Intra-rater and inter-rater reliability of a handheld myotonometer measuring myofascial stiffness of lower lumbar myofascial tissue in healthy adults.

Abstract

Biomechanical muscle properties, such as stiffness, can be valuable indicators of tissue health and show promise as a diagnostic and treatment measure for chronic low back pain (CLBP). The development of accessible assessment technologies, such as the MyotonPRO portable device, allows for the convenient quantification of muscle tone and stiffness changes. The aim of this study is to assess the reliability of lumbar erector spinae muscle stiffness with the MyotonPRO in healthy adults and to compare stiffness changes between prone and sitting position. Thirty asymptomatic participants (N = 15 women and N = 15 men) aged between 18 and 65 years were recruited to participate in this study. Two examiners tested muscle stiffness at the palpable muscle belly, one finger away from the spinous process at the level of the L4 vertebra, first from the left and then from the right side, both in prone position and after in sitting position. For inter-rater reliability, all participants were tested by two examiners on the same day, and intra-rater reliability was calculated using the same examiner's assessment results with an exact 24-h interval. Intraclass correlation coefficients (ICC), standard error measures (SEM) and minimum detectable change (MDC) with a 95% confidence interval were calculated to assess intra-rater and inter-rater reliability. Statistical analysis revealed good intra-rater reliability with an ICC of 0.88 (95% CI [0.76-0.94]) for the stiffness of the left erector spinae and excellent intra-rater reliability with an ICC of 0.91 (95% CI [0.82-0.95]) for the right erector spinae, both in the prone position. Intra-rater reliability in the sitting position was excellent to very good with an ICC of 0.91 (95% CI [0.82-0.96]) for the left side and an ICC of 0.89 (95% CI [0.78-0.95]) for the right side. The results for the left-sided prone position showed good inter-rater reliability with an ICC of 0.87 (95% CI [0.73-0.94]). The prone position on the right side also showed good inter-rater reliability with an ICC of 0.84 (95% CI [0.68-0.92]). The inter-rater reliability for the left and right side in the sitting position was excellent with an ICC of 0.96 (95% CI [0.92-0.98]) for the left side and an ICC of 0.95 (95% CI [0.90-0.97]) for the right side. This study demonstrated high reliability in measuring lumbar erector spinae muscle stiffness with the MyotonPRO in healthy adults and the ability of the device to detect even small changes in erector spinae muscle stiffness, testing both the right and left sides and measuring in both prone and sitting positions. The use of the sitting position to assess lumbar tissue tension in individuals may serve as a valuable substitute for the prone position, particularly for patients who experience discomfort in the prone position, and could have additional practical significance in clinical settings.