Archives of Physical Medicine and Rehabilitation
Volume 90, Issue 1 , Pages 87-94, January 2009

Reliability of Rehabilitative Ultrasound Imaging of the Transversus Abdominis and Lumbar Multifidus Muscles

  • Shane L. Koppenhaver, MPT

      Affiliations

    • College of Health, University of Utah, Salt Lake City, UT
    • Officer, United States Army
    • Corresponding Author InformationCorrespondence to Shane L. Koppenhaver, MPT, 1416 Downington Ave, Salt Lake City, UT 84105
  • ,
  • Jeffrey J. Hebert, DC

      Affiliations

    • College of Health, University of Utah, Salt Lake City, UT
  • ,
  • Julie M. Fritz, PhD, PT, ATC

      Affiliations

    • College of Health, University of Utah, Salt Lake City, UT
    • Intermountain Health Care, Salt Lake City, UT
  • ,
  • Eric C. Parent, PhD, PT

      Affiliations

    • Department of Physical Therapy/Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
  • ,
  • Deydre S. Teyhen, PhD, PT

      Affiliations

    • Officer, United States Army
    • US Army-Baylor University Doctoral Program in Physical Therapy, San Antonio, TX
  • ,
  • John S. Magel, DSc, PT

      Affiliations

    • Intermountain Health Care, Salt Lake City, UT

Abstract 

Koppenhaver SL, Hebert JJ, Fritz JM, Parent EC, Teyhen DS, Magel JS. Reliability of rehabilitative ultrasound imaging of the transversus abdominis and lumbar multifidus muscles.

Objectives

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

Design

Single-group repeated-measures reliability study.

Setting

University and orthopedic physical therapy clinic.

Participants

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

Interventions

Not applicable.

Main Outcome Measures

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

Results

By using the mean of 2 measures, intraexaminer reliability point estimates (ICC3,2) ranged from 0.96 to 0.99 for same-day comparisons and from 0.87 to 0.98 for between-day comparisons. Interexaminer reliability estimates (ICC2,2) ranged from 0.88 to 0.94 for within-day comparisons and from 0.80 to 0.92 for between-day comparisons. Reliability estimates comparing measurements by the 2 examiners of the same image (ICC2,2) ranged from 0.96 to 0.98. Reliability estimates were lower for percent thickness change measures than the corresponding single thickness measures for all conditions.

Conclusions

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

Key Words: Abdominal muscles, Low back pain, Rehabilitation, Reproducibility of results, Ultrasonography

List of Abbreviations: ADIM, abdominal drawing-in maneuver, ASLR, active straight leg raise, CI, confidence interval, ICC, intraclass correlation coefficient, LBP, low back pain, LOA, limits of agreement, MDC, minimal detectable change, ODI, modified Oswestry Disability Index, RUSI, rehabilitative ultrasound imaging, TrA, transversus abdominis

 

 Supported in part by Sonosite Inc, Bothell, WA, by providing the ultrasound machine used in this study at no charge to the Division of Physical Therapy, University of Utah.

 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

 Reprints are not available from the author.

PII: S0003-9993(08)01497-4

doi:10.1016/j.apmr.2008.06.022

Archives of Physical Medicine and Rehabilitation
Volume 90, Issue 1 , Pages 87-94, January 2009