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Intra-examiner and inter-examiner reliability of rehabilitative ultrasound imaging for lumbar multifidus and anterolateral abdominal muscles in females with recurrent low back pain: an observational, cross-sectional study

Hamid Zamani
Hamid Zamani
, 
Mahdi Dadgoo
Mahdi Dadgoo
, 
Mohammad Akbari
Mohammad Akbari
, 
Javad Sarrafzadeh
Javad Sarrafzadeh
 and 
Mohammadreza Pourahmadi
Mohammadreza Pourahmadi
   | Dec 15, 2021
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Article Category: research-article
Published Online: Dec 15, 2021
Page range: 286 - 293
Received: Jun 23, 2021
Accepted: Oct 12, 2021
DOI: https://doi.org/10.15557/jou.2021.0049
Keywords
© 2021 Polish Ultrasound Society. Published by Medical Communications Sp. z o.o.
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Fig. 1.

Sonography imaging of the transverse abdominis, and the internal oblique and external oblique muscles. A. Position of the patient. B. Position of the transducer
Sonography imaging of the transverse abdominis, and the internal oblique and external oblique muscles. A. Position of the patient. B. Position of the transducer

Fig. 2.

Sonography image of the transverse abdominis, and the internal oblique and external oblique muscles A. Rest condition. B. Abdominal draw in maneuver. 1 – transverse abdominis; 2 – internal oblique; 3 – external oblique; 4 – fascial layer
Sonography image of the transverse abdominis, and the internal oblique and external oblique muscles A. Rest condition. B. Abdominal draw in maneuver. 1 – transverse abdominis; 2 – internal oblique; 3 – external oblique; 4 – fascial layer

Fig. 3.

Sonography imaging of the lumbar multifidus muscles. A. Position of the patient. B. Position of the transducer
Sonography imaging of the lumbar multifidus muscles. A. Position of the patient. B. Position of the transducer

Fig. 4.

Sonography image of the lumbar multifidus in level of L5/S1 zygapophyseal joints. A. Rest condition. B. Contraction condition. 1 – fascial layer; 2 – lumbar multifidus; 3 – L5/S1 zygapophyseal joint
Sonography image of the lumbar multifidus in level of L5/S1 zygapophyseal joints. A. Rest condition. B. Contraction condition. 1 – fascial layer; 2 – lumbar multifidus; 3 – L5/S1 zygapophyseal joint

Intra-rater reliability of examiner A

Status Muscles Ultrasound measurements
Within-day (two hours) Between-day (one week)
Rest
Right TrA ICC (95% CI) 0.90 (0.71, 0.97) 0.85 (0.55, 0.95)
SEM (mm) 0.27 0.30
SEM% 8.34 8.95
MDC95 (mm) 0.75 0.83
Mean difference (95% CI) (mm) -0.01 (-0.29, 0.27) -0.21 (-0.53, 0.10)
95% LoA (mm) -1.69, 1.66 -1.73, 1.31
Left TrA ICC (95% CI) 0.88 (0.64, 0.96) 0.82 (0.47, 0.94)
SEM (mm) 0.25 0.35
SEM% 8.16 11.15
MDC95 (mm) 0.69 0.97
Mean difference (95% CI) (mm) -0.01 (-0.27, 0.26) -0.15 (-0.51, 0.22)
95% LoA (mm) -1.43, 1.42 -1.78, 1.48
Right IO ICC (95% CI) 0.82 (0.46, 0.94) 0.85 (0.56, 0.95)
SEM (mm) 0.53 0.50
SEM% 11.25 10.34
MDC95 (mm) 1.47 1.38
Mean difference (95% CI) (mm) 0.15 (-0.39, 0.69) -0.40 (-0.91, 0.12)
95% LoA (mm) -2.29, 2.59 -2.92, 2.12
Left IO ICC (95% CI) 0.76 (0.29, 0.92) 0.84 (0.53, 0.95)
SEM (mm) 0.59 0.49
SEM% 11.68 9.81
MDC95 (mm) 1.63 1.36
Mean difference (95% CI) (mm) 0.47 (-0.11, 1.06) -0.36 (-0.85, 0.14)
95% LoA (mm) -1.90, 2.85 -2.74, 2.03
Right EO ICC (95% CI) 0.96 (0.87, 0.99) 0.91 (0.75, 0.97)
SEM (mm) 0.26 0.39
SEM% 5.97 8.59
MDC95 (mm) 0.72 1.08
Mean difference (95% CI) (mm) -0.12 (-0.41, 0.16) -0.24 (-0.64, 0.16)
95% LoA (mm) -2.65, 2.39 -2.76, 2.29
Left EO ICC (95% CI) 0.80 (0.41, 0.93) 0.91 (0.73, 0.97)
SEM (mm) 0.69 0.41
SEM% 13.47 7.71
MDC95 (mm) 1.91 1.14
Mean difference (95% CI) (mm) -.091 (-0.78, 0.60) -0.29 (-0.72, 0.14)
95% LoA (mm) -3.12, 2.94 -2.95, 2.37
Right LM ICC (95% CI) 0.97 (0.90, 0.99) 0.80 (0.41, 0.93)
SEM (mm) 1.05 2.75
SEM% 3.69 9.77
MDC95 (mm) 2.91 7.62
Mean difference (95% CI) (mm) -0.93 (-2.13, 0.28) 1.57 (-1.20, 4.35)
95% LoA (mm) -12.84, 10.98 -10.50, 13.65
Left LM ICC (95% CI) 0.97 (0.92, 0.99) 0.90 (0.69, 0.96)
SEM (mm) 0.97 1.70
SEM% 3.43 5.94
MDC95 (mm) 2.69 4.71
Mean difference (95% CI) (mm) -0.04 (-1.06, 0.97) -0.71 (-2.53, 1.10)
95% LoA (mm) -11.02, 10.93 -11.24, 9.81
Contraction
Right TrA ICC (95% CI) 0.91 (0.74, 0.97) 0.73 (0.19, 0.91)
SEM (mm) 0.31 0.55
SEM% 6.39 10.95
MDC95 (mm) 0.86 1.52
Mean difference (95% CI) (mm) 0.01 (-0.32, 0.33) -0.35 (-0.89, 0.19)
95% LoA (mm) -2.01,2.02 -2.42, 1.73
Left TrA ICC (95% CI) 0.94 (0.83, 0.98) 0.93 (0.80, 0.98)
SEM (mm) 0.30 0.36
SEM% 5.85 6.97
MDC95 (mm) 0.83 1.00
Mean difference (95% CI) (mm) 0.01 (-0.30, 0.32) -0.09 (-0.46, 0.29)
95% LoA (mm) -2.38, 2.40 -2.76, 2.59
Right IO ICC (95% CI) 0.90 (0.70, 0.97) 0.83 (0.49, 0.94)
SEM (mm) 0.41 0.55
SEM% 7.57 10.23
MDC95 (mm) 1.14 1.52
Mean difference (95% CI) (mm) 0.22 (-0.22, 0.66) -0.13 (-0.69, 0.43)
95% LoA (mm) -2.33, 2.77 -2.73, 2.47
Left IO ICC (95% CI) 0.79 (0.37, 0.93) 0.88 (0.65, 0.96)
SEM (mm) 0.66 0.43
SEM% 11.16 7.36
MDC95 (mm) 1.83 1.19
Mean difference (95% CI) (mm) 0.61 (-0.07, 1.30) -0.47 (-0.91, -0.03)
95% LoA (mm) -2.23, 3.45 -2.88, 1.94
Contraction
Right EO ICC (95% CI) 0.97 (0.91, 0.99) 0.85 (0.55, 0.95)
SEM (mm) 0.22 0.56
SEM% 5.25 12.61
MDC95 (mm) 0.61 1.55
Mean difference (95% CI) (mm) -0.21 (-0.45, 0.03) -0.30 (-0.88, 0.29)
95% LoA (mm) -2.73, 2.31 -3.15, 2.56
Left EO ICC (95% CI) 0.91 (0.74, 0.97) 0.80 (0.41, 0.93)
SEM (mm) 0.41 0.64
SEM% 8.61 12.45
MDC95 (mm) 1.14 1.77
Mean difference (95% CI) (mm) -0.41 (-0.84, 0.01) -0.35 (-0.99, 0.30)
95% LoA (mm) -3.07, 2.24 -3.17, 2.48
Right LM ICC (95% CI) 0.97 (0.90, 0.99) 0.74 (0.24, 0.91)
SEM (mm) 1.07 2.83
SEM% 2.98 7.95
MDC95 (mm) 2.96 7.84
Mean difference (95% CI) (mm) -0.98 (-2.18, 0.22) 1.46 (-1.35, 4.26)
95% LoA (mm) -13.08, 11.12 -9.40, 12.32
Left LM ICC (95% CI) 0.97 (0.92, 0.99) 0.92 (0.77, 0.97)
SEM (mm) 1.01 1.56
SEM% 2.78 4.33
MDC95 (mm) 2.80 4.32
Mean difference (95% CI) (mm) 0.58 (-0.45, 1.61) 0.11 (-1.51, 1.74)
95% LoA (mm) -10.90, 12.05 -10.68, 10.91

Inter-rater reliability of examiners A and B

Muscles Ultrasound measurements
Rest Contraction
Right TrAa ICC (95% CI)b 0.85 (0.57, 0.95) 0.74 (0.21, 0.91)
SEM (mm)c 0.30 0.56
SEM% 8.80 10.83
MDC95 (mm) 0.83 1.55
Mean difference (95% CI) (mm) -0.10 (-0.41, 0.21) -0.05 (-0.62, 0.50)
95% LoA (mm) -1.62, 1.42 -2.21,2.10
Left TrA ICC (95% CI) 0.82 (0.28, 0.94) 0.94 (0.81, 0.98)
SEM (mm) 0.44 0.35
SEM% 12.62 6.79
MDC95 (mm) 1.22 0.97
Mean difference (95% CI) (mm) 0.55 (0.17, 0.93) -0.10 (-0.50, 0.29)
95% LoA (mm) -1.47, 2.56 -2.92, 2.71
Right IO ICC (95% CI) 0.82 (0.47, 0.94) 0.83 (0.51, 0.94)
SEM (mm) 0.68 0.59
SEM% 12.77 10.48
MDC95 (mm) 1.88 1.63
Mean difference (95% CI) (mm) 0.58 (-0.10, 1.26) 0.38 (-0.22, 0.98)
95% LoA (mm) -2.55, 3.71 -2.43, 3.20
Left IO ICC (95% CI) 0.87 (0.60, 0.95) 0.88 (0.63, 0.96)
SEM (mm) 0.52 0.53
SEM% 9.91 8.68
MDC95 (mm) 1.44 1.47
Mean difference (95% CI) (mm) 0.15 (-0.41, 0.71) 0.05 (-0.54, 0.64)
95% LoA (mm) -2.67, 2.97 -2.98, 3.08
Right EO ICC (95% CI) 0.87 (0.62, 0.96) 0.82 (0.42, 0.94)
SEM (mm) 0.48 0.71
SEM% 9.89 14.31
MDC95 (mm) 1.33 1.97
Mean difference (95% CI) (mm) 0.39 (-0.08, 0.86) 0.75 (0.10, 1.40)
95% LoA (mm) -2.23, 3.01 -2.56, 4.05
Left EO ICC (95% CI) 0.85 (0.55, 0.95) 0.84 (0.54, 0.95)
SEM (mm) 0.53 0.65
SEM% 9.57 11.83
MDC95 (mm) 1.47 1.80
Mean difference (95% CI) (mm) 0.15 (-0.41, 0.72) 0.36 (-0.31, 1.04)
95% LoA (mm) -2.55, 2.86 -2.84, 3.57
Right LM ICC (95% CI) 0.88 (0.64, 0.96) 0.73 (0.21, 0.91)
SEM (mm) 2.25 2.72
SEM% 8.30 7.94
MDC95 (mm) 6.24 7.53
Mean difference (95% CI) (mm) -0.55 (-2.97, 1.87) -1.27 (-3.94, 1.40)
95% LoA (mm) -13.28, 12.18 -11.54, 9.00
Left LM ICC (95% CI) 0.96 (0.89, 0.99) 0.98 (0.94, 0.99)
SEM (mm) 1.10 0.78
SEM% 3.80 2.19
MDC95 (mm) 3.05 2.16
Mean difference (95% CI) (mm) -0.06 (-1.27, 1.15) -0.59 (-1.45, 0.27)
95% LoA (mm) -10.88, 10.76 -11.38, 10.20
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