Reliability of diaphragmatic mobility assessment: A systematic review

Abstract

Introduction: Diaphragm Mobility (DM) assessment is gaining interest in the field of medicine and in the healthcare sector. Despite its clinical usage, the measure of reliability in assessing DM is not clearly known. Aim: To critically appraise the evidence describing the reliability measures of DM assessment using any of the diagnostic modalities. Material and methods: A systematic search across five databases was carried out from January 1990 to September 2016. Quality Appraisal of Reliability Studies (QUAREL) and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system were used to assess the risk of bias and for rating the quality of the evidence. In addition, levels of evidence grading which synthesize all the included articles for grading were also used. Results and discussion: Four papers were included for assessing both intra-rater and inter-rater reliability using ultrasound and radiography. Three papers reported ICC measures of reliability, with one paper reporting CV% of reliability. The results demonstrate that, overall, lower levels of evidence exist among the selected articles between moderate and good for intra-rater reliability and good for inter-rater reliability measures. The synthesis of all the included articles demonstrated that, overall, moderate evidence exists. Conclusions: There were moderate-to-good reliability measures with a low risk of bias in both the forms of reliability for assessing diaphragmatic mobility.