OBJECTIVES
To evaluate the intraexaminer and interexaminer reliability of rehabilitative ultrasound imaging (RUSI) in obtaining thickness measurements of the transversus abdominis (TrA) and lumbar multifidus muscles at rest and during contractions.


DESIGN
Single-group repeated-measures reliability study.


SETTING
University and orthopedic physical therapy clinic.


PARTICIPANTS
A volunteer sample of adults (N=30) with current nonspecific low back pain (LBP) was examined by 2 clinicians with minimal RUSI experience.


INTERVENTIONS
Not applicable.


MAIN OUTCOME MEASURES
Thickness measurements of the TrA and lumbar multifidus muscles at rest and during contractions were obtained by using RUSI during 2 sessions 1 to 3 days apart. Percent thickness change was calculated as thickness(contracted)-thickness(rest)/thickness(rest). Intraclass correlation coefficients (ICC) were used to estimate reliability.


RESULTS
By using the mean of 2 measures, intraexaminer reliability point estimates (ICC(3,2)) ranged from 0.96 to 0.99 for same-day comparisons and from 0.87 to 0.98 for between-day comparisons. Interexaminer reliability estimates (ICC(2,2)) ranged from 0.88 to 0.94 for within-day comparisons and from 0.80 to 0.92 for between-day comparisons. Reliability estimates comparing measurements by the 2 examiners of the same image (ICC(2,2)) ranged from 0.96 to 0.98. Reliability estimates were lower for percent thickness change measures than the corresponding single thickness measures for all conditions.


CONCLUSIONS
RUSI thickness measurements of the TrA and lumbar multifidus muscles in patients with LBP, when based on the mean of 2 measures, are highly reliable when taken by a single examiner and adequately reliable when taken by different examiners.

Reliability of rehabilitative ultrasound imaging of the transversus abdominis and lumbar multifidus musculature

Ultrasonography comparison of diaphragm thickness and excursion between athletes with and without lumbopelvic pain.

Background National surveys in New Zealand, Australia and the United Kingdom suggest ultrasound imaging (USI) use by physiotherapists is increasing However, concerns exist regarding clarity for scopes of practice, and availability and standardisation of training Objectives To investigate physiotherapists' understanding of scopes of practice for the use of USI; clarify the professional contexts, clinical uses and levels of training; and identify barriers preventing physiotherapists’ USI use Design A cross-sectional, observational survey Methods An Internet-based survey, offered in 20 different languages, was used including items covering five domains: (1) demographic and professional characteristics; (2) knowledge of scope of practice; (3) USI use; (4) USI training content and duration; and (5) perceived barriers to physiotherapists’ use of USI Results 1307 registered physiotherapists from 49 countries responded; 30% were unsure of the scope of practice for physiotherapists’ USI use 38% of participants were users of USI, reporting varied contexts and clinical uses, reflected in the broader categories of: (i) biofeedback; (ii) diagnosis; (iii) assessment; (iv) injection guidance; (v) research; (vi) and teaching The training users received varied, with formal training more comprehensive 62% were non-users, the most common barrier was lack of training (76%) Conclusion These findings suggest physiotherapists' USI use is increasing in various contexts; however, there is uncertainty regarding scopes of practice There are discrepancies in training offered, with a lack of training the most common barrier to physiotherapists’ use of USI International guidelines, including a USI training framework, are needed to support the consistent and sustainable use of USI in physiotherapy

Exploring the use of ultrasound imaging by physiotherapists: An international survey

The purpose of this study was to investigate the effects of functional progressive resistance exercise (FPRE) on muscle tone, dynamic balance and functional ability in children with spastic cerebral palsy. Twenty-five subjects were randomized into two groups: the FPRE group (n = 13) and the control group (n = 12). The experimental group participated in an FPRE program for 30 min per day, three times per week for six weeks. Knee extensor strength, rehabilitative ultrasound imaging (RUSI), muscle tone, dynamic balance, and functional ability was evaluated. The results showed statistically significant time × group interaction effects on the dominant side for knee extensor strength and cross-sectional area (CSA) in RUSI (p < 0.05). On both sides for thickness of the quadriceps (TQ) in RUSI, muscle tone and dynamic balance were statistically significant time × group interaction effects (p < 0.05). Additionally, knee extensor strength, CSA, TQ in RUS, muscle tone, dynamic balance and gross motor function measure (GMFM) in functional ability were significantly increased between pre- and post-intervention within the FPRE group (p < 0.05). The results suggest that FPRE is both feasible and beneficial for improving muscle tone, dynamic balance and functional ability in children with spastic cerebral palsy.

https://www.mdpi.com/2227-9067/7/8/85/pdf

Effect of Functional Progressive Resistance Exercise on Lower Extremity Structure, Muscle Tone, Dynamic Balance and Functional Ability in Children with Spastic Cerebral Palsy

The use of rehabilitative ultrasound imaging (RUSI) to evaluate diaphragm thickness during breathing in athletes who suffer from non-specific lumbopelvic pain presents some measurement errors. The purpose of this study was to evaluate intra- and inter-sessions, intra- and inter-rater reliabilities, and concurrent validity of diaphragm thickness measurements during breathing using transcostal RUSI with a novel thoracic orthotic device that was used to fix the US probe versus those measurements obtained using manual fixation. A total of 37 athletes with non-specific lumbopelvic pain were recruited. Intra- (same examiner) and inter-rater (two examiners) and intra- (same day) and inter-session (alternate days) reliabilities were analyzed. All measurements were obtained after manual probe fixation and after positioning the thoracic orthotic device to fix the US probe in order to correctly correlate both measurement methods. Both left and right hemi-diaphragm thickness measurements were performed by transcostal RUSI at maximum inspiration, expiration, and the difference between the two parameters during relaxed breathing. Intra-class correlation coefficients (ICC), standard errors of measurement (SEM), minimum detectable changes (MCD), systematic errors, and correlations (r) were assessed. Orthotic device probe fixation showed excellent reliability (ICC = 0.852–0.996, SEM = 0.0002–0.054, and MDC = 0.002–0.072), and most measurements did not show significant systematic errors (p > 0.05). Despite manual probe fixation with a reliability ranging from good to excellent (ICC = 0.714–0.997, SEM = 0.003–0.023, and MDC = 0.008–0.064 cm), several significant systematic measurement errors (p < 0.05) were found. Most significant correlations between both orthotic device and manual probe fixation methods were moderate (r = 0.486–0.718; p < 0.05). Bland–Altman plots indicated adequate agreement between both measurement methods according to the agreement limits. The proposed novel thoracic orthotic device may allow ultrasound probe fixation to provide valid and reliable transcostal RUSI measurements of diaphragmatic thickness during relaxed breathing thus reducing some measurement errors and avoiding systematic measurement errors. It may be advisable to measure diaphragm thickness and facilitate visual biofeedback with respect to diaphragm re-education during normal breathing in athletes with non-specific lumbopelvic pain.

Concurrent Validity and Reliability of Manual Versus Specific Device Transcostal Measurements for Breathing Diaphragm Thickness by Ultrasonography in Lumbopelvic Pain Athletes.

Background: Research of ultrasound use in physiotherapy and daily practice has led to its use as an everyday tool. Methods: The aims were: (1) Checking the proposed systematic review protocol methodology; (2) evaluating the evidence from the last five years; and (3) coordinating the work of the team of reviewers in performing a complete systematic review. Thus, this is a pilot study prior to a full systematic review. The findings in databases related to health sciences with the meta-search engine Discovery EBSCO, Covidence, and Revman were used. Inclusion and exclusion criteria were described for eligibility. Results: Search provided 1029 references regarding the lumbar region on ultrasound scans. Of these, 33 were duplicates. After Covidence, 996 studies were left for screening. A full-text reading brought one randomized clinical trial (RCT). Conclusions: Validity and reliability references were found. The most suitable points were novice versus expert, and ultrasound versus electromyography (EMG) with just one RCT cohort, and observational and case reports. The lines of investigation increasingly endorsed the validity of using ultrasound in physiotherapy. Post-acquisition image analysis could also be a future line of research.

https://www.mdpi.com/2076-3417/9/1/181/pdf

Samuel Fernández Carnero

Papers

Rehabilitative Ultrasound Imaging Evaluation in Physiotherapy: Piloting a Systematic Review.