The Effect of Averaging Multiple Trials on Measurement Error During Ultrasound Imaging of Transversus Abdominis and Lumbar Multifidus Muscles in Individuals With Low Back Pain (original) (raw)
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European Spine Journal, 2009
Ultrasound (US) measures are used by clinicians and researchers to evaluate improvements in activity of the abdominal muscles in patients with low back pain. Studies evaluating the reproducibility of these US measures provide some information; however, little is known about the reproducibility of these US measures over time in patients with low back pain. The objectives of this study were to estimate the reproducibility of ultrasound measurements of automatic activation of the lateral abdominal wall muscles using a leg force task in patients with chronic low back pain. Thirty-five participants from an existing randomised, blinded, placebo-controlled trial participated in the study. A reproducibility analysis was undertaken from all patients using data collected at baseline and after treatment. The reproducibility of measurements of thickness, muscle activation (thickness changes) and muscle improvement/deterioration after intervention (differences in thickness changes from single images made before and after treatment) was analysed. The reproducibility of static images (thickness) was excellent (ICC 2,1 = 0.97, 95% CI = 0.96-0.97, standard error of the measurement (SEM) = 0.04 cm, smallest detectable change (SDC) = 0.11 cm), the reproducibility of thickness changes was moderate (ICC 2,1 = 0.72, 95% CI 0.65-0.76, SEM = 15%, SDC 41%), while the reproducibility of differences in thickness changes from single images with statistical adjustment for duplicate measures was poor (ICC 2,1 = 0.44, 95% CI 0.33-0.58, SEM = 21%, SDC = 66.5%). Improvements in the testing protocol must be performed in order to enhance reproducibility of US as an outcome measure for abdominal muscle activation.
Medicina, 2021
Background and Objectives: Ultrasound echo intensity (EI) of the lumbar multifidus muscle (LMM) could offer valuable insights regarding muscle quality in people with low back pain (LBP). However, whether the rater’s experience noticeably influences the reliability and precision of LMM EI measurements has not been established. The aims of this study were to investigate the intra-rater and inter-rater reliability of LMM EI measurements, and to compare the reliability and SEM between a novice and an experienced rater. Materials and Methods: Twenty athletes (10 females, 10 males) with a history of LBP were included in this study. Transverse ultrasound images of LMM were taken at L5 in prone. LMM EI measurements were obtained bilaterally by tracing the maximum ROI representing the LMM cross-sectional area (CSA), avoiding the inclusion of bone or surrounding fascia. All measurements were performed by two novice raters and an experienced researcher. Each measurement was acquired by each ra...
Reliability of two ultrasonic imaging analysis methods in quantifying lumbar multifidus thickness.
Journal of Orthopadic & Sports Physical Therapy [Epub ahead of print], 2013
STUDY DESIGN: Reliability study OBJECTIVES: To compare the within- and between-day intra-rater reliability of rehabilitative ultrasound imaging (RUSI) using static images (RUSIs) and video clips (RUSIvc) in quantifying multifidus muscle thickness at rest and while contracted. The secondary objectives were to compare the measurement precision of averaging multiple measures, and the reliability estimates in individuals with and without low back pain (LBP). BACKGROUND: Although intra-rater reliability of RUSIs in measuring multifidus thickness has been established, using RUSIvc may improve reliability estimates as examiners may select the optimal image from the video clip. Further, multiple measurements, and LBP status may affect RUSI reliability estimates. METHODS: RUSIs and RUSIvc were used to quantify multifidus muscle thickness at rest and during contraction, and percent thickness change in 27 volunteers (13 without LBP, and 14 with LBP). Three RUSIs and three RUSIvc were collected in each of two sessions 1 to 4 days apart. Reliability and precision were assessed using intraclass correlation coefficients (ICC), standard error of measurement, minimal detectable change, bias and 95% limits of agreement. RESULTS: Using an average of two measures yielded optimal measurement precision for RUSIs and RUSIvc. Based on the average of two measures obtained under the same circumstance, there was no significant difference in the reliability estimates between RUSIs and RUSIvc across all testing conditions. Reliability point estimates (ICC3,2) of multifidus thickness were 0.99 for within-day comparisons and ranged from 0.93 to 0.98 for between-day comparisons. The within- and between-day ICC3,2 of percent thickness change ranged from 0.97 to 0.99, and 0.80 to 0.90, respectively. The exploratory analysis showed no significant difference in the reliability estimates between asymptomatic and LBP participants across most testing conditions. CONCLUSION: Both RUSI methods yielded high reliability estimates for multifidus muscle measurements. Using the average of two measures obtained optimal measurement precision. Overall, RUSIvc is a reliable surrogate of RUSIs for multifidus muscle measurements with an additional advantage of shorter duration of data collection. KEY WORDS: low back pain, LM, reproducibility, RUSI, ultrasonography
Diagnostics
Purpose: The purpose of this study was to investigate the test-retest reliability of ultrasound (US) thickness measurements and the muscle contraction ratio (CR) of lumbar multifidus (LM) and transversus abdominis (TA) muscles in participants with and without nonspecific chronic low back pain (NCLBP). Methods: A total of 62 participants (37 with NCLBP, 25 without NCLBP) with participated in the study. The within-day and between-day reliability of US thickness measurements and CR in a lying (supine for TA and prone for LM) and sitting positions for both muscles (sitting on a gym ball with both feet on the ground or lifting one foot off the floor) were assessed. Reliability analysis was performed with intraclass correlations (ICCs) for these two static and dynamic positions. Results: Test-retest reliability was calculated to be good to high for the static position (ICC = 0.72–0.95) and the dynamic position (ICC = 0.74–0.94) sonographic measurements in both group of TA measurement. Tes...
Although individual reports suggest that baseline morphometry or activity of transversus abdominis or lumbar multifidus predict clinical outcome of low back pain (LBP), a related systematic review is unavailable. Therefore, this review summarized evidence regarding the predictive value of these muscular characteristics. Candidate publications were identified from 6 electronic medical databases. After review, 5 cohort studies were included. Although this review intended to encompass studies using different muscle assessment methods, all included studies coincidentally used ultrasound imaging. No research investigated the relation between static morphometry and clinical outcomes. Evidence synthesis showed limited evidence supporting poor baseline transversus abdominis contraction thickness ratio as a treatment effect modifier favoring motor control exercise. Limited evidence supported that high baseline transversus abdominis lateral slide was associated with higher pain intensity after various exercise interventions at 1-year follow-up. However, there was limited evidence for the absence of relation between the contraction thickness ratio of transversus abdominis or anticipatory onset of lateral abdominal muscles at baseline and the short-or long-term LBP intensity after exercise interventions. There was conflicting evidence for a relation between baseline percent thickness change of lumbar multifidus during contraction and the clinical outcomes of patients after various conservative treatments. Given study heterogeneity, the small number of included studies and the inability of conventional greyscale B-mode ultrasound imaging to measure muscle activity, our findings should be interpreted with caution. Further large-scale prospective studies that use appropriate technology (ie, electromyography to assess muscle activity) should be conducted to investigate the predictive value of morphometry or activity of these muscles with respect to LBP-related outcomes measures.
Critical Reviews in Physical and Rehabilitation Medicine, 2010
Clinical diagnosis and treatment of low back pain may be enhanced through the use of imaging modalities. This study investigates the use of rehabilitative ultrasound imaging in the physiotherapy management of low back pain associated with dysfunction of the transversus abdominis and multifidus muscles. Although encouraging, current evidence for integrating rehabilitative ultrasound imaging into clinical practice is weak and several knowledge gaps have been identified. In particular, the impact on clinical outcomes needs to be determined and well-designed randomized controlled trials investigating effectiveness for improving physical therapy assessment and treatment are required before endorsing translation of rehabilitative ultrasound imaging into clinical practice.
Chiropractic & Manual Therapies, 2013
Background: Ultrasound (US) imaging has been considered as a non-invasive technique to measure thickness and estimate relative abdominal muscle activity. Although some studies have assessed the reliability of US imaging, no study has assessed the reliability of US measurement of automatic activity of abdominal muscles in positions with different levels of stability in participants with chronic low back pain (cLBP). The purpose of this study was to investigate within-day and between-days reliability of US thickness measurements of automatic activity of the abdominal muscles in asymptomatic participants and within-day reliability in those with cLBP.
Reliability of diagnostic ultrasound in measuring the multifidus muscle
Chiropractic & Manual Therapies, 2015
Background: Ultrasound is frequently used to measure activity in the lumbar multifidus muscle (LMM). However previous reliability studies on diagnostic ultrasound and LMM have included a limited number of subjects and few have used Bland-Altman's Limits of Agreement (LOA). Further one does not know if activity affects the subjects' ability to contract the LMM. Methods: From January 2012 to December 2012 an inter-and intra-examiner reliability study was carried out in a clinical setting. It consisted of a total of four experiments with 30 subjects in each study. Two experienced examiners performed all measurements. Ultrasound measurements were made of: 1. the LMM in the resting state, 2. during a contracted state, 3. on subsequent days, and, before and after walking. Reliability and agreement was tested for 1. resting LMM, 2. contracted LMM, and 3. thickness change in the LMM. Mean values of three measurements were used for statistical analysis for each spinal level. The intra-class correlation coefficient (ICC) 3.1 and 3.2 was used to test for reliability, and Bland-Altman's LOA method to test for agreement.