Ultrasound Imaging Analysis of the Lumbar Multifidus Muscle Echo Intensity: Intra-Rater and Inter-Rater Reliability of a Novice and an Experienced Rater (original) (raw)
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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
Journal of Geriatric Physical Therapy, 2015
Background and Purpose-Ultrasound imaging (USI) has been shown to be a reliable measure for direct assessment of the lumbar multifidi among younger adults. However, given ageand chronic low back pain (CLBP)-related spinal changes, similar studies are needed prior to clinical use of USI among older adults with CLBP. The goals of this study were to evaluate intraand inter-examiner reliability for USI assessment of multifidi thickness at rest and during a contraction and to determine standard error of measurement values (SEMs) and minimal detectable change values (MDCs) among older adults with CLBP. Methods-Thirty-one adults, aged 60 to 85 years, with CLBP were recruited. Two examiners performed USI assessments of multifidus thickness at rest and during a contralateral lower extremity lift. Intraclass correlation coefficients (ICCs) were used to estimate inter-and intraexaminer reliability. SEMs and MDCs were calculated. Results-All USI measurement techniques demonstrated excellent within-day, inter-examiner procedural reliability (ICCs: 0.82-0.85) and good-to-excellent between-days, inter-examiner procedural reliability (ICCs: 0.72-0.79). SEMs ranged from 0.36-0.46 centimeters (cm); MDCs ranged from 1.01-1.26 cm. Regardless of the measurement technique, examiner 1, the more experienced examiner, demonstrated lower SEMs and MDCs than examiner 2. Discussion-Lower ICCs, greater SEMs, and greater MDCs for USI multifidus thickness assessment in older adults with CLBP when compared to previously published, procedural reliability results for younger adults with and without low back pain, may indicate that imaging is
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...
Journal of Clinical Medicine, 2020
New trends in ultrasound imaging are focused on exploration of morphology and muscle quality. The main goal of the study was to evaluate the first-order descriptor and echostructure of lumbar multifidus at the L4 vertebral level in athletes with and without chronic lumbopelvic pain (CLPP). A case-control study was performed in 15 semiprofessional athletes with CLPP and 15 without (healthy athletes). Lumbar multifidus echointensity and echovariation were measured for muscle quality assessment. Echostructure was used to evaluate lumbar multifidus cross-sectional area (CSA) at resting and during muscle contraction, respective differences during both phases (CSADif.), activation patterns, and thoracolumbar fasciae morphology and thickness. Significant differences with a large effect size were observed in quantitative data from CLPP and healthy athletes for left lumbar multifidus CSADif. and thoracolumbar fasciae morphology. Categorical data showed statistically significant differences w...
Role of MRI and ultrasonography in evaluation of multifidus muscle in chronic low back pain patients
International Journal of Research in Medical Sciences, 2016
Low back pain (LBP) is a condition that will affect 60-80% of the population at some stage in their life. Epidemiological studies have shown that simple backache has point prevalence and a 1-month prevalence of 15-30% and 30-40% respectively. 1-3 Studies that have been performed state that LBP is a selflimiting condition, but many people who have suffered from LBP will experience recurring episodes, which could lead to the development of chronic LBP. Back pain carries a worse prognosis if it was disabling or associated with sciatica. 4 Less is known about the epidemiology of chronic low-back pain with no associated work disability or compensation. 5 For most episodes of low back pain, a specific underlying cause is never identified or even looked for, and the pain is believed to be due to mechanical problems such as muscle strain or joint sprain. 6 Causes of chronic low back pain 7 Nonspecific or idiopathic-attributed to spinal muscle strain or sprain. These patients are, in general, younger and have no clinical red flags.
Journal of Ultrasonography, 2021
Aim: To examine the reliability of rehabilitative ultrasound imaging performed to measure the thickness of the transverse abdominis, internal oblique, external oblique, and lumbar multifidus muscles in females with recurrent low back pain. Material and methods: A sample of 15 women was recruited. Two independent examiners recorded the thickness of their deep abdominal and spinal muscles by rehabilitative ultrasound imaging. Imaging scans of the transverse abdominis, internal oblique, and external oblique muscles were performed in the supine position and in the midaxillary line, between the lower edge of the ribcage and the iliac crest. Imaging of the lumbar multifidus was done in the prone position and at the level of the L5/S1 zygapophyseal joints. Imaging scans were performed bilaterally in rest and contraction, three times by the first examiner (at baseline, after two hours, and one week later) and once by the second examiner. Results: Good to excellent within-session intra-rater (ICC = 0.76, 0.97), good to excellent between-session intra-rater reliability (ICC = 0.73, 0.93), and good to excellent inter-rater reliability (ICC = 0.73, 0.98) were obtained. Conclusions: The results showed that rehabilitative ultrasound imaging can be used as an excellent reliable instrument by one or two examiners to measure the thickness of the transverse abdominis, internal oblique, external oblique and lumbar multifidus muscles in females with recurrent low back pain.