Highlights
- •Intersession reliability was achievable using multimodal ultrasonography post stroke.
- •Elastography measures showed correlation with myotonometry and spasticity scores.
- •Structural measures were correlated with isometric peak torque assessments.
- •Correlations with vascular measures were less apparent.
Abstract
Objective
To assess the test-retest reliability of diagnostic ultrasonography measurements of
the bilateral biceps brachii (BB), brachial artery, medial gastrocnemius (MG), and
popliteal artery in survivors of stroke and their convergent validity with related
clinical comparators.
Design
Cross-sectional study.
Setting
All procedures were conducted in a university laboratory.
Participants
Sixty-five community dwelling adults (N=65; 26 women, 39 men) with an average age
of 60.9±7.7 years and stroke duration of 5.7±3.9 years participated in this study.
Interventions
Not applicable.
Main Outcome Measures
Measures of muscle structure (ie, thickness, cross-sectional area, fascicle length,
pennation angle), stiffness, and intramuscular blood perfusion were conducted using
B-mode, elastography and color flow Doppler ultrasonography modes, respectively. Convergent
validity was assessed by examining correlations between ultrasonography measures and
assessments of related constructs (ie, dynamic stiffness, isometric peak torque, spasticity,
and systemic vascular function using myotonometry, dynamometry, the Composite Spasticity
Scale, and the Ankle-Brachial Index, respectively). A 2-way random-effects intraclass
correlation coefficient (ICC) model (ICC2,3) was used to determine agreement between intersession measures among a smaller cohort
of participants with stroke (n=20).
Results
ICC estimates ranged from moderate to excellent for muscle stiffness (paretic: ICC=0.74-0.89;
nonparetic: ICC=0.66-0.88), structure (paretic: ICC=0.87-0.99; nonparetic: ICC=0.81-0.98),
and blood perfusion measures (paretic: ICC=0.74-0.84; nonparetic: ICC=0.73-0.88).
Weak to moderate associations were found between myotonometry and elastography measures
of the bilateral BB (r=0.29-0.52, P≤.05) and MG muscles (r=0.31-0.69, P≤.05). The correlations between elastography measures and spasticity scores for the
paretic upper (r=0.35-0.63, P≤.05) and lower limbs (r=0.25-0.37, P≤.05) were also weak to moderate.
Conclusions
Elastography demonstrated mostly weak to moderate correlation with measures of stiffness
using myotonometry as well as scores of paretic upper and lower limb spasticity. The
results also indicate acceptable intersession reliability for muscle and vascular
measures using several ultrasonography modalities among individuals with chronic stroke.
Keywords
List of abbreviations:
ABI (Ankle-Brachial Index), BB (biceps brachii), CSS (Composite Spasticity Scale), EFOV (extended field of view), FMA (Fugl-Meyer Assessment), ICC (intraclass correlation coefficient), MAL (Motor Activity Log), MG (medial gastrocnemius), OCSP (Oxfordshire Community Stroke Project Classification), OR (odds ratio), %SSD (percentage of side-to-side difference)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 22, 2021
Accepted:
September 22,
2021
Received in revised form:
September 18,
2021
Received:
June 19,
2021
Footnotes
Tiev Miller was funded by a postgraduate research studentship through the Department of Rehabilitation Sciences at Hong Kong Polytechnic University (funding code: RL27). This study was substantially supported by a research grant provided to Marco Y. C. Pang by the Research Grants Council (General Research Fund: 151031/18M).
Disclosures: none
Identification
Copyright
© 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
