Abstract
BackgroundUltrasound is frequently used to measure activity in the lumbar multifidus muscle (LMM). However previous reliability studies on diagnostic ultrasound and LMM have included a limited number of subjects and few have used Bland-Altman’s Limits of Agreement (LOA). Further one does not know if activity affects the subjects’ ability to contract the LMM.MethodsFrom January 2012 to December 2012 an inter- and intra-examiner reliability study was carried out in a clinical setting. It consisted of a total of four experiments with 30 subjects in each study. Two experienced examiners performed all measurements. Ultrasound measurements were made of: 1. the LMM in the resting state, 2. during a contracted state, 3. on subsequent days, and, before and after walking. Reliability and agreement was tested for 1. resting LMM, 2. contracted LMM, and 3. thickness change in the LMM. Mean values of three measurements were used for statistical analysis for each spinal level. The intra-class correlation coefficient (ICC) 3.1 and 3.2 was used to test for reliability, and Bland-Altman’s LOA method to test for agreement.ResultsAll of the studies indicate high levels of reliability, but as the LMM thickness increased (increasing contraction) the agreement between examiners was poorer than for low levels of contraction.ConclusionsThe use of diagnostic ultrasound to measure the LMM seems to be reliable in subjects who have little or no change in thickness of the LMM with contraction.
Highlights
The lumbar multifidus muscle and low back pain It is well known that non-specific low back pain (LBP) is a prevalent disorder often with numerous recurring episodes [1]
Examiners Inter and intra-examiner reliability was tested between two chiropractors who were both experienced in diagnostic ultrasound for the musculoskeletal system
The measurements obtained by the examiner were saved onto the ultrasound machine, and recorded on two different sets of paper that were kept separate until all measurements had been obtained
Summary
Examiners Inter and intra-examiner reliability was tested between two chiropractors who were both experienced in diagnostic ultrasound for the musculoskeletal system. The sample size was considered a convenience sample as the study was conducted in a routine clinical practice setting. The majority of these subjects were LBP patients patients with other spinal complaints such as mid back pain, neck pain, and/or extremity pain were included. In addition some pain-free subjects were recruited from outside the clinic This case mix was to include subjects with the potential ability to produce a contraction of the LMM as well as those with the potential not to. Procedures Ultrasound measurements In this study all the measurements of the LMM were taken with the subjects in a prone position with a pillow placed under the abdomen to flatten the lumbar lordosis as this provides better contact for the transducer.
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