Abstract
BackgroundThe use of musculoskeletal ultrasound (MSUS) in the diagnosis and management of foot and ankle musculoskeletal pathology is increasing. Due to the wide use of MSUS and the depth and breadth of training required new proposals advocate tailored learning of the technique to discrete fields of practice. The aims of the study were to evaluate the inter-observer agreement between a MSUS radiologist and a podiatrist, who had completed basic skills training in MSUS, in the MSUS assessment of the forefoot of patients with Rheumatoid Arthritis.MethodsA consecutive sample of thirty-two patients with rheumatoid arthritis was assessed for presence of synovitis, erosions and bursitis within the forefoot using MSUS. All MSUS assessments were performed independently on the same day by a podiatrist and one of two Consultant Radiologists experienced in MSUS.ResultsModerate agreement on image acquisition and interpretation was achieved for bursitis (kappa 0.522; p < 0.01) and erosions (kappa 0.636; p < 0.01) and fair agreement for synovitis (kappa 0.216; p < 0.05) during the primary assessments. Following a further training session, substantial agreement (kappa 0.702) between the two investigators was recorded. The sensitivity of the podiatrist using MSUS was 82.4% for detection of bursitis, 83.0% for detection of erosion and 84.0% for detection of synovitis. Specificity of the podiatrist using MSUS was 88.9% for detection of bursitis, 80.7% for detection of erosion and 35.9% for detection of synovitis.ConclusionThis study demonstrated good inter-observer agreement between a podiatrist and radiologist on MSUS assessment of the forefoot, particularly for bursitis and erosions, in patients with rheumatoid arthritis. There is scope to further evaluate and consider the role of podiatrists in the MSUS imaging of the foot following appropriate training and also in the development of reliable protocols for MSUS assessment of the foot.
Highlights
As technology has improved, clinical expertise in performing musculoskeletal ultrasound (MSUS) has advanced dramatically [1,2]
This study provided an opportunity to evaluate the interobserver agreement between a radiologist and podiatrist who had followed recommended training guidelines for MSUS, in the MSUS assessment of the forefoot of patients with Rheumatoid Arthritis (RA)
Bursitis was present in 51/62 feet, synovitis in 81/124 MTP joints and erosions in 53/124 MTP joints scanned by the Radiologist (Table 3)
Summary
Clinical expertise in performing musculoskeletal ultrasound (MSUS) has advanced dramatically [1,2]. There have been a number of studies that have utilised MSUS to diagnose specific soft tissue foot pain in healthy volunteers [3,4,5] and soft tissue problems in Rheumatoid Arthritis (RA) [6,7]. The reported challenges in training for this skill are primarily due to the quality and interpretation of the ultrasound images that are acknowledged as being greatly dependent on the expertise and experience of the operator [13]. The aims of the study were to evaluate the inter-observer agreement between a MSUS radiologist and a podiatrist, who had completed basic skills training in MSUS, in the MSUS assessment of the forefoot of patients with Rheumatoid Arthritis
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