Reduced Joint Range of Motion in Nursing Home Residents: A Documentation Gap With Functional Implications

Abstract

Objectives To ascertain to what extent reduced range of motion (ROM) and tender joints identified through a standardized physical examination were documented in the medical records of nursing home residents and to describe functional dependence and pain scores in relation to documentation status. Design Cross-sectional study. Setting and Participants One hundred nursing home residents of Cicero Zorggroep, the Netherlands. Methods Joint findings were assessed by standardized physical examination, including ROM across 15 joint groups by passive movement and the 68 tender joint counts. Medical records were reviewed for documentation of findings for the same joint, the presence of a rheumatic and musculoskeletal disease diagnosis, and pharmacologic and nonpharmacologic treatment. Functional dependence was assessed using the Katz Index and pain using a visual analog scale or the Pain Assessment Checklist for Seniors with Limited Ability to Communicate. Results Among residents (mean age, 83.3 years; 66% female), reduced ROM was identified in 69%, yet documented in the medical record in only 4%. Tender joints were identified in 48% of residents, with a documentation rate of 46%. Hip ROM limitation was the most prevalent finding (51%), yet was not documented in a single case. Residents with undocumented ROM limitations showed significantly higher functional dependence than residents without ROM limitations, particularly in transferring ( P < .001), whereas pain scores did not differ significantly between these groups (visual analog scale, P = .426). Most residents received analgesics; rheumatic and musculoskeletal disease–specific medication was used by fewer than 15% across all groups. Conclusions and Implications A documentation gap exists for mobility-relevant joint findings in nursing home residents. The differential documentation rates may reflect the absence of pain as a clinical trigger for ROM documentation. Systematic physical examination with explicit documentation of ROM limitations could support more targeted care planning and treatment decisions.