Abstract
Rehabilitative ultrasound imaging (RUSI) technique seems to be a valid and reliable tool for diagnosis and treatment in physiotherapy and has been widely studied in the lumbopelvic region the last three decades. The aims for this utility in clinical settings must be review through a systematic review, meta-analysis and meta-regression. A systematic review was designed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines with PROSPERO registration and per review in all phases of the process using COVIDENCE, analysis of risk of bias and meta-analysis using REVMAN, and meta-regression calculation using STATA. Database screening provided 6544 references, out of which 321 reported narrative synthesis, and 21 reported quantitative synthesis, while only 7 of them provided comparable data to meta-analyze the variables pain and muscle thickness. In most cases, the forest plots showed considerable I2 heterogeneity indexes for multifidus muscle thickness (I2 = 95%), low back pain (I2 = 92%) and abdominal pain (I2 = 95%), not important for transversus abdominis muscle thickness (I2 = 22%), significant heterogenity (I2 = 69%) depending on the subgroup and not important internal oblique muscle thickness (I2 = 0%) and external oblique muscle thickness (I2 = 0%). Meta-regression did not provide significant data for the correlations between the variables analyzed and the intervention, age, and BMI (Body Mass Index). This review reveals that RUSI could contribute to a high reliability of the measurements in the lumbopelvic region with validity and reliability for the assessments, as well as showing promising results for diagnosis and intervention assessment in physiotherapy compared to the traditional model, allowing for future lines of research in this area.
Highlights
The use of an imaging diagnostic tool such as ultrasound (US) in physiotherapy became evident during the first Rehabilitative Ultrasound Imaging [1] (RUSI) Symposium, where an international consensus was reached that meant a turning point in the field, since it became published and recognized by the World Physiotherapy [2]
Heterogeneity levels are low; for the remaining variables, the metaanalyses results were in favor of the control group or with high heterogeneity indexes, which may be due to the small number of studies compared, since their methodology prevented them from being included in the meta-analysis
The forest plot study in the meta-analysis shows that motor control exercises are effective in the treatment of low back pain, obtaining better results compared to other treatments, because of an increase in muscle thickness and contraction capacity, which can be shown with an US
Summary
The use of an imaging diagnostic tool such as ultrasound (US) in physiotherapy became evident during the first Rehabilitative Ultrasound Imaging [1] (RUSI) Symposium, where an international consensus was reached that meant a turning point in the field, since it became published and recognized by the World Physiotherapy [2]. The second edition of this Symposium widened the conceptual framework of the US in physiotherapy and its uses, becoming evident in two publications that describe thoroughly both its scientific event program and its field of interest and competences [3,4]. There is a high incidence of musculoskeletal pain, being the second cause of disability [10] worldwide. Treatment is costly for healthcare systems, with a direct yearly repercussion of $1.02 billion [14] in Australia in 1997 and 11 billion pounds [15] in the UK in 1998
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