used on repeat visits

  17. Clinical implications • Use of a standardised protocol will allow reliable data to be collected on repeated basis, • Monitor efficacy of management of patients with changing limb volume.

  18. Queen Margaret University Thank You

  19. Acknowledgements • MSc pre registration Physiotherapy students: 2007 2006 Francis Burgin Nicola Dinsmore Áine O’Connor Georgina Enderson MaryAnne Geraghty

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