E-22 Clinical Case Slide - Shoulder Issues

Abstract

Doppler ultrasound is used to detect intratendinous blood flow (IBF) in Achilles tendinopathy. Commonly applied Doppler modes are color Doppler (CD), power Doppler (PD), and broadband power Doppler “advanced dynamic flow” (ADF). Regarding literature, PD is most often recommended when investigating IBF. However, the consistency and reliability of detecting IBF using different Doppler ultrasound modes is insufficiently investigated. PURPOSE: To investigate the consistency as well as intra- and inter-observer reliability of examining IBF in Achilles tendinopathy patients using CD, PD and ADF. METHODS: Both Achilles tendons of 13 participants (6 f, 7 m, 37±11 yrs, 1.77±0.10 m, 74±16 kg, physical activity 6.8±6.0 hrs/wk) with at least one sided clinically diagnosed Achilles tendinopathy were examined with Doppler ultrasound by 2 investigators (I1 and I2) in randomized order in a test-retest (M1, M2) design. Due to the evident effect of activity on the presence of IBF, M1 and M2 were performed consecutively on the same day. For each investigation, PD was used as reference to localize the highest amount of IBF. Subsequently, the selected area was examined with all 3 Doppler modes in randomized order by taking video clips. Both investigators analysed their own recordings using a modified Öhberg-Score several days after the examination. Kendall’s Coefficient of Concordance (Kendall’s W) and Fleiss Kappa Coefficient were used to compare the 3 modes. For analysis of intra- and inter-observer reliability, Kendall’s tau Correlation Coefficient (CC) was used. RESULTS: In M1, IBF was found in 20/26 (I1) and 18/26 (I2) tendons. In M2, vessels were present in 22/26 (I1) and 17/26 (I2) tendons, respectively. Comparing the 3 modes for both examiners in M1 and M2, Kendall’s W ranged from 0.96-0.98 (Fleiss Kappa 0.73-0.83). The CC for intra-observer reliability of both examiners ranged from 0.85-0.90. For inter-observer reliability, CC ranged from 0.68-0.73 in M1 to 0.77-0.79 in M2. CONCLUSION: The results show an overall very good consistency of the 3 modes, a good intra- and a moderate inter-observer reliability. The higher intra- than inter-observer reliability may be ascribed to the difficile implementation of IBF imaging and a limited objectivity and precision of the scoring system which should be revised in further research.