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. 2015 Apr 15:23:15.
doi: 10.1186/s12998-015-0059-6. eCollection 2015.

Reliability of diagnostic ultrasound in measuring the multifidus muscle

Eirik Johan Skeie  1 , Jan Arve Borge  2 , Charlotte Leboeuf-Yde  3 , Jenni Bolton  4 , Niels Wedderkopp  5
Affiliations

Reliability of diagnostic ultrasound in measuring the multifidus muscle

Eirik Johan Skeie et al. Chiropr Man Therap. .

Abstract

Background: Ultrasound 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.

Methods: From 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.

Results: All 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.

Conclusions: The 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.

Keywords: Agreement; Diagnostic ultrasound; Intraclass correlation coefficient; Limits of agreement; Lumbar multifidus; Measurement; Reliability.

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Figures

Figure 1
Figure 1
Ultrasound image of resting LMM (left image) contracted LMM (right image). Calipers placed on the apex of facet joint of L4, and on the interface between the thoracolumbar fascia and subcutaneous fat.
Figure 2
Figure 2
LOA plot showing agreement between examiner 1 and examiner 2. Study objective 1, measurement of LMM thickness on one still image (N = 30).
Figure 3
Figure 3
LOA plot showing agreement between examiner 1 and examiner 2. Study objective 2, measurement of resting LMM on two sets of images (N = 30).
Figure 4
Figure 4
LOA plot showing agreement between examiner 1 and examiner 2. Study objective 2, measurement of contracted LMM on two sets of images (N = 30).
Figure 5
Figure 5
LOA plot showing agreement between examiner 1 and examiner 2. Study objective 2, measurement of contraction (distance 2 – distance 1) LMM on two sets of images (N = 30).
Figure 6
Figure 6
LOA plot showing agreement between examiner 1 and examiner 2. Study objective 2, measurement of LMM contraction expressed as relative % (distance 2 – distance 1)/distance 1) on two sets of images (N = 30).
Figure 7
Figure 7
Scatter plot of subjects in study objective 3. Day to day scatter, x-axis shows day 1, y axis day 2.
Figure 8
Figure 8
LOA plot showing agreement between examiner 1 before and after the subject performed a motor task. Study objective 4, measuring resting LMM before and after a simple motor task on two sets of images (N = 30).
Figure 9
Figure 9
LOA plot showing agreement between examiner 1 before and after the subject performed a motor task. Study objective 4, measuring contracted LMM before and after a simple motor task on two sets of images (N = 30).
Figure 10
Figure 10
LOA plot showing agreement between examiner 1 before and after the subject performed a motor task. Study objective 4, measurement of contraction (distance 2 – distance 1) LMM on two sets of images (N = 30).
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References

    1. Donelson R, McIntosh G, Hall H. Is it time to rethink the typical course of low back pain? PMR. 2012;4(6):394–401. doi: 10.1016/j.pmrj.2011.10.015. - DOI - PubMed
    1. Kjaer P, Bendix T, Sorensen JS, Korsholm L, Leboeuf-Yde C. Are MRI-defined fat infiltrations in the multifidus muscles associated with low back pain? BMC Med. 2007;5:2. doi: 10.1186/1741-7015-5-2. - DOI - PMC - PubMed
    1. Zhao WP, Kawaguchi Y, Matsui H, Kanamori M, Kimura T. Histochemistry and morphology of the multifidus muscle in lumbar disc herniation: comparative study between diseased and normal sides. Spine. 2000;25(17):2191–9. doi: 10.1097/00007632-200009010-00009. - DOI - PubMed
    1. Yoshihara K, Nakayama Y, Fujii N, Aoki T, Ito H. Atrophy of the multifidus muscle in patients with lumbar disk herniation: histochemical and electromyographic study. Orthopedics. 2003;26(5):493–5. - PubMed
    1. Kader DF, Wardlaw D, Smith FW. Correlation between the MRI changes in the lumbar multifidus muscles and leg pain. Clin Radiol. 2000;55(2):145–9. doi: 10.1053/crad.1999.0340. - DOI - PubMed

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