METHODOLOGICAL STUDY
Reliability of B-mode ultrasonography for abdominal muscles in asymptomatic and patients with acute low back pain

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Summary

The purpose of this methological study was to develop a reliable method for measuring transversus abdominis, rectus abdominis, external oblique and internal oblique muscles in asymptomatic human subjects and patients with acute low back pain (ALBP). This was a single operator reliability design study using ultrasound imaging to measure muscle thickness in 27 subjects on three separate occasions. Intra-class correlation coefficients (ICC) and standard error of measurement (SEM) were used to analyze muscle thickness. The mean, SD, ICC and SEM for external oblique, internal oblique, transversus abdominis and rectus abdominis muscles in asymptomatic subjects were (5.38, 1.64, 0.96, 0.33), (9.35, 3.42, 0.97, 0.073), (4.36, 1.93, 0.81, 0.45), (10.8, 2.18, 0.85, 0.84), respectively. The mean, SD, ICC, SEM for external oblique, internal oblique and transversus abdominis muscles in patients with ALBP were (5.58, 0.97, 0.87, 0.35), (9.72, 1.92, 0.87, 0.31), (4.36, 1, 0.91, 0.3), respectively. Earlier study on ultrasonographic measurement for neck multifidus muscles has suggested that the reliability of muscle thickness is higher in asymptomatic subjects compared with those in the symptomatic subjects. However, the present study showed high reliability for both symptomatic and asymptomatic subjects. This difference may be related to non-atrophic changes in abdominal muscles in acute low back patients. The results of this study indicate that the measurement of abdominal muscle thickness with B-mode ultrasonography can be performed reliably even in patients with ALBP.

Introduction

Diagnostic ultrasound is incorporated into many aspects of medical evaluation including applications for musculoskeletal measurement and diagnosis (Rhodes and Bishop, 1997; Stokes et al., 1997; Hashimoto et al., 1999). Real-time ultrasound enables the visual imaging and measurement of deep structures within the trunk (Misuri et al., 1997; Cohen et al., 1997; Rezasoltani et al., 2002; Stokes et al., 2005; Rankin et al., 2005). It is the most cost-effective and feasible method among the imaging modalities, to measure, muscle thickness. Muscles are visualized in real-time and measurements can be obtained in a related state and in different states of contraction as well as during movements (Haracke et al., 1988; Hodges et al., 2003; Ferreira et al., 2004; McMeeken et al., 2004; Watanabe et al., 2004). The reliability of ultrasound, as an instrument for measuring muscle thickness, has been reported in some studies (Hides et al., 1996; Pietrek et al., 2000; Bounce et al., 2002; Critchley and Coutts, 2002; Kristjansson, 2004). A recent research on the reliability of cervical multifidus muscle in asymptomatic and symptomatic subjects has demonstrated, lower reliability levels in patients (Kristjansson, 2004). The purpose of this study was to evaluate the intra-operator reliability for the measurement of thickness in transverse abdominis, rectus abdominis, external, and internal oblique muscles in symptomatic subjects and patients with acute low back pain (ALBP).

Section snippets

Subjects

Twenty-seven healthy adults (7 female and 20 males) aged between 18 and 48 years old with no history of low back pain, no spinal deformity, and no history of neuromuscular or musculoskeletal and cardiopulmonary diseases were selected as the normal subjects and 12 patients with known nonspecific ALBP were recruited as the patient group (Table 1). Ethical approval was granted by the Iranian Ministry of Health, Ethics Committee, and subjects gave informed consent to participate in this study.

Ultrasonography protocol

A

Results

The mean, SD of muscle thickness for external obliques, internal obliques, transversus abdominis and rectus abdominis in the asymptomatic subjects was (5.38±1.64);(9.35±3.42);(4.36±1.03), and (10.8±2.18), respectively (Table 2). The mean, SD for the external obliques, internal obliques, and transversus abdominis muscles in ALBP group was (5.58±0.97), (9.72±1.92), and (4.36±1.00), respectively (Table 3). These results indicate that the measures have good to excellent reliability between and

Discussion

The results of this study indicate that the B-mode ultrasonography protocol used in this study is reliable in detecting the thickness of abdominal muscles in asymptomatic and ALBP subjects. To the best of our knowledge, this is the first study to demonstrate that ultrasonography imaging may provide reliable measurements of abdominal muscle thickness in ALBP patients.

Bounce et al. (2002) reported the reliability of M-mode ultrasonography of abdominal muscles in supine, standing, and walking

Conclusion

The results of this study indicate that the measurement of abdominal muscle thickness with B-mode ultrasonography can be performed reliably in ALBP patients. This might help to differentially diagnose and assess the outcomes of prescribed treatments for ALBP patients.

Acknowledgments

The authors would like to thank Dr. Mohamad Parnianpour for his advice and Prof. Maria Stokes and Dr. Duncan Critchley for sending their papers, and Mr. Oskouei for editing paper.

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