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Rummens S, Dierckx S, Brumagne S, Desloovere K, Peers K. Three-dimensional freehand ultrasonography to measure muscle volume of the lumbar multifidus: Reliability of processing technique and validity through comparison to magnetic resonance imaging. J Anat 2024; 244:601-609. [PMID: 38087647 PMCID: PMC10941570 DOI: 10.1111/joa.13988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 03/16/2024] Open
Abstract
There is a growing interest in muscle characteristics of the lumbar multifidus related to low back pain, but findings between studies are inconsistent. One of the issues explaining these conflicting findings might be the use of two-dimensional measures of cross-sectional area and thickness of the lumbar multifidus in most studies, which might be a suboptimal representation of the entire muscle volume. A three-dimensional volumetric assessment, combined with standardized imaging and processing measurement protocols, is highly recommended to quantify spinal muscle morphology. Three-dimensional freehand ultrasonography is a technique with large potential for daily clinical practice. It is achieved by combining conventional two-dimensional ultrasound with a motion-tracking system, recording the position and orientation of the ultrasound transducer during acquisition, resulting in a three-dimensional reconstruction. This study investigates intra- and interprocessor reliability for the quantification of muscle volume of the lumbar multifidus based on three-dimensional freehand ultrasound and its validity, in 31 patients with low back pain and 20 healthy subjects. Two processors manually segmented the lumbar multifidus on three-dimensional freehand ultrasound images using Stradwin software following a well-defined method. We assessed the concurrent validity of the measurement of multifidus muscle volume using three-dimensional freehand ultrasound compared with magnetic resonance imaging in 10 patients with low back pain. Processing reliability and agreement were determined using intraclass correlation coefficients, Bland-Altman plots, and calculation of the standard error of measurement and minimal detectable change, while validity was defined based on correlation analysis. The processing of three-dimensional freehand ultrasound images to measure lumbar multifidus volume was reliable. Good to excellent intraclass correlation coefficients were found for intraprocessor reliability. For interprocessor reliability, the intraclass correlation coefficients were moderate to good, emphasizing the importance of processing guidelines and training. A single processor analysis is preferred in clinical studies or when small differences in muscle volume are expected. The correlation between magnetic resonance imaging and three-dimensional freehand ultrasound measurements of lumbar multifidus volume was moderate to good but with a systematically smaller multifidus volume measured on three-dimensional freehand ultrasound. These results provide opportunities for both researchers and clinicians to reliably assess muscle structure using three-dimensional freehand ultrasound in patients with low back pain and to monitor changes related to pathology or interventions. To allow implementation in both research and clinical settings, guidelines on three-dimensional freehand ultrasound processing and training were provided.
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Affiliation(s)
- Sofie Rummens
- Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | - Sofie Dierckx
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Simon Brumagne
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Koen Peers
- Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
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Cha KH, Yeo SM, Son JH, Kim YJ, Lee CH. The intra- and inter-rater reliability of measuring trunk coronal asymmetry by adjusting positioning variability: A prospective study. J Back Musculoskelet Rehabil 2024; 37:317-325. [PMID: 37955076 DOI: 10.3233/bmr-230042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
BACKGROUND Chronic low back pain (LBP) can lead to muscle spasms, limited range of motion, and abnormal posture, resulting in trunk muscle asymmetry. OBJECTIVE This study aimed to assess the intra- and inter-rater reliability of a quantitative measurement of trunk coronal asymmetry in patients with chronic LBP, minimizing unnecessary gravity and friction force using a manual table in the prone position. METHODS This prospective study was conducted at a single center, targeting patients with chronic LBP to measure trunk coronal asymmetry on a manual table in the prone position. The intra-class correlation coefficient (ICC) was calculated using one-way random-effects and two-way mixed-effects models. RESULTS Fifty-eight patients who had LBP for more than three months were enrolled from May 1, 2021, to December 31, 2021. The intra- and inter-rater reliabilities of the two examiners' measurements were 0.872 and 0.899, and 0.852, respectively. Based on pain severity, the participants were classified into mild and severe groups, with ICCs of 0.823 and 0.889, and 0.936 and 0.918, respectively. CONCLUSION Measurement of trunk coronal asymmetry in the prone position using a manual table demonstrates high intra- and inter-rater reliability. In addition, the reliability increases with greater pain severity.
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Affiliation(s)
- Kyoung Hyeon Cha
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Seung Mi Yeo
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Ju-Hyun Son
- Department of Rehabilitation Medicine, MI Hospital, Jangyumyeon, Korea
| | - Young-Joon Kim
- Department of Economics and Finance, Sangmyung University, Seoul, Korea
| | - Chang-Hyung Lee
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Rehabilitation Medicine, School of Medicine and Research, Pusan National University, Yangsan, Korea
- Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
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Zhang C, Chen X, Yin Y, Xie D, Luo J, Ai Y, Zhan W, Kan H, Zhang S, Jiang G, Hu X. Functional Alterations of the Basal Ganglia Are Associated with Voluntary Activation of the Core Stabilizing Muscles in Patients with Chronic Low Back Pain: A Cross-Sectional Study. Pain Res Manag 2023; 2023:2028379. [PMID: 37693681 PMCID: PMC10484657 DOI: 10.1155/2023/2028379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/15/2023] [Accepted: 08/11/2023] [Indexed: 09/12/2023]
Abstract
Purpose Deficits in voluntary activation of the core stabilizing muscles are consistently observed in patients with chronic low back pain (CLBP); however, the underlying neural mechanism remains unclear. This cross-sectional study aimed at testing the hypothesis that the impaired voluntary activation of core stabilizing muscles is associated with structural and functional alterations in the basal ganglia, thalamus, and cortex in patients with CLBP. Methods We obtained structural and resting-state functional magnetic resonance imaging (rs-fMRI) data from 53 patients with CLBP and 67 healthy controls and estimated the alterations in grey matter volume (GMV) and functional and effective connectivity (EC) of regions with altered GMV via whole brain analysis. The voluntary activation of the multifidus (MF) and transversus abdominis (TrA) was evaluated by ultrasound imaging in these patients. Results Compared with the HCs, they displayed a significant decrease in GMV in the bilateral thalamus and caudate nucleus, a significant increase in GMV in the left middle frontal gyrus, and increased resting-state functional connectivity between the right caudate nucleus and the bilateral precuneus (voxel-level p < 0.005, Gaussian random field-corrected p < 0.05). The patients also showed increased EC from the right caudate nucleus to the bilateral precuneus, which was significantly correlated with voluntary activation of the bilateral MF and TrA (all p < 0.050). Conclusions Grey matter alterations may be confined to regions responsible for perception, motor control, and emotion regulation in patients with CLBP. The interrupted EC from the basal ganglia to the default mode network might be involved in the impairment of voluntary activation of the core stabilizing muscles.
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Affiliation(s)
- Chanjuan Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
| | - Xi Chen
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
| | - Yi Yin
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou 510317, China
| | - Dongfeng Xie
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
| | - Jing Luo
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
| | - Yinan Ai
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
| | - Wenfeng Zhan
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou 510317, China
| | - Hongjun Kan
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
| | - Shuxian Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
| | - Guihua Jiang
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou 510317, China
| | - Xiquan Hu
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
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Elliott-Burke T, Dillon T, Bailey J, Miller S, Joos R, Buros Stein A. Lumbar multifidus muscle ultrasound imaging: Is handheld technology reliable? Musculoskelet Sci Pract 2023; 65:102771. [PMID: 37182391 DOI: 10.1016/j.msksp.2023.102771] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/25/2023] [Accepted: 04/28/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Advancement in ultrasound imaging technology has led to the development of handheld devices that are more accessible to physical therapists due to decreased cost, reduced size, and improved ease of use relative to current established units. Physical therapists use ultrasound imaging of the lumbar multifidus muscle (LMM) to assist in rehabilitation of patients with lumbar pathology. OBJECTIVES To identify the inter-device reliability of measuring the LMM thickness during a sustained contraction when comparing handheld (Butterfly iQ+) and established (SonoSite M-Turbo) ultrasound units. A secondary purpose was to determine the reliability of a student physical therapist using both devices. DESIGN A reliability measurement study METHOD: A blinded examiner identified the LMM at the L4 vertebral level and measured the thickness of the contracted muscle utilizing both the handheld and established ultrasound devices. ICC values were calculated to determine the inter-device and intra-rater reliability. RESULTS The study included 42 healthy participants, 30 females and 12 males, with a mean age of 38.5 years. The inter-device reliability during a sustained LMM contraction was excellent (ICC = 0.92, 95% CI: 0.87-0.94) and the intra-rater reliability was good for both the handheld (ICC = 0.85, 95% CI: 0.73-0.92) and established (ICC = 0.89, 95% CI: 0.82-0.93) ultrasound units. CONCLUSION Results support the use of handheld ultrasound by physical therapists and students to measure the LMM thickness. Future studies could investigate the reliability of handheld ultrasound in a variety of musculoskeletal and pathological structures important to PT practice.
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Affiliation(s)
- Teresa Elliott-Burke
- Department of Physical Therapy, College of Health Sciences, Midwestern University, Downers Grove, IL, USA.
| | - Thomas Dillon
- Department of Physical Therapy, College of Health Sciences, Midwestern University, Downers Grove, IL, USA
| | - Jasmin Bailey
- Department of Physical Therapy, College of Health Sciences, Midwestern University, Downers Grove, IL, USA
| | - Shannon Miller
- Department of Physical Therapy, College of Health Sciences, Midwestern University, Downers Grove, IL, USA
| | - Rachel Joos
- Department of Physical Therapy, College of Health Sciences, Midwestern University, Downers Grove, IL, USA
| | - Amy Buros Stein
- Office of Research and Sponsored Programs, Midwestern University, Glendale, AZ, USA
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Bozorgmehr A, Ebrahimi Takamjani I, Akbari M, Salehi R, Mohsenifar H, Rasouli O. Reliability of Ultrasound Measurements of the Lumbar Multifidus and Transversus Abdominis Muscles during Lying and Unstable Sitting Positions in Individuals With and Without Chronic Low Back Pain. J Biomed Phys Eng 2023; 13:157-168. [PMID: 37082545 PMCID: PMC10111103 DOI: 10.31661/jbpe.v0i0.2003-1078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 05/28/2020] [Indexed: 04/22/2023]
Abstract
Background The reliability studies are limited to support ultrasound usage during dynamic conditions; for example, unstable sitting position. Objective This study aims to examine the reliability of ultrasound measurements of the lumbar multifidus and transversus abdominis during lying and unstable sitting positions in individuals with chronic low back pain (CLBP) and asymptomatic individuals considering abnormal lumbar lordosis. Material and Methods In this observational study, intrarater within-day and between-day reliability of muscle thickness and contraction ratio of the lumbar multifidus and transversus abdominis muscles were assessed using ultrasound imaging. In total, 40 participants (27 with CLBP, 13 asymptomatic individuals) with abnormal lumbar lordosis were recruited. The degree of lumbar lordosis has been measured by a flexible ruler. The muscle thickness was assessed at lying and sitting on a gym ball for both muscles in three sessions. Results Both groups had well to high ICCs of thickness measurement and contraction ratio in the transversus abdominis and lumbar multifidus muscles during both static (ICC=0.71-0.99) and semi-dynamic conditions (ICC=0.73-0.98). The standard error of measurements and minimal detectable changes were rather small in both groups. Conclusion Ultrasound imaging is a highly reliable method to assess muscle thicknesses and contraction ratio of the transversus abdominis and lumbar multifidus during different conditions, even in patients with CLBP and abnormal lumbar lordosis.
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Affiliation(s)
- Ali Bozorgmehr
- Rehabilitation Research Center, Department of Physical Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Ismail Ebrahimi Takamjani
- Rehabilitation Research Center, Department of Physical Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Akbari
- Rehabilitation Research Center, Department of Physical Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Salehi
- Rehabilitation Research Center, Department of Rehabilitation Management, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Holakoo Mohsenifar
- Rehabilitation Research Center, Department of Physical Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Omid Rasouli
- Department of Public Health and Nursing, Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Mitchell UH, Johnson AW, Adams L, Kho J, Pace N, Owen PJ. Lateral abdominal muscles of adults with hypermobility may be partially impaired during contraction. BMJ Open Sport Exerc Med 2022; 8:e001343. [PMID: 36111125 PMCID: PMC9454039 DOI: 10.1136/bmjsem-2022-001343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 11/19/2022] Open
Abstract
Background Muscle function may be impaired in people with generalised hypermobility, yet prior studies have primarily focused on muscles within the extremities. We aimed to examine changes in lateral abdominal muscle (transversus abdominis (TrA) and the external (EO) and internal abdominal obliques (IO)) thickness and length during contraction between participants with and without hypermobility. Methods This cross-sectional study examined 12 participants with hypermobility and 12 age-matched, sex-matched, height-matched and weight-matched participants without hypermobility. The Beighton and Belavy-Owen-Mitchell score assessed systemic hypermobility. Muscle thickness and length were measured via panoramic ultrasound scans at rest and during contraction. Results When compared with rest across all lumbar levels (L1–L5), contraction produced a lesser increase in TrA thickness (β=0.03, p=0.034) for participants with hypermobility compared with control. No group-by-condition interaction was observed for TrA length across all lumbar levels (L1–L5; p=0.269). Contraction produced a greater decrease in EO thickness (β=0.08, p=0.002) at L3 only for participants with hypermobility compared with control. No group-by-condition interactions were observed for IO thickness. Conclusion Participants with hypermobility had partially impaired lateral abdominal muscle function given a lesser ability to increase TrA muscle thickness during contraction compared with controls.
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Affiliation(s)
- Ulrike H Mitchell
- Department of Exercise Sciences, Brigham Young University, Provo, Utah, USA
| | - A Wayne Johnson
- Department of Exercise Sciences, Brigham Young University, Provo, Utah, USA
| | - Lauren Adams
- Department of Exercise Sciences, Brigham Young University, Provo, Utah, USA
| | - Jade Kho
- Department of Exercise Sciences, Brigham Young University, Provo, Utah, USA
| | - Nicolas Pace
- Department of Exercise Sciences, Brigham Young University, Provo, Utah, USA
| | - Patrick J Owen
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia
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Wang H, Zheng J, Fan Z, Luo Z, Wu Y, Cheng X, Yang J, Zhang S, Yu Q, Lo WLA, Wang C. Impaired static postural control correlates to the contraction ability of trunk muscle in young adults with chronic non-specific low back pain: A cross-sectional study. Gait Posture 2022; 92:44-50. [PMID: 34823100 DOI: 10.1016/j.gaitpost.2021.11.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/28/2021] [Accepted: 11/15/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Patients with chronic non-specific low back pain (CNSLBP) were found with impaired postural control in previous studies. Since the trunk muscle take important efforts on core stability, the study aimed to examine the relationships of postural control during stance tasks and the contractility of trunk muscle in young adults with CNSLBP and without. METHODS Healthy individuals (n = 25) and individuals with CNSLBP (n = 30) were included. The thickness of the bilateral transversus abdominis (TrA) and lumbar multifidus (MF) was measured during rest and maximal voluntary contraction, and the change percentages (TrA%, MF%) were calculated. Regarding postural control, COP path length and sway area during the stance tasks were measured thrice in each group. RESULTS The bilateral TrA% of the CNSLBP group was less than that of the HC group (p < 0.05). The bilateral TrA% of the CNSLBP group was less than that of the HC group (p < 0.05). The bilateral MF% showed no significantly different(p > 0.05) between the two groups. Compared with healthy controls, CNSLBP patients resulted larger path length and sway area of COP during most of static stance tasks. During the EO task in the CNSLBP group, TrA% was found correlate to COP path length (p < 0.05); the right MF% was correlated with COP sway area (p < 0.05). No significant correlations appeared in the healthy controls (p > 0.05). CONCLUSIONS Compared with healthy individuals, impaired postural control during static stance with eyes open in patients with CNSLBP was likely to be related to the poor contraction ability of bilateral transversus abdominis and correlated to the normal contraction ability of right lumbar multifidus.
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Affiliation(s)
- Hongjiang Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Jiaxuan Zheng
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Ziyan Fan
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Zichong Luo
- Department of Electromechanical Engineering, Faculty of Science and Technology, University of Macau, Macau, China
| | - Yi Wu
- School of Arts and Design, Guangdong University of Technology, Guangzhou 510080, China
| | - Xue Cheng
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Jiajia Yang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Siyun Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Qiuhua Yu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Wai Leung Ambrose Lo
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Chuhuai Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.
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Lin S, Zhu B, Zheng Y, Liu S, Wang C. Effect of RUSI-based core stability exercise on chronic non-specific low back pain patients: study protocol for a randomised controlled trial. BMJ Open 2021; 11:e047317. [PMID: 34907039 PMCID: PMC8671944 DOI: 10.1136/bmjopen-2020-047317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Low back pain (LBP) is one of the most highly prevalent pain both in developed countries and low-income and middle-income countries. Despite increasing healthcare resources and numerous treatment methods for LBP, the efficacy of these therapeutic strategies is still uncertain. Recently, core stability exercise (CSE) is popularly applied as a preventive or rehabilitative method in the treatment of LBP. However, the adequate activation of the local muscle systems of CSE needs further optimisation and quantification. This trial aims to investigate the feasibility and efficacy of CSE monitored by real-time ultrasound image (RUSI) on LBP individuals. METHODS AND ANALYSIS Forty subjects with chronic non-specific LBP (CNLBP), aged from 20 to 50 years, will be randomly allocated into two groups using sealed, consecutively numbered opaque envelopes: (1) study group (SG): CSE monitored by RUSI and (2) control group (CG): identical CSE without monitoring. Interventions will last 30 mins, two times a week for 8 weeks. The primary outcomes include pain intensity, disability and quality of life, and the secondary outcomes will be the postural control static stability, onset timing of trunk muscles activation, ultrasound images of muscle thickness and surface electromyography (sEMG) signal of muscle activities. Outcome measures will be collected at baseline, 4 and 8 weeks during training, and at 6 months follow-up. Data will be collected and analysed by an assessor blinded to group allocation. Effect sizes and mixed-model repeated measures analysis of variance (2 groups×4 time points) will be calculated. ETHICS AND DISSEMINATION This protocol and informed consent has been approved by the Institutional Research Ethics Committee of the First Affiliated Hospital, Sun Yat-sen University (Approval number: [2020] 254-1). The findings of this study will be disseminated to participants through social networks and will be submitted to peer-reviewed journals and scientific conferences. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Registry (ChiCTR2000034498).
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Affiliation(s)
- Shanshan Lin
- Department of Rehabilitation Medicine, Jiangmen Central Hospital, Jiangmen, Guangdong, China
- Department of Rehabilitation Medicine, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Bo Zhu
- Department of Hepatobiliary Surgery, Jiangmen Central Hospital, Jiangmen, Guangdong, China
| | - Yiyi Zheng
- Department of Rehabilitation Medicine, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Shufeng Liu
- Department of Rehabilitation Medicine, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Chuhuai Wang
- Department of Rehabilitation Medicine, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
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Fernández-Carnero S, Martin-Saborido C, Achalandabaso Ochoa-Ruiz de Mendoza A, Ferragut-Garcias A, Cuenca-Zaldivar JN, Leal-Quiñones A, Calvo-Lobo C, Gallego-Izquierdo T. The Role of Rehabilitative Ultrasound Imaging Technique in the Lumbopelvic Region as a Diagnosis and Treatment Tool in Physiotherapy: Systematic Review, Meta-Analysis and Meta-Regression. J Clin Med 2021; 10:5699. [PMID: 34884401 PMCID: PMC8658262 DOI: 10.3390/jcm10235699] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/22/2021] [Accepted: 12/01/2021] [Indexed: 01/25/2023] Open
Abstract
Rehabilitative ultrasound imaging (RUSI) technique seems to be a valid and reliable tool for diagnosis and treatment in physiotherapy and has been widely studied in the lumbopelvic region the last three decades. The aims for this utility in clinical settings must be review through a systematic review, meta-analysis and meta-regression. A systematic review was designed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines with PROSPERO registration and per review in all phases of the process using COVIDENCE, analysis of risk of bias and meta-analysis using REVMAN, and meta-regression calculation using STATA. Database screening provided 6544 references, out of which 321 reported narrative synthesis, and 21 reported quantitative synthesis, while only 7 of them provided comparable data to meta-analyze the variables pain and muscle thickness. In most cases, the forest plots showed considerable I2 heterogeneity indexes for multifidus muscle thickness (I2 = 95%), low back pain (I2 = 92%) and abdominal pain (I2 = 95%), not important for transversus abdominis muscle thickness (I2 = 22%), significant heterogenity (I2 = 69%) depending on the subgroup and not important internal oblique muscle thickness (I2 = 0%) and external oblique muscle thickness (I2 = 0%). Meta-regression did not provide significant data for the correlations between the variables analyzed and the intervention, age, and BMI (Body Mass Index). This review reveals that RUSI could contribute to a high reliability of the measurements in the lumbopelvic region with validity and reliability for the assessments, as well as showing promising results for diagnosis and intervention assessment in physiotherapy compared to the traditional model, allowing for future lines of research in this area.
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Affiliation(s)
- Samuel Fernández-Carnero
- Physiotherapy and Pain Group, Department of Physiotherapy and Nursing, Alcalá University, 28801 Alcalá de Henares, Spain; (S.F.-C.); (A.A.O.-R.d.M.); (A.F.-G.); (T.G.-I.)
| | | | - Alexander Achalandabaso Ochoa-Ruiz de Mendoza
- Physiotherapy and Pain Group, Department of Physiotherapy and Nursing, Alcalá University, 28801 Alcalá de Henares, Spain; (S.F.-C.); (A.A.O.-R.d.M.); (A.F.-G.); (T.G.-I.)
- Área de Fisioterapia, Departamento de Ciencias de la Salud, Universidad de Jaén, Jaén, 23071 Andalucía, Spain
| | - Alejandro Ferragut-Garcias
- Physiotherapy and Pain Group, Department of Physiotherapy and Nursing, Alcalá University, 28801 Alcalá de Henares, Spain; (S.F.-C.); (A.A.O.-R.d.M.); (A.F.-G.); (T.G.-I.)
- Departamento de Enfermería y Fisioterapia, Islas Baleares University, 07122 Ciudad de Palma, Spain
| | | | | | - Cesar Calvo-Lobo
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain;
| | - Tomas Gallego-Izquierdo
- Physiotherapy and Pain Group, Department of Physiotherapy and Nursing, Alcalá University, 28801 Alcalá de Henares, Spain; (S.F.-C.); (A.A.O.-R.d.M.); (A.F.-G.); (T.G.-I.)
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Zamani H, Dadgoo M, Akbari M, Sarrafzadeh J, Pourahmadi M. Intra-examiner and inter-examiner reliability of rehabilitative ultrasound imaging for lumbar multifidus and anterolateral abdominal muscles in females with recurrent low back pain: an observational, cross-sectional study. J Ultrason 2021; 21:e286-e293. [PMID: 34970439 PMCID: PMC8678713 DOI: 10.15557/jou.2021.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/12/2021] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Hamid Zamani
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mahdi Dadgoo
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Akbari
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Javad Sarrafzadeh
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Pourahmadi
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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11
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Farragher J, Pranata A, El-Ansary D, Parry S, Williams G, Royse C, Royse A, O'Donohue M, Bryant A. Reliability of lumbar multifidus and iliocostalis lumborum thickness and echogenicity measurements using ultrasound imaging. Australas J Ultrasound Med 2021; 24:151-160. [PMID: 34765425 DOI: 10.1002/ajum.12273] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 05/09/2021] [Accepted: 05/11/2021] [Indexed: 01/04/2023] Open
Abstract
Purpose To establish the test-retest and inter-rater reliability of lumbar multifidus (LM) and iliocostalis lumborum (IL) muscle thickness and echogenicity as derived using ultrasound imaging. Methods Ultrasound images of the LM and IL were collected from 11 healthy participants on two occasions, 1 week apart, by two independent assessors. Measures of LM and IL thickness and echogenicity were subject to test-retest and inter-rater reliability, which was assessed by calculation of an F statistic, the interclass correlation coefficient (ICC), the standard error of measurement, 95% confidence intervals and Bland-Altman plots. This study was given approval by The University of Melbourne Behavioural and Social Sciences Human Ethics Sub-Committee (ref: 1749845). Results Assessors A and B showed good to excellent test-retest reliability for LM thickness (ICC3,3 A: 0.89 and B: 0.98), LM echogenicity (ICC3,3 A: 0.93 and B: 0.95) and IL echogenicity (ICC3,3 A: 0.87 and B: 0.83). Test-retest reliability for IL thickness was poor for Assessor A but excellent for Assessor B. Both assessors demonstrated excellent inter-rater reliability for LM thickness and echogenicity (ICC2,3: 0.79 and 0.94), but poor reliability for IL thickness and echogenicity (ICC2,3: 0.00 and 0.39). Conclusions Inter-rater and test-retest reliability was excellent for LM but was less reliable for measures of the IL muscle.
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Affiliation(s)
- Joshua Farragher
- Centre for Health Exercise & Sports Medicine The University of Melbourne Melbourne Vic. Australia
| | - Adrian Pranata
- Department of Nursing and Allied Health Swinburne University of Technology Hawthorn Vic. Australia
| | - Doa El-Ansary
- Department of Nursing and Allied Health Swinburne University of Technology Hawthorn Vic. Australia.,Department of Surgery The University of Melbourne Melbourne Vic. Australia.,Westmead Private Hospital Clinical Research Institute Westmead NSW Australia
| | - Selina Parry
- Department of Physiotherapy The University of Melbourne Melbourne Vic. Australia
| | - Gavin Williams
- Department of Physiotherapy The University of Melbourne Melbourne Vic. Australia.,Epworth Hospital Richmond Vic. Australia
| | - Colin Royse
- Department of Surgery The University of Melbourne Melbourne Vic. Australia.,The Royal Melbourne Hospital Melbourne Vic. Australia.,Outcomes Research Consortium Cleveland Clinic Cleveland OH USA
| | - Alistair Royse
- Department of Surgery The University of Melbourne Melbourne Vic. Australia
| | | | - Adam Bryant
- Centre for Health Exercise & Sports Medicine The University of Melbourne Melbourne Vic. Australia
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12
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Batıbay S, Külcü DG, Kaleoğlu Ö, Mesci N. Effect of Pilates mat exercise and home exercise programs on pain, functional level, and core muscle thickness in women with chronic low back pain. J Orthop Sci 2021; 26:979-985. [PMID: 33386201 DOI: 10.1016/j.jos.2020.10.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 07/13/2020] [Accepted: 10/15/2020] [Indexed: 02/09/2023]
Abstract
BACKGROUND To investigate the effects of Pilates exercise in patients with chronic non-specific low back pain (CNLBP) by training core stabilization muscles in aspects such as: pain, functional level, depression, quality of life, and muscle thickness measured by Ultrasound Imaging (UI) and to compare it with home based exercise. METHODS A prospective, randomized-single blinded study included 60 female patients with CNLBP. Patients were randomized into Pilates (group 1) or home exercise group (group 2) three times/week for eight weeks. The evaluations were made at the beginning and end of the treatment. Outcome parameters were VAS, Oswestry Disability Index, Qubec Disability Scale, Short Form-36, Beck Depression Questionnaire, sit and reach, Modified Schöber and sit up tests. Multifidus and abdominal muscle thickness were measured by UI. RESULTS Significant improvement has been observed in all parameters in both groups. It was found that Group 1 was more effective in terms of all parameters (p < 0.05). CONCLUSIONS Both Pilates and home exercises are effective in treating patients with chronic low back pain. UI can be useful for evaluating the core muscle thickness progression of chronic low back pain patients who are undergoing exercise therapy.
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Affiliation(s)
- Sevilay Batıbay
- Faculty of Medicine, Department of Physical Therapy and Rehabilitation, Division of Rheumatology, Gazi University, Ankara, Turkey.
| | - Duygu Geler Külcü
- Haydarpaşa Numune Education and Research Hospital, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey
| | - Özlem Kaleoğlu
- Haydarpaşa Numune Education and Research Hospital, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey
| | - Nilgün Mesci
- Haydarpaşa Numune Education and Research Hospital, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey
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13
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Hofste A, Soer R, Groen GJ, van der Palen J, Geerdink FJB, Oosterveld FGJ, Kiers H, Wolff AP, Hermens H. Functional and morphological lumbar multifidus characteristics in subgroups with low back pain in primary care. Musculoskelet Sci Pract 2021; 55:102429. [PMID: 34271415 DOI: 10.1016/j.msksp.2021.102429] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Since the contribution of the lumbar multifidus(LM) is not well understood in relation to non-specific low back pain(LBP), this may limit physiotherapists in choosing the most appropriate treatment strategy. OBJECTIVES This study aims to compare clinical characteristics, in terms of LM function and morphology, between subacute and chronic LBP patients from a large clinical practice cohort compared to healthy controls. DESIGN Multicenter case control study. METHOD Subacute and chronic LBP patients and healthy controls between 18 and 65 years of age were included. Several clinical tests were performed: primary outcomes were the LM thickness from ultrasound measurements, trunk range of motion(ROM) from 3D kinematic tests, and median frequency and root mean square values of LM by electromyography measurements. The secondary outcomes Numeric Rating Scale for Pain(NRS) and the Oswestry Disability Index(ODI) were administered. Comparisons between groups were made with ANOVA, p-values<0.05, with Tukey's HSD post-hoc test were considered significant. RESULTS A total of 161 participants were included, 50 healthy controls, 59 chronic LBP patients, and 52 subacute LBP patients. Trunk ROM and LM thickness were significantly larger in healthy controls compared to all LBP patients(p < 0.01). A lower LM thickness was found between subacute and chronic LBP patients although not significant(p = 0.11-0.97). All between-group comparisons showed no statistically significant differences in electromyography outcomes (p = 0.10-0.32). NRS showed no significant differences between LBP subgroups(p = 0.21). Chronic LBP patients showed a significant higher ODI score compared to subacute LBP patients(p = 0.03). CONCLUSIONS Trunk ROM and LM thickness show differences between LBP patients and healthy controls.
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Affiliation(s)
- Anke Hofste
- University of Groningen, University Medical Center Groningen, Anesthesiology Pain Center, the Netherlands; Saxion University of Applied Sciences, Faculty Physical Activity and Health, Enschede, the Netherlands.
| | - Remko Soer
- Saxion University of Applied Sciences, Faculty Physical Activity and Health, Enschede, the Netherlands; University of Groningen, University Medical Center Groningen, Pain Center, the Netherlands
| | - Gerbrand J Groen
- University of Groningen, University Medical Center Groningen, Anesthesiology Pain Center, the Netherlands; University of Groningen, University Medical Center Groningen, Pain Center, the Netherlands
| | - Job van der Palen
- Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, Netherlands; Medical School Twente, Medisch Spectrum Twente, Enschede, Netherlands
| | - Frank J B Geerdink
- Saxion University of Applied Sciences, Faculty Physical Activity and Health, Enschede, the Netherlands
| | - Frits G J Oosterveld
- Saxion University of Applied Sciences, Faculty Physical Activity and Health, Enschede, the Netherlands
| | - Henri Kiers
- Institute for Human Movement Studies, University of Applied Sciences Utrecht, Utrecht, the Netherlands
| | - André P Wolff
- University of Groningen, University Medical Center Groningen, Anesthesiology Pain Center, the Netherlands; University of Groningen, University Medical Center Groningen, Pain Center, the Netherlands
| | - Hermie Hermens
- Department of Biomedical Signals & Systems, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, Netherlands; Telemedicine Group, Roessingh Research and Development Enschede, the Netherlands
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14
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Prolonged sitting-induced back pain influences abdominal muscle thickness in a sitting but not a supine position. Sci Rep 2021; 11:16369. [PMID: 34385531 PMCID: PMC8360962 DOI: 10.1038/s41598-021-95795-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 07/29/2021] [Indexed: 11/08/2022] Open
Abstract
The current study explored whether (i) abdominal muscle thickness differed between non-painful supine and painful sitting positions and (ii) the sitting position was more reliable and useful than the supine position to discriminate between people with and without prolonged sitting-induced lower back pain (LBP). Participants with and without prolonged sitting-induced LBP participated. The thickness of the transversus abdominis (TrA), internal oblique (IO), and external oblique (EO) muscles was measured using ultrasonography in supine, usual sitting, and upright sitting positions. Analysis of variance was used to compare muscle thickness among the positions. Intraclass correlation coefficients and receiver operating characteristic curves were used to determine which position reliably identified between group. The group with LBP showed significantly greater EO muscle thickness than that without LBP only in the upright sitting position. In the group without LBP, the TrA thickness was significantly greater in the usual and upright sitting positions than in the supine position, but there was no significant difference in TrA thickness among three positions in LBP group. Only EO thickness in the upright sitting position significantly predicted prolonged sitting-induced LBP. The current study suggests that clinicians should assess abdominal activation patterns in the upright sitting rather than supine position before applying abdominal muscle motor control training for patients with prolonged sitting-induced LBP, and to distinguish between those with and without prolonged sitting-induced LBP.
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15
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The reliability of rehabilitative ultrasound to measure lateral abdominal muscle thickness: A systematic review and meta-analysis. Musculoskelet Sci Pract 2021; 53:102357. [PMID: 33743453 DOI: 10.1016/j.msksp.2021.102357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Variations in rehabilitative ultrasound imaging (RUSI) protocols may alter lateral abdominal muscle (LAM) thickness measurements. A standardised protocol is required for clinicians to accurately compare LAM thickness changes. OBJECTIVE In healthy and lower back pain (LBP) populations, to assess the 1) overall reliability of RUSI to diagnose LAM thickness via meta-analysis, 2) reliability of ultrasound variables to diagnose LAM thickness via systematic review, and 3) propose a RUSI protocol for the LAM using variables associated with excellent reliability (intraclass correlation coefficient [ICC] >0.9). DESIGN Systematic review and meta-analysis. METHOD Databases were searched from January 2000 for studies reporting the reliability of RUSI on the LAM at rest. Title, abstract and full-text screening were performed. Reference lists of reviews and included full-text articles were scanned for further articles. Study characteristic, ultrasound procedure and reliability data were extracted, and article quality assessed. Data was synthesised using meta-analysis to determine the overall reliability for RUSI in different subgroups; calculation of the mean ICCs and standard error of measurements of protocol variables; and narrative synthesis of protocols to contrast those of differing reliability. RESULTS Twenty-seven articles, involving 884 participants were included. Reliability ranged from good-to-excellent (ICC 0.859-0.958) in all subgroups. Protocols ranged in subject selection and position, examiner experience, transducer position with the comprehensiveness of protocol description the main limitation of the reviewed literature. Based on the findings an ultrasound protocol was proposed. CONCLUSIONS RUSI variables for the LAM at rest show moderate-to-excellent reliability; future research should explore reliability following the proposed protocol.
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16
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Quantitative assessment of the lumbar intervertebral disc via T2 shows excellent long-term reliability. PLoS One 2021; 16:e0249855. [PMID: 33852631 PMCID: PMC8046347 DOI: 10.1371/journal.pone.0249855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/25/2021] [Indexed: 12/05/2022] Open
Abstract
Methodologies for the quantitative assessment of the spine tissues, in particular the intervertebral disc (IVD), have not been well established in terms of long-term reliability. This is required for designing prospective studies. 1H water T2 in the IVD (“T2”) has attained wider use in assessment of the lumbar intervertebral discs via magnetic resonance imaging. The reliability of IVD T2 measurements are yet to be established. IVD T2 was assessed nine times at regular intervals over 368 days on six anatomical slices centred at the lumbar spine using a spin-echo multi-echo sequence in 12 men. To assess repeatability, intra-class correlation co-efficients (ICCs), standard error of the measurement, minimal detectable difference and co-efficients of variation (CVs) were calculated along with their 95% confidence intervals. Bland-Altman analysis was also performed. ICCs were above 0.93, with the exception of nuclear T2 at L5/S1, where the ICC was 0.88. CVs of the central-slice nucleus sub-region ranged from 4.3% (average of all levels) to 10.1% for L5/S1 and between 2.2% to 3.2% for whole IVD T2 (1.8% for the average of all levels). Averaging between vertebral levels improved reliability. Reliability of measurements was least at L5/S1. ICCs of degenerated IVDs were lower. Test-retest reliability was excellent for whole IVD and good to excellent for IVD subregions. The findings help to establish the long-term repeatability of lumbar IVD T2 for the implementation of prospective studies and determination of significant changes within individuals.
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17
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Valentín-Mazarracin I, Nogaledo-Martín M, López-de-Uralde-Villanueva I, Fernández-de-las-Peñas C, Stokes M, Arias-Buría JL, Díaz-Arribas MJ, Plaza-Manzano G. Reproducibility and Concurrent Validity of Manual Palpation with Rehabilitative Ultrasound Imaging for Assessing Deep Abdominal Muscle Activity: Analysis with Preferential Ratios. Diagnostics (Basel) 2021; 11:diagnostics11020298. [PMID: 33668663 PMCID: PMC7918832 DOI: 10.3390/diagnostics11020298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/02/2021] [Accepted: 02/10/2021] [Indexed: 11/16/2022] Open
Abstract
The abdominal drawing-in maneuver (ADIM) is a clinical tool used for identifying preferential activity of deep abdominal muscles. However, concurrent validity and reproducibility of palpation during the ADIM has not been formally investigated. The aims of this study were (1) to assess intra- and interrater reliability of manual palpation during the ADIM, and (2) to determine the concurrent validity of manual palpation during the ADIM by calculating preferential activation ratio cut-off as assessed with ultrasound imaging (RUSI). Thirty-two subjects (n = 16 patients with nonspecific low back pain and 16 comparable healthy individuals) performed the ADIM in a supine hook-lying position. Two experienced assessors evaluated the presence or absence of preferential contraction of the deep abdominal muscles by palpation during the ADIM on 2 different days. Intrarater (test-retest) and interrater reliability of palpation were calculated using Cohen's kappa coefficients. Muscle thickness of the transverse abdominis (TrA), internal oblique (IO), and external oblique (EO) muscles at rest and during the ADIM were also measured. TrA-Contraction Ratio (TrA-CR), TrA-Preferential Activation Ratio (TrA-PAR), and Modified-TrA-PR (M-TrA-PAR) were calculated. The concurrent validity of manual palpation was determined using the correlation between manual palpation and imaging and by calculating ROC curve (operating characteristics curve), Youden index, and sensitivity and specificity. Intra- and interrater reliability of manual palpation during the ADIM was excellent (k: 0.82-1.00) and good to excellent (k: 0.71-1.00), respectively. Interrater reliability for muscle thickness ranged from good to excellent (ICC3,1 0.79-0.91). Manual palpation and TrA ratio showed low to moderate correlations (r: 0.36-0.60). When evaluating the diagnostic accuracy of manual palpation, the best predictive model (ROC value: 0.89; p < 0.001) for correct a preferential contraction of TrA was obtained when the M-TrA-PAR was ≥0.08 (sensitivity: 0.95-1.00; specificity: 0.62). Good to excellent intra- and interrater reliability of manual palpation was found during the ADIM in both patients and healthy groups. Manual palpation showed concurrent validity for identifying the preferential activity of the TrA muscle supporting its use in clinical practice.
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Affiliation(s)
| | | | - Ibai López-de-Uralde-Villanueva
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, 28040 Madrid, Spain; (I.L.-d.-U.-V.); (M.J.D.-A.); (G.P.-M.)
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain;
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, 28922 Madrid, Spain
- Correspondence: ; Tel.: +34-91-488-88-84
| | - María Stokes
- School of Health Sciences, University of Southampton, Southampton S017 1BJ, UK;
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Southampton NG7 2UH, UK
| | - José L. Arias-Buría
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain;
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, 28922 Madrid, Spain
| | - María J. Díaz-Arribas
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, 28040 Madrid, Spain; (I.L.-d.-U.-V.); (M.J.D.-A.); (G.P.-M.)
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, 28040 Madrid, Spain; (I.L.-d.-U.-V.); (M.J.D.-A.); (G.P.-M.)
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18
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Botticchio A, Mourad F, Fernández-Carnero S, Arias-Buría JL, Santodomingo Bueno A, Mesa Jiménez J, Gobbo M. Short-Term Morphological Changes in Asymptomatic Perimandibular Muscles after Dry Needling Assessed with Rehabilitative Ultrasound Imaging: A Proof-of-Concept Study. J Clin Med 2021; 10:jcm10020209. [PMID: 33435581 PMCID: PMC7827231 DOI: 10.3390/jcm10020209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/28/2020] [Accepted: 01/02/2021] [Indexed: 12/17/2022] Open
Abstract
Facial anatomical structures are not easily accessible to manual palpation. The aim of our study is to objectively assess temporomandibular joint and perimandibular muscles dimensions by means of sonographic measurements before and after dry needling (DN) in asymptomatic subjects. Seventeen subjects participated in this before-after study with a within-subject control. After random allocation, one side of the face was used for the intervention and the contralateral as control. DN was performed on the temporal, masseter, and sternocleidomastoid muscles. Each subject was examined bilaterally before, immediately after, and one month after the intervention through Rehabilitative Ultrasound Imaging (RUSI) of the temporomandibular articular disc and the three target muscles. Maximum mouth opening was measured at baseline and at one month. After a single DN session, articular disc thickness significantly decreased; muscles’ thicknesses (except for temporal thickness) significantly decreased immediately and at follow-up on the treated side; no significant changes resulted for the control side. The maximum mouth opening increased from 4.77 mm to 4.86 mm. RUSI may be useful to assess the dimensions and thickness of the temporomandibular disc and muscles before and after an intervention. DN influences muscle morphology, and it has a positive influence on mouth opening in the short term.
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Affiliation(s)
- Alice Botticchio
- Poliambulatorio Physio Power, 25124 Brescia, Italy;
- Correspondence: ; Tel.: +39-3291-0297-28
| | - Firas Mourad
- Poliambulatorio Physio Power, 25124 Brescia, Italy;
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, 00133 Roma, Italy
- Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, 4671 Differdange, Luxembourg
| | | | - José Luis Arias-Buría
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain;
| | | | | | - Massimiliano Gobbo
- Laboratory of Clinical Integrative Physiology, University of Brescia, 25123 Brescia, Italy;
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy
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19
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Abbasi S, Hadian Rasanani MR, Olyaei GR, Ghotbi N, Rasouli O. Reliability of ultrasound measurement of the lateral abdominal and lumbar multifidus muscles in individuals with chronic low back pain: A cross-sectional test-retest study. J Bodyw Mov Ther 2020; 26:394-400. [PMID: 33992273 DOI: 10.1016/j.jbmt.2020.12.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 09/26/2020] [Accepted: 12/19/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Ultrasound (US) imaging has been suggested to evaluate the morphology and function of trunk muscles; however, little is known about the reliability of the US measures in patients with chronic low back pain (CLBP). This study aimed to evaluate intrarater reliability of US imaging of the lateral abdominal and lumbar multifidus muscles in individuals with nonspecific CLBP. METHODS In this cross-sectional study, intrarater within-day and between-day reliability of US measurements of the transversus abdominis, internal oblique, external oblique and lumbar multifidus (at the L3-L4, L4-L5, and L5-S1 levels) muscles were obtained on both sides. The resting and contracted thickness and contraction ratio of each muscle were measured in 21 individuals with nonspecific CLBP. RESULTS All US measurements of the lateral abdominal and lumbar multifidus muscles demonstrated good to excellent within-day (Intraclass correlation coefficients (ICCs: 0.80-0.98) and between-day (ICCs: 0.80-0.97) reliability. The standard error of the measurement (SEMs) and minimal detectable change (MDCs) of the lateral abdominal muscles on both sides ranged 0.5-1.6 mm and 0.4-4.4 mm, respectively. The SEMs and MDCs of the LM muscles on both sides ranged 1.1-2.7 mm and 2.86-7.49 mm, respectively. CONCLUSION The findings indicate that US imaging has good to high intrarater within- and between-day reliability for assessing absolute thickness and contraction ratio of the trunk muscles on both right and left sides in patients with nonspecific CLBP. The vertical alignment of the US transducer is a reliable method for assessing the lateral abdominal muscles.
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Affiliation(s)
- Soheila Abbasi
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, (TUMS), Tehran, Iran.
| | - Mohammad Reza Hadian Rasanani
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, International Campus (TUMS, IC-TUMS), Brain and Spinal Injury Research Center (BASIR), Tehran, Iran.
| | - Gholam Reza Olyaei
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, (TUMS), Tehran, Iran.
| | - Nastaran Ghotbi
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, (TUMS), Tehran, Iran.
| | - Omid Rasouli
- Department of Public Health and Nursing, Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
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Pain Catastrophizing Is Related to Static Postural Control Impairment in Patients with Nonspecific Chronic Low Back Pain: A Cross-Sectional Study. Pain Res Manag 2020; 2020:9629526. [PMID: 33193926 PMCID: PMC7641713 DOI: 10.1155/2020/9629526] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/01/2020] [Accepted: 10/10/2020] [Indexed: 12/29/2022]
Abstract
Purpose Pain catastrophizing may contribute to the altered trunk muscle activity in patients with nonspecific chronic low back pain (NSCLBP). It is unclear if pain catastrophizing influences static postural control in patients with NSCLBP. This study aimed to investigate the relationship between pain catastrophizing and static postural control in NSCLBP patients. Methods Sixty-eight participants with NSCLBP and 40 healthy participants were recruited. Postural control was assessed by the sway area and the sway length of the center of pressure (COP) during balance tests. Pain catastrophizing in participants with NSCLBP was assessed by the Pain Catastrophizing Scale (PCS). Bilateral transversus abdominis (TrA) activation was evaluated by ultrasound imaging-measured percent change in muscle thickness. Associations between COP parameter and PCS/subscales of PCS were examined by multiple linear regression (MLR). Results Our results observed a larger COP sway area in NSCLBP group under eyes-closed condition (p < 0.001) and a lower level of voluntary activation of the bilateral TrA (p < 0.001), compared with the healthy control group. The MLR analyses revealed that the COP area sway under eyes-closed condition was significantly associated with the PCS score/helplessness score of PCS, voluntary activation of the left TrA, and age in participants with NSCLBP (β = 0.222/0.236, 0.341/0.344, and 0.328/0.325; p=0.045/0.033, 0.002, and 0.004, resp.). Conclusions Static postural control was associated with pain catastrophizing, voluntary activation of TrA, and age in participants with NSCLBP. This indicated that pain catastrophizing may affect postural control and should be considered when interpreting balance test results and managing NSCLBP.
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Belasso CJ, Behboodi B, Benali H, Boily M, Rivaz H, Fortin M. LUMINOUS database: lumbar multifidus muscle segmentation from ultrasound images. BMC Musculoskelet Disord 2020; 21:703. [PMID: 33097024 PMCID: PMC7585198 DOI: 10.1186/s12891-020-03679-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Among the paraspinal muscles, the structure and function of the lumbar multifidus (LM) has become of great interest to researchers and clinicians involved in lower back pain and muscle rehabilitation. Ultrasound (US) imaging of the LM muscle is a useful clinical tool which can be used in the assessment of muscle morphology and function. US is widely used due to its portability, cost-effectiveness, and ease-of-use. In order to assess muscle function, quantitative information of the LM must be extracted from the US image by means of manual segmentation. However, manual segmentation requires a higher level of training and experience and is characterized by a level of difficulty and subjectivity associated with image interpretation. Thus, the development of automated segmentation methods is warranted and would strongly benefit clinicians and researchers. The aim of this study is to provide a database which will contribute to the development of automated segmentation algorithms of the LM. CONSTRUCTION AND CONTENT This database provides the US ground truth of the left and right LM muscles at the L5 level (in prone and standing positions) of 109 young athletic adults involved in Concordia University's varsity teams. The LUMINOUS database contains the US images with their corresponding manually segmented binary masks, serving as the ground truth. The purpose of the database is to enable development and validation of deep learning algorithms used for automatic segmentation tasks related to the assessment of the LM cross-sectional area (CSA) and echo intensity (EI). The LUMINOUS database is publicly available at http://data.sonography.ai . CONCLUSION The development of automated segmentation algorithms based on this database will promote the standardization of LM measurements and facilitate comparison among studies. Moreover, it can accelerate the clinical implementation of quantitative muscle assessment in clinical and research settings.
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Affiliation(s)
- Clyde J. Belasso
- Department of Electrical and Computer Engineering, Concordia University, Montreal, H3G 1M8 Canada
- PERFORM Centre, Concordia University, Montreal, H4B 1R6 Canada
| | - Bahareh Behboodi
- Department of Electrical and Computer Engineering, Concordia University, Montreal, H3G 1M8 Canada
- PERFORM Centre, Concordia University, Montreal, H4B 1R6 Canada
| | - Habib Benali
- Department of Electrical and Computer Engineering, Concordia University, Montreal, H3G 1M8 Canada
- PERFORM Centre, Concordia University, Montreal, H4B 1R6 Canada
| | - Mathieu Boily
- PERFORM Centre, Concordia University, Montreal, H4B 1R6 Canada
- Department of Diagnostic Radiology, McGill University, Montreal, H3G 1A4 Canada
| | - Hassan Rivaz
- Department of Electrical and Computer Engineering, Concordia University, Montreal, H3G 1M8 Canada
- PERFORM Centre, Concordia University, Montreal, H4B 1R6 Canada
| | - Maryse Fortin
- PERFORM Centre, Concordia University, Montreal, H4B 1R6 Canada
- Department of Health, Kinesiology & Applied Physiology, Concordia University, Montreal, H4B 1R6 Canada
- Centre de recherche interdisciplinaire en réadaptation (CRIR), Constance Lethbridge Rehabilitation Centre, Montreal, H4B 1T3 Canada
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Clinical Assessment and Thickness Changes of the Oblique and Multifidus Muscles Using a Novel Screening Tool and Exercise Program: A Randomized Controlled Trial. J Sport Rehabil 2020; 30:384-394. [PMID: 32723925 DOI: 10.1123/jsr.2019-0156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 01/02/2020] [Accepted: 04/26/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Training and assessment of the abdominal and trunk muscles are widely used in the clinical setting. However, it is unknown what types of exercises are most effective in activation of both the global and local stabilizers in these regions. OBJECTIVE The purpose of this study was to establish the reliability of a novel clinical screening tool (sling screen) to assess the muscles of the abdomen and trunk. The second aim was to use the clinical screening tool and musculoskeletal ultrasound to compare the effects of a rotary-based exercise program that targets both the global and local muscles to the effects of a traditional exercise program on the activation of the abdominal and trunk muscles. DESIGN Double-blind, randomized controlled trial. SETTING Sports medicine facility. PARTICIPANTS AND INTERVENTIONS Thirty-one healthy participants were randomly allocated to receive a single-session rotary-based or traditional "core" exercise program. MAIN OUTCOME MEASURES The participants were assessed at the baseline and immediately postintervention. The primary outcome measures were muscle thickness examined by musculoskeletal ultrasound and clinical examination of muscle activation using a screening tool. The data were collected by blind assessors. Reliability and validity of a clinical screening tool (sling screen) were also assessed. RESULTS The analysis of the covariance tests showed a significant increase in oblique thickness for the rotary exercise group. All participants displayed a significant increase in multifidus thickness. The Wilcoxon signed-rank tests revealed a significant increase in clinical assessment scores in the rotary exercise group but not the traditional exercise group. Reliability of the sling screen ranged from moderate to good. CONCLUSION This clinical trial provides evidence that a rotary-based exercise program may be more effective in producing increases in oblique muscle thickness than traditional "core" exercises in young, healthy adults. The sling screen tool was able to identify these muscle thickness changes. Future studies should investigate how these results correlate to injury risk, other populations, and also how to implement the sling screen into clinical practice.
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23
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Kennedy VL, Flavell CA, Doma K. Intra-rater reliability of transversus abdominis measurement by a novice examiner: Comparison of "freehand" to "probe force device" method of real-time ultrasound imaging. ULTRASOUND (LEEDS, ENGLAND) 2020; 27:156-166. [PMID: 32549895 DOI: 10.1177/1742271x19831720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/04/2019] [Indexed: 11/16/2022]
Abstract
A "free hand" real-time-ultrasound method is commonly applied to measure transversus abdominis. Potentially, this increases transversus abdominis measurement error due to uncontrolled variability in probe to skin force, inclination, and roll, particularly for novice examiners. This single-group repeated-measures reliability study compared the intra-rater reliability of transversus abdominis thickness and activation measurement by a novice examiner between free hand and a standardized probe force device method. The examiner captured ultrasound videos of transversus abdominis in a single session in healthy participants (n = 33). Free hand ultrasound featured uncontrolled probe force, inclination, and roll, while probe force device method ultrasound standardized these parameters. Images of transversus abdominis at rest and contracted were measured and transversus abdominis activation calculated. Intraclass correlation coefficient, coefficient of variation, standard error of measurement, and worthwhile differences were calculated. The probe force device method resulted in greater reliability (intraclass correlation coefficient = 0.75-0.96) and lower measurement error (coefficient of variation = 8.89-28.7%) compared to free hand (intraclass correlation coefficient = 0.63-0.93; coefficient of variation = 6.52-29.4%). Reliability was good for all measurements except free hand TrA-C, which was moderate. TrA-C had the lowest reliability, followed by contracted thickness of the transverse abdominis, with resting thickness of the transverse abdominis being highest. Worthwhile differences were lower using a probe force device method versus free hand for resting thickness of the transverse abdominis and contracted thickness of the transverse abdominis and similar for TrA-C. Standardization using probe force device method ultrasound to measure transversus abdominis improved intra-rater reliability in a novice examiner. Use of a probe force device method is recommended to improve reliability through reduced sources of measurement error. Probe force device method intra- and inter-rater reliability in examiners of varying experience, in clinical populations, and to visualize other structures merits exploration.
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Affiliation(s)
| | | | - Kenji Doma
- James Cook University, Townsville, Australia
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24
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Hofste A, Soer R, Hermens HJ, Wagner H, Oosterveld FGJ, Wolff AP, Groen GJ. Inconsistent descriptions of lumbar multifidus morphology: A scoping review. BMC Musculoskelet Disord 2020; 21:312. [PMID: 32429944 PMCID: PMC7236939 DOI: 10.1186/s12891-020-03257-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 03/31/2020] [Indexed: 12/18/2022] Open
Abstract
Background Lumbar multifidus (LM) is regarded as the major stabilizing muscle of the spine. The effects of exercise therapy in low back pain (LBP) are attributed to this muscle. A current literature review is warranted, however, given the complexity of LM morphology and the inconsistency of anatomical descriptions in the literature. Methods Scoping review of studies on LM morphology including major anatomy atlases. All relevant studies were searched in PubMed (Medline) and EMBASE until June 2019. Anatomy atlases were retrieved from multiple university libraries and online. All studies and atlases were screened for the following LM parameters: location, imaging methods, spine levels, muscle trajectory, muscle thickness, cross-sectional area, and diameter. The quality of the studies and atlases was also assessed using a five-item evaluation system. Results In all, 303 studies and 19 anatomy atlases were included in this review. In most studies, LM morphology was determined by MRI, ultrasound imaging, or drawings – particularly for levels L4–S1. In 153 studies, LM is described as a superficial muscle only, in 72 studies as a deep muscle only, and in 35 studies as both superficial and deep. Anatomy atlases predominantly depict LM as a deep muscle covered by the erector spinae and thoracolumbar fascia. About 42% of the studies had high quality scores, with 39% having moderate scores and 19% having low scores. The quality of figures in anatomy atlases was ranked as high in one atlas, moderate in 15 atlases, and low in 3 atlases. Discussion Anatomical studies of LM exhibit inconsistent findings, describing its location as superficial (50%), deep (25%), or both (12%). This is in sharp contrast to anatomy atlases, which depict LM predominantly as deep muscle. Within the limitations of the self-developed quality-assessment tool, high-quality scores were identified in a majority of studies (42%), but in only one anatomy atlas. Conclusions We identified a lack of standardization in the depiction and description of LM morphology. This could affect the precise understanding of its role in background and therapy in LBP patients. Standardization of research methodology on LM morphology is recommended. Anatomy atlases should be updated on LM morphology.
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Affiliation(s)
- Anke Hofste
- Anesthesiology Pain Center, University of Groningen, University Medical Center Groningen, Location Beatrixoord, Dilgtweg 5, Haren, the Netherlands. .,Faculty of Physical Activity and Health, Saxion University of Applied Sciences, Enschede, the Netherlands.
| | - Remko Soer
- Anesthesiology Pain Center, University of Groningen, University Medical Center Groningen, Location Beatrixoord, Dilgtweg 5, Haren, the Netherlands.,Faculty of Physical Activity and Health, Saxion University of Applied Sciences, Enschede, the Netherlands
| | - Hermie J Hermens
- Department of Biomedical Signals & Systems, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, the Netherlands.,Telemedicine Group, Roessingh Research and Development, Enschede, the Netherlands
| | - Heiko Wagner
- Department of Movement Science, Institute of Sport and Exercise Sciences, Münster, Germany
| | - Frits G J Oosterveld
- Faculty of Physical Activity and Health, Saxion University of Applied Sciences, Enschede, the Netherlands
| | - André P Wolff
- Anesthesiology Pain Center, University of Groningen, University Medical Center Groningen, Location Beatrixoord, Dilgtweg 5, Haren, the Netherlands
| | - Gerbrand J Groen
- Anesthesiology Pain Center, University of Groningen, University Medical Center Groningen, Location Beatrixoord, Dilgtweg 5, Haren, the Netherlands
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Moghadam N, Ghaffari MS, Noormohammadpour P, Rostami M, Zarei M, Moosavi M, Kordi R. Comparison of the recruitment of transverse abdominis through drawing-in and bracing in different core stability training positions. J Exerc Rehabil 2019; 15:819-825. [PMID: 31938704 PMCID: PMC6944888 DOI: 10.12965/jer.1939064.352] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 11/22/2019] [Indexed: 11/22/2022] Open
Abstract
There are many proposed core stability exercises in a variety of positions; however, it is not clear that in which position, activation of transverse abdominis muscle is utmost. We aimed to compare the activation of transverse abdominis muscle in different core stability exercise positions through ultrasound imaging. in a 20 subjects' study we compared the effectiveness of drawing-in and bracing maneuvers on transverse abdominis in different core stability exercise positions (supine, hook lying, supine with 90° flexed knee and hip, supine with stretched knees and 90° flexed hips, bridge, bridge with one stretched knee and Bird dog). We used activation ratio and preferential activation ratio as measurements of transverse abdominis activation. Abdominal Bracing in the bridge position showed the highest activation of transverse abdominis (P<0.05). The results showed significantly higher activation of transverse abdominis, measured by preferential activation ratio, in bridge position during abdominal bracing.
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Affiliation(s)
- Navid Moghadam
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Selk Ghaffari
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Pardis Noormohammadpour
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Sports and Exercise Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Rostami
- Brain and Spinal Cord Injuries Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Zarei
- Department of Orthopedics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mersad Moosavi
- Department of Orthopedics, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Kordi
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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26
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Rummens S, Robben E, De Groef A, Van Wambeke P, Janssens L, Brumagne S, Desloovere K, Peers K. Factors Associated With the Ultrasound Characteristics of the Lumbar Multifidus: A Systematic Review. PM R 2019; 12:82-100. [PMID: 31264799 DOI: 10.1002/pmrj.12212] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 06/21/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The first aim of this review was to investigate the association between age, sex, height, weight, physical activity level, posture, lumbar level and body side, and structural characteristics (cross-sectional area [CSA], thickness, linear dimensions, and echo intensity) of the lumbar multifidus (LM) measured by ultrasound. Second, differences between healthy individuals and patients with chronic low back pain (CLBP) were investigated. TYPE: Systematic review. LITERATURE SURVEY PubMed, Embase and Web of Science were searched until September 2018. METHODOLOGY Studies were included if (a) full text was available in English, Dutch, or French; (b) participants were older than 18 years of age and were asymptomatic or had nonspecific CLBP; and (c) the relation between structural characteristics of the LM, measured by ultrasound, and at least one of the above-mentioned factors was described, and/or a comparison between a CLBP and control group was made. Data were extracted independently by two reviewers. Quality of studies was assessed using an adapted version of the Downs and Black checklist. SYNTHESIS Twenty-seven studies were included. Thickness and CSA of the LM do not correlate with age. Males have a larger LM size than females. Thickness and CSA of left and right LM are highly correlated in healthy subjects. More significant side-to-side differences are present in subjects with CLBP than in those without. Muscle size increases from proximal to caudal lumbar levels. The presence of CLBP is associated with muscle size and function. CONCLUSIONS The association between the factors age, sex, height, weight, physical activity level, posture, lumbar level, body side, and presence of CLBP, and the ultrasound characteristics of the LM is discussed. These factors should be taken into account in future research on structural muscle characteristics, or when correlating with functional behavior or investigating the effect of a targeted intervention. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Sofie Rummens
- Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | - Elise Robben
- Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | - An De Groef
- Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Peter Van Wambeke
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | - Lotte Janssens
- REVAL Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
| | - Simon Brumagne
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Koen Peers
- Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
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27
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Rehabilitative Ultrasound Imaging Evaluation in Physiotherapy: Piloting a Systematic Review. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9010181] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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28
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Reliability of sonography in the assessment of lumbar stabilizer muscles size in healthy subjects and patients with scoliosis. J Bodyw Mov Ther 2019; 23:138-141. [DOI: 10.1016/j.jbmt.2018.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 03/30/2018] [Accepted: 05/12/2018] [Indexed: 11/23/2022]
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Taghipour M, Mohseni-Bandpei MA, Behtash H, Abdollahi I, Rajabzadeh F, Pourahmadi MR, Emami M. Reliability of Real-time Ultrasound Imaging for the Assessment of Trunk Stabilizer Muscles: A Systematic Review of the Literature. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:15-26. [PMID: 29688574 DOI: 10.1002/jum.14661] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 03/16/2018] [Accepted: 03/20/2018] [Indexed: 06/08/2023]
Abstract
Rehabilitative ultrasound (US) imaging is one of the popular methods for investigating muscle morphologic characteristics and dimensions in recent years. The reliability of this method has been investigated in different studies. As studies have been performed with different designs and quality, reported values of rehabilitative US have a wide range. The objective of this study was to systematically review the literature conducted on the reliability of rehabilitative US imaging for the assessment of deep abdominal and lumbar trunk muscle dimensions. The PubMed/MEDLINE, Scopus, Google Scholar, Science Direct, Embase, Physiotherapy Evidence, Ovid, and CINAHL databases were searched to identify original research articles conducted on the reliability of rehabilitative US imaging published from June 2007 to August 2017. The articles were qualitatively assessed; reliability data were extracted; and the methodological quality was evaluated by 2 independent reviewers. Of the 26 included studies, 16 were considered of high methodological quality. Except for 2 studies, all high-quality studies reported intraclass correlation coefficients (ICCs) for intra-rater reliability of 0.70 or greater. Also, ICCs reported for inter-rater reliability in high-quality studies were generally greater than 0.70. Among low-quality studies, reported ICCs ranged from 0.26 to 0.99 and 0.68 to 0.97 for intra- and inter-rater reliability, respectively. Also, the reported standard error of measurement and minimal detectable change for rehabilitative US were generally in an acceptable range. Generally, the results of the reviewed studies indicate that rehabilitative US imaging has good levels of both inter- and intra-rater reliability.
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Affiliation(s)
- Morteza Taghipour
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammad Ali Mohseni-Bandpei
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- University Institute of Physical Therapy, Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan
| | - Hamid Behtash
- Department of Orthopedics, Hazrat e Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Iraj Abdollahi
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Fatemeh Rajabzadeh
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammad Reza Pourahmadi
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mahnaz Emami
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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30
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Djordjevic OC, Konstantinovic LM, Miljkovic N. Difference between subjects in early chronic phase of low back pain with and without neuropathic component: observational cross-sectional study. Eur J Phys Rehabil Med 2018; 55:217-224. [PMID: 30345731 DOI: 10.23736/s1973-9087.18.05226-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Neuropathic pain in early chronic low back pain is insufficiently recognized and treated. AIM The aim of this study was to establish if there is a difference among chronic low back pain subjects with and without neuropathic pain and healthy subjects, in clinical characteristic and the level of trunk muscle activation. DESIGN Cross sectional observational study. SETTING Rehabilitation clinic, inpatient and outpatient. POPULATION Thirty-three subjects in early chronic phase of low back pain and 26 healthy subjects were included in this research. METHODS Clinical characteristics and relative thickness change of lumbar multifidus and transversal abdominal muscle, measured by ultrasound, in neuropathic, non-neuropathic chronic low back pain and healthy subjects were analyzed. RESULTS Chronic low back pain subjects with neuropathic pain reported higher level of pain on Visual Analog Scale (VAS) (back pain P=0.016, leg pain P=0.006), had higher Oswestry Disability Score (P=0.029), had lower motor (P=0.001) and sensory leg scores (P=0.000), and decreased level of activation of transversal abdominal muscle (P=0.000) comparing to chronic low back pain group without neuropathic pain. Low back pain subjects with leg pain ≥5 on VAS were 11.2 times more prone to develop neuropathic pain. Motor leg score ≤47 increases this chance 35 times. Sensory leg score ≤25 increases this chance 14 times. Reduced activation of transversal abdominal muscle for 40-50% increases this chance 7-24 times. CONCLUSIONS Chronic low back pain subjects with neuropathic pain were more painful and disabled, had lower motor and sensory scores, and lower relative thickness change of transversal abdominal muscle comparing to the low back pain group without neuropathic pain. Self -reported leg pain intensity of 5 or more on VAS, motor score of 47 and less, sensory scores of 25 and less and diminished activation of transversal abdominal muscle significantly increase the chance that chronic low back pain subject has neuropathic component of pain. CLINICAL REHABILITATION IMPACT Neuropathic pain in early chronic low back pain subjects might be more readily recognized if patients with radiculopathy and diminished activation of transversal abdominal muscle were regularly screened for neuropathic pain.
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Affiliation(s)
- Olivera C Djordjevic
- Clinic for Rehabilitation "Dr. M. Zotovic", Belgrade, Serbia - .,Faculty of Medicine, University of Belgrade, Belgrade, Serbia -
| | - Ljubica M Konstantinovic
- Clinic for Rehabilitation "Dr. M. Zotovic", Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nadica Miljkovic
- Faculty of Electrical Engineering, University of Belgrade, Belgrade, Serbia
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Intra- and inter-rater reliabilities for novel muscle thickness assessment during Co-contraction with dual-rehabilitative ultrasound imaging. Phys Ther Sport 2018; 32:109-114. [DOI: 10.1016/j.ptsp.2018.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 02/26/2018] [Indexed: 01/22/2023]
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32
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Sutherlin MA, Gage M, Mangum LC, Hertel J, Russell S, Saliba SA, Hart JM. Changes in Muscle Thickness Across Positions on Ultrasound Imaging in Participants With or Without a History of Low Back Pain. J Athl Train 2018; 53:553-559. [PMID: 29912568 DOI: 10.4085/1062-6050-491-16] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Injury-prediction models have identified trunk muscle function as an identifiable factor for future injury. A history of low back pain (HxLBP) may also place athletes at increased risk for future low back pain. Reduced muscle thickness of the lumbar multifidus (LM) and transversus abdominis (TrA) has been reported among populations with clinical low back pain via ultrasound imaging in multiple positions. However, the roles of the LM and TrA in a more functional cohort and for injury prediction are still unknown. OBJECTIVES To (1) assess the reliability of LM and TrA ultrasound measures, (2) compare changes in muscle thickness across positions between persons reporting or not reporting HxLBP, and (3) determine the ability to distinguish between groups. DESIGN Cross-sectional study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS Participants were 34 people who did not report HxLBP (age = 22 ± 7 years, body mass index = 23.7 ± 2.7) and 25 people who reported HxLBP (age = 25 ± 10 years, body mass index = 24.0 ± 3.2). MAIN OUTCOME MEASURE(S) Muscle thickness and changes in muscle thickness of the LM and TrA as shown on ultrasound imaging. RESULTS Intraclass correlation coefficients ranged from 0.641 to 0.943 for all thickness measures and from 0 to 0.693 for all averaged thickness modulations bilaterally. Participants who reported HxLBP had voluntarily reduced TrA thickness modulations compared with those not reporting HxLBP ( P = .03), and the testing position influenced TrA thickness modulations ( P < .01). No differences were observed for LM thickness modulations between groups or positions ( P > .05). A tabletop cutoff value of 1.32 had a sensitivity of 0.640 and a specificity of 0.706, whereas a seated cutoff value of 1.18 had a sensitivity of 0.600 and a specificity of 0.647. CONCLUSIONS In participants reporting HxLBP, TrA thickness modulations were lower and both tabletop and seated thickness modulations were able to distinguish reported HxLBP status. These findings suggest that TrA muscle function may be altered by HxLBP.
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Affiliation(s)
| | - Matthew Gage
- Department of Health Professions, Liberty University, Lynchburg, VA
| | - L Colby Mangum
- Department of Kinesiology, University of Virginia, Charlottesville
| | - Jay Hertel
- Department of Kinesiology, University of Virginia, Charlottesville
| | - Shawn Russell
- Department of Kinesiology, University of Virginia, Charlottesville
| | - Susan A Saliba
- Department of Kinesiology, University of Virginia, Charlottesville
| | - Joseph M Hart
- Department of Kinesiology, University of Virginia, Charlottesville
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Shimizu N, Hashidate H, Ota T, Saito A. Reliability of intensity-based physical activity measurement using an activity monitor in people with subacute stroke in the hospital setting: a cross-sectional study. Top Stroke Rehabil 2018. [DOI: 10.1080/10749357.2018.1446486] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Natsuki Shimizu
- Major in Health Sciences, The Graduate School of Kyorin University, Mitaka, Japan
- Hatsudai Rehabilitation Hospital, Shibuya, Japan
| | - Hiroyuki Hashidate
- Department of Physical Therapy, Kyorin University School of Health Sciences, Mitaka, Japan
| | - Tomohiro Ota
- Major in Health Sciences, The Graduate School of Kyorin University, Mitaka, Japan
- Hatsudai Rehabilitation Hospital, Shibuya, Japan
| | - Akihiko Saito
- Department of Physical Therapy, Kyorin University School of Health Sciences, Mitaka, Japan
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Test-retest reliability of ultrasound measures of intrinsic foot motor function. Phys Ther Sport 2018; 30:39-47. [DOI: 10.1016/j.ptsp.2017.11.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 11/22/2017] [Accepted: 11/29/2017] [Indexed: 12/18/2022]
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Larivière C, Gagnon DH, Henry SM, Preuss R, Dumas JP. The Effects of an 8-Week Stabilization Exercise Program on Lumbar Multifidus Muscle Thickness and Activation as Measured With Ultrasound Imaging in Patients With Low Back Pain: An Exploratory Study. PM R 2017; 10:483-493. [DOI: 10.1016/j.pmrj.2017.10.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 08/25/2017] [Accepted: 10/21/2017] [Indexed: 11/24/2022]
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Cuellar WA, Blizzard L, Callisaya ML, Hides JA, Jones G, Ding C, Winzenberg TM. Test-retest reliability of measurements of abdominal and multifidus muscles using ultrasound imaging in adults aged 50-79 years. Musculoskelet Sci Pract 2017; 28:79-84. [PMID: 28715299 DOI: 10.1016/j.msksp.2016.11.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 11/04/2016] [Accepted: 11/19/2016] [Indexed: 11/16/2022]
Abstract
Test-retest reliability of the combined process of ultrasound imaging (USI) and image measurement of thickness of abdominal and upper lumbar multifidus (MF) muscles and MF cross sectional area (CSA) of older adults has not been established. Imaging muscles of older adults can be challenging due to age-related changes in the spine and skeletal muscle so establishing test-retest reliability in this population is important. This study aimed to evaluate test-retest reliability of USI of abdominal and MF muscle thickness and MF CSA for adults aged 50-79 years. One operator took single sets of ultrasound images of abdominal and MF muscles of 23 adults aged 50-79 years participating in a clinical trial of vitamin D supplementation for knee osteoarthritis, on two occasions, one week apart. Images were subsequently measured by a single examiner. Test-retest reliability for abdominal muscle thickness and MF CSA was substantial (intraclass correlation coefficients (ICC) > 0.81) and for MF thickness ranged from fair to substantial (ICC 0.55-0.86). The standard error of measurement (SEM) was low (0.02-0.21) in every case. ICCs were low and SEM values were high for percentage thickness change. The substantial test-retest reliability of abdominal and MF (L4-L5) muscle thickness and of MF CSA supports the use of USI as a clinical and research tool to assess abdominal and MF muscle thickness and MF CSA of older adults.
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Affiliation(s)
- W A Cuellar
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; School of Medicine, University of Tasmania, Hobart, Tasmania, Australia.
| | - L Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - M L Callisaya
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Southern Clinical School, Monash Medical Centre, Monash University, Clayton, Victoria, Australia
| | - J A Hides
- Centre for Musculoskeletal Research, Mary MacKillop Institute for Health Research, Australian Catholic University, Brisbane, Queensland, Australia
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - C Ding
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Arthritis Research Institute, 1st Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - T M Winzenberg
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
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Wilson A, Hides JA, Blizzard L, Callisaya M, Cooper A, Srikanth VK, Winzenberg T. Measuring ultrasound images of abdominal and lumbar multifidus muscles in older adults: A reliability study. ACTA ACUST UNITED AC 2016; 23:114-9. [DOI: 10.1016/j.math.2016.01.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 01/08/2016] [Accepted: 01/08/2016] [Indexed: 02/07/2023]
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Belavý DL, Armbrecht G, Felsenberg D. Real-time ultrasound measures of lumbar erector spinae and multifidus: reliability and comparison to magnetic resonance imaging. Physiol Meas 2015; 36:2285-99. [DOI: 10.1088/0967-3334/36/11/2285] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Mangum LC, Sutherlin MA, Saliba SA, Hart JM. Reliability of Ultrasound Imaging Measures of Transverse Abdominis and Lumbar Multifidus in Various Positions. PM R 2015; 8:340-347. [PMID: 26428485 DOI: 10.1016/j.pmrj.2015.09.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 09/15/2015] [Accepted: 09/21/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine the reliability of measurement of muscle activation via ultrasound imaging measures of the transverse abdominis (TrA) and lumbar multifidus (LM) in tabletop, seated, standing, and walking conditions. DESIGN Descriptive laboratory study. SETTING University research laboratory. PARTICIPANTS Sixteen healthy participants (age, 20.4 ± 1.8 years; height, 167.7 ± 9.0 cm; mass, 65.1 ± 10.8 kg). INTERVENTIONS None. MAIN OUTCOME MEASUREMENTS The activation ratio (AR) of TrA and LM and preferential activation ratio of TrA in tabletop, seated, standing, and walking positions were assessed by the same examiner during 2 ultrasound imaging sessions 24-72 hours apart. Statistical analysis included determination of intraclass correlation coefficients (ICCs) using analysis of variance for each muscle and position between sessions. RESULTS Excellent reliability was found in TrA AR between sessions for healthy participants in the tabletop position (ICC3,k = 0.903), and acceptable to excellent reliability was found in seated (ICC3,k = 0.613), standing (ICC3,k = 0.553), and walking (ICC3,k = 0.737) positions. LM AR was fair in the tabletop position for these participants (ICC3,k = 0.264). The preferential activation ratio for healthy participants was substantially reliable in tabletop and seated positions (ICC3,k = 0.668, 0.684) and showed fair reliability for walking (ICC3,k = 0.455). CONCLUSIONS Ultrasound imaging is a reliable method of measuring muscle thickness across multiple positions in healthy persons. This measure may be used to compare abdominal muscle thickness across populations or after interventions. LM AR was only found to be reliable in the tabletop position.
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Affiliation(s)
- L Colby Mangum
- University of Virginia Exercise and Sport Injury Laboratory, 210 Emmet St South, Charlottesville, VA 22904(∗).
| | - Mark A Sutherlin
- University of Virginia Exercise and Sport Injury Laboratory, 210 Emmet St South, Charlottesville, VA 22904(†)
| | - Susan A Saliba
- University of Virginia Exercise and Sport Injury Laboratory, 210 Emmet St South, Charlottesville, VA 22904(‡)
| | - Joseph M Hart
- University of Virginia Exercise and Sport Injury Laboratory, 210 Emmet St South, Charlottesville, VA 22904(¶)
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