INTRA‐RATER AND INTER‐RATER RELIABILITY OF THE FIVE IMAGE‐BASED CRITERIA OF THE FOOT POSTURE INDEX‐6

Purpose/Background:

The Foot Posture Index‐6 (FPI‐6) is considered a simple quantification tool to assess static foot alignment. Palpation of the foot is required for assessment of one of the six criteria that comprise the FPI‐6; the remaining five criteria may be evaluated using still‐frame photographs. Using only the image‐based criteria may allow multiple clinicians to evaluate large groups of patients quickly. Reliability using only these five image‐based criteria has not been established. The purposes of the current study were to establish the inter‐ and intra‐rater reliability using five image‐based criteria from the Foot Posture Index‐6 (FPI‐6) as well as to examine the agreement between the raters in identifying foot type using the composite five FPI scores.

Methods:

Forty participants (23 females, 17 males; 23.67 ± 8.49 years; 64.59 ± 14.43 kg; 166.07 ± 11.79 cm) volunteered for this study. An investigator took three photos with a digital camera of the medial longitudinal arch, posterior ankle, and of the talonavicular joint approximately 45° from the posterior calcaneus for both right and left feet. Two investigators assessed the five image‐based criteria of the FPI‐6 for both feet of 40 participants on three occasions separated by a day. Inter‐and intra‐rater reliability were assessed with Intraclass Correlation Coefficients (ICC_3,2). The amount of agreement for classification of foot posture type between the two raters was assessed with Cohen''s kappa coefficient. Significance was set a priori at P < 0.05.

Results:

The inter‐rater reliability was poor to moderate for all three sessions (ICC_3,2 = 0.334‐0.634). For the foot posture classification, the amount of agreement between two raters was poor for left (κ= 0.12) and right (κ= 0.19) feet. The intra‐rater reliability was excellent for left (ICC_3,2=0.956) and right feet (ICC_3,2=0.959).

Conclusions:

Excellent intra‐rater and poor to moderate inter‐rater reliability was found using only the five image‐based criteria of the FPI‐6. However, the classification of foot posture did not improve the amount of agreement between raters. Therefore, caution is needed when interpreting FPI scores from five image‐based criteria.

Levels of Evidence:

3b     

Interrater and Intrarater Reliability of the Active Knee Extension (AKE) Test among Healthy Adults

[Purpose] The purpose of this study was to determine the reliability of the active knee extension (AKE) test among healthy adults. [Subjects] Fourteen healthy participants (10 men and 4 women) volunteered and gave informed consent. [Methods] Two raters conducted AKE tests independently with the aid of a simple and inexpensive stabilizing apparatus. Each knee was measured twice, and the AKE test was repeated one week later. [Results] The interrater reliability intraclass correlation coefficients (ICC_2,1) were 0.87 for the dominant knee and 0.81 for the nondominant knee. In addition, the intrarater (test-retest) reliability ICC_3,1 values range between 0.78–0.97 and 0.75–0.84 for raters 1 and 2 respectively. The percentages of agreement within 10° for AKE measurements were 93% for the dominant knee and 79% for the nondominant knee. [Conclusion] The finding suggests the current AKE test showed excellent interrater and intrarater reliability for assessing hamstring flexibility in healthy adults.Key words: Hamstring, Flexibility, Range of movement     

Thickness of the middle trapezius muscle measured by rehabilitative ultrasound imaging: description of the technique and reliability study

A technique is described for measuring the thickness of the middle trapezius muscle using rehabilitative ultrasound imaging (RUSI). A test–retest study was employed to investigate the reliability of the technique in a convenience sample of 16 asymptomatic participants aged 20–41 (12 women). The middle trapezius muscle was imaged using RUSI with participants in a standardized sitting position. The principal investigator took measurements on two consecutive days to examine intra‐rater reliability, and two additional investigators took measurements on the second day to investigate inter‐rater reliability of the measurement technique. Reliability was examined using intra‐class correlation coefficients (ICC), standard error of measurement (SEM), and Bland and Altman plots. The results demonstrated that inter‐rater reliability was good between raters (ICC_2,3 = 0·81, SEM = 0·94 mm) and was moderate for the same rater between days (ICC_3,2 = 0·67, SEM = 1·0 mm). This study demonstrates that RUSI can be used reliably to measure muscle thickness of the middle trapezius muscle following the procedure described.     

INTRA‐ AND INTER‐RATER RELIABILITY OF THE SELECTIVE FUNCTIONAL MOVEMENT ASSESSMENT (SFMA)

Purpose/Background:

The Selective Functional Movement Assessment (SFMA) is a clinical assessment system designed to identify musculoskeletal dysfunction by evaluation of fundamental movements for limitations or symptom provocation. The purpose of this study was to determine the intra‐ and inter‐rater reliability of the ten fundamental movement patterns of the SFMA in a healthy population using the SFMA categorical and criterion checklist scoring tools.

Methods:

35 healthy subjects (22.9 years +/− 1.9) were recorded with two digital video cameras (1‐frontal view/1‐sagittal view) while they performed the ten fundamental movements patterns that comprise the SFMA. Evaluators with varying experience with the SFMA (rater A, > 100 hours; rater B, 25 hours; and rater C, 16 hours) and not present at the initial data collection evaluated each video using categorical and criterion checklist scoring tools. Evaluators repeated this process at least one week later. The evaluators'' composite results were compared between and within raters using the kappa coefficient and ICC''s for categorical scoring and criterion checklist scoring, respectively.

Results

Substantial to almost perfect intra‐rater reliability of the SFMA (kappa, % agreement) was observed for all raters using the categorical scoring tool (rater A: .83, .91; rater B: .78, .88; and rater C: .72, .85). The criterion checklist scoring tool yielded intra‐rater ICCs (3,1; 95% confidence interval) ranging from good to poor with rater A demonstrating the highest reliability (ICC [SEM]) (.52 [2.36]) and rater C the lowest reliability (.26 [3.42]). Inter‐rater reliability of the categorical scoring tool was slight to substantial (.41‐.61, .69‐.79) while the criterion checklist tool (ICC 2,1) demonstrated unacceptable inter‐rater reliability when assessed in all raters together (.43 [2.7]).

Conclusions

As hypothesized, intra‐and inter‐rater reliability of categorical scoring and criterion checklist scoring of the ten fundamental movements of the SFMA was higher in raters with greater experience.     

Reliability of measuring the passive range of shoulder horizontal adduction using a smartphone in the supine versus the side-lying position

[Purpose] The purpose of this study was to compare the reliability of the measurement of the passive range of motion (PROM) of shoulder horizontal adduction (SHA) measurements using a smartphone for the assessment posterior shoulder tightness (PST) between the side-lying and supine test positions. [Subjects and Methods] Forty-seven subjects (mean ± age, 24.9 ± 3.5 years) without shoulder pathology were included in this study. Intra-rater and inter-rater reliabilities were determined using intraclass correlation coefficients. The SHA PROM of each subject’s dominant shoulder was measured using a smartphone by two investigators in two positions: the standard supine position, and a side-lying position on the tested side. [Results] The intra-rater reliability of the supine measurements was fair to good (ICC_3,1 = 0.72–0.89), and for the side-lying measurements was excellent (ICC_3,1 = 0.95–0.97). The inter-rater reliability of the supine measurements was fair (ICC_2,2 = 0.79) and for the side-lying measurements was excellent (ICC_2,2 = 0.94). [Conclusion] These results suggest that for healthy subjects, measurements of SHA using smartphones in the side-lying position has superior intra-rater and inter-rater reliabilities compared to the standard supine position.Key words: Reliability, Horizontal adduction, Smartphone     

RELIABILITY OF THREE MEASURES OF ANKLE DORSIFLEXION RANGE OF MOTION

Purpose/Background:

A variety of methods exist to measure ankle dorsiflexion range of motion (ROM). Few studies have examined the reliability of a novice rater. The purpose of this study was to determine the reliability of ankle ROM measurements using three different techniques in a novice rater.

Methods:

Twenty healthy subjects (mean±SD, age=24±3 years, height=173.2±8.1 cm, mass=72.6±15.2 kg) participated in this study. Ankle dorsiflexion ROM measures were obtained in a weight-bearing lunge position using a standard goniometer, digital inclinometer, and a tape measure using the distance-to-wall technique. All measures were obtained three times per side, with 10 minutes of rest between the first and second set of measures. Intrarater reliability was determined using an intraclass correlation coefficient (ICC_2,3) and associated 95% confidence intervals (CI). Standard error of measurement (SEM) and the minimal detectable change (MDC) for each measurement technique were also calculated.

Results:

The within-session intrarater reliability (ICC_2,3) estimates for each measure are as follows: tape measure (right 0.98, left 0.99), digital inclinometer (right 0.96; left 0.97), and goniometer (right 0.85; left 0.96). The SEM for the tape measure method ranged from 0.4–0.6 cm and the MDC was between 1.1–1.5 cm. The SEM for the inclinometer was between 1.3–1.4° and the MDC was 3.7–3.8°. The SEM for the goniometer ranged from 1.8–2.8° with an MDC of 5.0–7.7°.

Conclusions:

The results indicate that reliable measures of weight-bearing ankle dorsiflexion ROM can be obtained from a novice rater. All three techniques had good reliability and low measurement error, with the distance-to-wall technique using a tape measure and inclinometer methods resulting in higher reliability coefficients (ICC_2,3=0.96 to 0.99) and a lower SEM compared to the goniometer (ICC_2,3=0.85 to 0.96).

Level of Evidence:

2b     

Ultrasound imaging of the serratus anterior muscle at rest and during contraction

The purpose of this study is to describe a clinically feasible method for measuring the thickness of the serratus anterior (SA) muscle using rehabilitative ultrasound imaging (RUSI) and to determine the reliability of repeated measures of that method. An exploratory clinical measurement study using a test–retest methodology was utilized to determine the reliability of the measurements in a sample of 20 healthy subjects. While sitting with the arm flexed 120°, the SA of each subject was imaged at rest, during an active hold and while holding a three pound weight. On Day 1, images were repeated three times for each condition by the same examiner. On Day 2, Examiner 1 and Examiner 2 repeated the scans. Images were examined offline by Examiner 1 with SA thickness measured superior to the most distal rib in the image. Reliability was evaluated using intraclass correlation coefficients (ICCs) and Bland–Altman plots. The intra‐examiner reliability (same day) during rest, active hold and active hold with resistance was ICC_3,3 = 0·892; ICC_3,3 = 0·951; and ICC_3,3 = 0·869–0·971, respectively. Intra‐examiner reliability between days ranged from ICC_3,2 = 0·613 at rest to ICC_3,2 = 0·736 during active hold with resistance. Interexaminer reliability was moderate during active hold (ICC_2,2 = 0·526) and active hold with resistance (ICC_2,2 = 0·535) and poor during rest (ICC_2,2 = 0·425). This study demonstrates that SA thickness can be measured reliably using RUSI by the same examiner and suggests that active movements may increase that reliability.     

Sonographic measurement of the normal suprascapular nerve and omohyoid muscle

The aim of this study was to obtain normative ultrasonography (US) data on the suprascapular nerve (SSN) and omohyoid muscle (OM) in the lateral cervical region. The SSN and OM are known to be related throughout the nerve's course, yet little imaging data exists on these structures at areas more proximal than the suprascapular foramen. US data from a convenience sample of 33 asymptomatic subjects between 21 and 42 years of age were collected. Cross sectional area (CSA) of the SSN, distances from the OM to the SSN, and long-axis diameter of the OM at three reference points were obtained. The mean CSA of the SSN at both its origin and over the first rib was 1.9 mm² and at the distal clavicle was 2.0 mm². The mean distance of the OM to the SSN at these locations was 7.6 mm, 4.2 mm and 2.8 mm respectively. The mean long axis diameter of the OM was 2.4 mm at the SSN origin, 3.4 mm at the first rib, and 4.1 mm at the distal clavicle. We present US data from asymptomatic subjects on the SSN and OM. Our results show that the SSN nerve CSA is consistent throughout the nerves proximal course. Furthermore, the OM and SSN tend to approximate as they course distally. Future studies with larger samples will better characterize the normal sonoanatomy of these structures between genders and across different ages.     

Intra- and Interrater Reliability of Remote Assessment of Transfers by Wheelchair Users Using the Transfer Assessment Instrument (Version 4.0)

ObjectiveTo evaluate the reliability, standard error of measurement, minimum detectable change, and item-level consistency of the Transfer Assessment Instrument (TAI) version 4.0 when used to evaluate transfer quality remotely.DesignParticipants transferred from their wheelchair to a mat table (transfer 1), repeated this after a 10-minute delay to assess intrarater reliability (transfer 2), and repeated this 1-2 days later to assess test-retest reliability (transfer 3). Each transfer was scored in person by 4 raters and asynchronously by a remote clinician rater.Setting2017 National Veterans Wheelchair Games.ParticipantsConvenience sample of 44 full-time wheelchair users (N=44).InterventionsNot applicable.Main Outcome MeasuresTAI total score, subscores (wheelchair setup, body setup, flight/landing), and item scores (15 items).ResultsModerate to excellent reliability was found when scoring remotely for TAI total and subscores for intrarater (intraclass correlation coefficient (ICC(3,1)=0.687-0.854), test-retest (ICC(3,1)=0.695-0.836), and interrater reliability (ICC(3,5)=0.746-0.962). Remote rater total score and flight/landing subscore were greater (indicating higher transfer quality) compared to the average in-person raters (P=.021 and P=.005, respectively). There were no differences between transfers 1-3 in remote rater scores. Item-level percentage agreement between the remote rater and in-person exceeded the 75% cutoff for clinical utility for all items.ConclusionsThe TAI is a reliable outcome measure for assessing transfer technique remotely.     

Isometric muscle strength in children and adolescents using Handheld dynamometry: reliability and normative data for the Brazilian population

Objective

Isometric muscle strength measured by Handheld dynamometer indicates physical ability. There is no normative data for the Brazilian population. This study aims (a) to describe the development of isometric muscle strength in healthy children and adolescents 5–15 years of age; (b) to evaluate Handheld dynamometer inter and intra-rater reliability.

Normative Cross-Sectional Area of the C5-C8 Nerve Roots Using Ultrasonography

This study will define a normal range of values for the cross-sectional area (CSA) of the C5-C8 ventral rami in normal subjects and will assess the interexaminer reliability of the CSA measurements. We also describe the normal sonoanatomy of the C5-C8 ventral rami. Thirty-three normal subjects (20 female) were scanned bilaterally. The mean CSA and reference ranges for the C5, C6, C7 and C8 ventral rami were 7.1 ± 4.1 mm², 10.6 ± 4.3 mm², 12.1 ± 4.1 mm² and 10.7 ± 4.8 mm², respectively. The intraclass correlation coefficient (ICC) demonstrated good reliability with a coefficient of 0.76 overall, with individual level coefficients at C5, C6, C7 and C8 of 0.69, 0.71, 0.76 and 0.72, respectively. This is the first study to obtain normative CSA measurements of the C5-C8 ventral rami. (E-mail: daniel.haun@logan.edu)     

Assessment of the reproducibility of the indirect ultrasound method of measuring diaphragm mobility

The aim of this study was to assess the reproducibility of the ultrasound (US) measurement of craniocaudal displacement of the left branch of the portal vein as an indirect method of measuring right hemidiaphragm mobility in healthy young adults. Forty‐one healthy participants were selected, ranging from 20 to 30 years of age. The US tests were conducted and interpreted by two observers (A and B) on two separate occasions (Test 1 and Test 2). Intra‐observer and interobserver reproducibility and repeatability of US measurements were determined by the intraclass correlation coefficient (ICC_[2,1]) using a 95% confidence interval (CI). Interobserver reproducibility assessment showed ‘high correlation’ for Test 1 and Test 2 (ICC_[2,1] = 0·83, 95% CI = 0·70–0·91, and ICC_[2,1]  = 0·79, 95% CI = 0·61–0·89, respectively). Intra‐observer reproducibility assessment showed ‘moderate correlation’ for observer A (ICC_[2,1]  = 0·69, 95% CI = 0·45–0·84) and for observer B (ICC_[2,1]  = 0·65, 95% CI = 0·39–0·81). Repeatability assessment showed ‘high correlation’ for all tests performed (ICC_[2,1]  = 0·86, 0·80, 0·74, 0·79, P<0·001). In conclusion, US measurement of craniocaudal displacement of the left branch of the portal vein is a reproducible method of measuring right hemidiaphragm mobility in healthy young adults.     

The value of sonographic quantitative parameters in the diagnosis of carpal tunnel syndrome in the Vietnamese population

ObjectiveTo examine the value of ultrasound (US) in the diagnosis of carpal tunnel syndrome (CTS) in the Vietnamese population.MethodsThis prospective cross-sectional study involved 42 wrists of 25 patients with idiopathic CTS evaluated by US. In addition, 38 wrists of 22 healthy volunteers were included as the control group.ResultsSignificant differences in the median nerve cross-sectional area (CSA) at different levels were found between patients with CTS and controls. Using a cut-off value of 9.5 mm² for the median nerve CSA at the pisiform (p-CSA), US had a sensitivity and specificity of 95.2% and 97.4%, respectively, for the diagnosis of CTS. Area under the curve analysis revealed a sensitivity and specificity of 100% and 95.4%, respectively, for the prediction of severe CTS using a p-CSA of >15.5 mm².ConclusionsThe median nerve CSA is a highly accurate parameter in the diagnosis of CTS. We recommend using a p-CSA of >9.5 mm² as a diagnostic criterion for CTS and a p-CSA of >15.5 mm² as a marker for severe CTS in the Vietnamese population.Research Registry number: 7261     

Reliability of the Modified CKCUEST and correlation with shoulder strength in adolescent basketball and volleyball players

BackgroundPhysical performance tests provide a more complete picture of the functional status of the athlete's upper extremity.ObjectivesThe primary purpose was to evaluate the reliability of the Modified Closed Kinetic Chain Upper Extremity Stability Test (MCKCUEST) in adolescent volleyball and basketball players. The secondary objective was to evaluate the relationship between the MCKCUEST and shoulder rotation isometric strength in this population.MethodsSeventy-three healthy basketball (n = 39) and volleyball (n = 34) players participated to establish the reliability and correlations of the MCKCUEST. We used a two-session measurement design to evaluate the reliability of the MCKCUEST. Shoulder rotation isometric strength was performed to determine relationships with the MCKCUEST.ResultsThe intraclass correlation coefficients (ICC_2,1) for intra-session reliability of the MCKCUEST ranged from 0.86 to 0.89, and the between days test–retest reliability (ICC_3,1) was 0.93. The standard error of measurement (1 touch) and the minimal detectable change (3 touches) showed clinically acceptable absolute reliability values. A weak correlation was found between the MCKCUEST power score and shoulder rotation isometric strength (r values between 0.3 and 0.4).ConclusionsResults demonstrated good to excellent relative reliability and clinically acceptable absolute reliability values for the MCKCUEST on adolescent basketball and volleyball athletes. Performances on the MCKCUEST were weakly associated with shoulder rotation strength.     

Separate assessment of gluteus medius and minimus: B-mode or M-mode ultrasound?

Abstract

The hip abductors gluteus medius (Gmed) and minimus (Gmin) differ slightly in function and how they are affected by hip joint pathology. A separate assessment of Gmed and Gmin is feasible by ultrasound (US) imaging. B-mode and M-mode US can be used to measure muscle thickness. Two B- and two M-mode scans of Gmed and Gmin thickness were taken in relaxation on 16 asymptomatic volunteers, repeated within 4 days on 11 subjects. Three types of intra-rater reliability of muscle thickness measurements were examined: (1) within-session reliability comparing two scans from the same session, (2) between-days reliability comparing thickness from two scanning occasion within 4 days and (3) reliability of taking thickness measurements by re-measuring the same US scans after 1 week. Thickness measurements on B- and M-mode images provided ICC_3,1 >0.96 for within-session reliability. ICC_3,k >0.89 for between-days reliability and ICC_3,1 >0.85 for re-reading the same scans were estimated. Minimal detectable changes >1.0?mm within-session, >2.4?mm between-days and >1.7?mm for re-reading scans indicated that small thickness changes are not detectable. The investigation suggests a slight advantage for fascia recognition in B-mode and the advantage of visual control of muscle relaxation in M-mode.     

Absolute reliability of isokinetic knee flexion and extension measurements adopting a prone position

The main purpose of this study was to determine the absolute and relative reliability of isokinetic peak torque (PT), angle of peak torque (APT), average power (PW) and total work (TW) for knee flexion and extension during concentric and eccentric actions measured in a prone position at 60, 180 and 240° s^?1. A total of 50 recreational athletes completed the study. PT, APT, PW and TW for concentric and eccentric knee extension and flexion were recorded at three different angular velocities (60, 180 and 240° s^?1) on three different occasions with a 72‐ to 96‐h rest interval between consecutive testing sessions. Absolute reliability was examined through typical percentage error (CV_TE), percentage change in the mean (ChM) and relative reliability with intraclass correlations (ICC_3,1). For both the knee extensor and flexor muscle groups, all strength data (except APT during knee flexion movements) demonstrated moderate absolute reliability (ChM < 3%; ICCs > 0·70; and CV_TE < 20%) independent of the knee movement (flexion and extension), type of muscle action (concentric and eccentric) and angular velocity (60, 180 and 240° s^?1). Therefore, the current study suggests that the CV_TE values reported for PT (8–20%), APT (8–18%) (only during knee extension movements), PW (14–20%) and TW (12–28%) may be acceptable to detect the large changes usually observed after rehabilitation programmes, but not acceptable to examine the effect of preventative training programmes in healthy individuals.     

Inter-Rater,Intra-Rater,and Inter-Machine Reliability of Quantitative Ultrasound Measurements of the Patellar Tendon

The use of ultrasound (US) to perform quantitative measurements of musculoskeletal tissues requires accurate and reliable measurements between investigators and ultrasound machines. The objective of this study was to evaluate inter-rater and intra-rater reliability of patellar tendon measurements between providers with different levels of US experience and inter-machine reliability of US machines. Sixteen subjects without a history of knee pain were evaluated with US examinations of the patellar tendon. Each tendon was scanned independently by two investigators using two different ultrasound machines. Tendon length and cross-sectional area (CSA) were obtained, and examiners were blinded to each other's results. Tendon length was measured using a validated system involving surface markers and calipers, and CSA was measured using each machine's measuring software. Intra-class correlation coefficients (ICCs) were used to determine reliability of measurements between observers, where ICC > 0.75 was considered good and ICC > 0.9 was considered excellent. Inter-rater reliability between sonographers was excellent and revealed an ICC of 0.90 to 0.92 for patellar tendon CSA and an ICC of 0.96 for tendon length. ICC for intra-rater reliability of tendon CSA was also generally excellent, with ICC between 0.87 and 0.96. Inter-machine reliability was excellent, with ICC of 0.91–0.98 for tendon CSA and 0.96–0.98 for tendon length. Bland–Altman plots were constructed to measure validity and demonstrated a mean difference between sonographers of 0.03 mm² for CSA measurements and 0.2 mm for tendon length. Using well-defined scanning protocols, a novice and an experienced musculoskeletal sonographer attained high levels of inter-rater agreement, with similarly excellent results for intra-rater and inter-machine reliability. To our knowledge, this study is the first to report inter-machine reliability in the setting of quantitative musculoskeletal ultrasound.     

Does Magnetic Resonance Imaging Provide Superior Reliability for Achilles and Patellar Tendon Cross-Sectional Area Measurements Compared with Ultrasound Imaging?

This study investigated the reliability of Achilles and patellar tendon cross-sectional area (CSA) measurement using ultrasound imaging (USI) and magnetic resonance imaging (MRI). Fifteen healthy adults were imaged twice on two occasions, interrupted by a tendon loading protocol. Tendon CSA segmentations were conducted by an experienced and an inexperienced rater blinded to information regarding subject, session and loading status. USI provided good test-retest reliability (intra-class correlation coefficient [ICC] 2,1 > 0.85, standard error of measurement [SEM] 5%–6%), while with MRI it was excellent (ICC 2,1 > 0.92, SEM 4%) for the experienced rater. This study suggests that MRI provides superior reliability for tendon CSA measurements compared with USI. However, the difference in reliability between the methods was small, and the results were inconclusive regarding objectivity and sensitivity to change when assessed based on the effect of loading. We concluded that both methods can be used for reliable CSA measurements of the Achilles and patellar tendons when using a highly standardized measurement protocol and when conducted by an experienced rater.     

Assessment of Gluteus Maximus Muscle Area With Different Image Analysis Programs

Wu GA, Bogie K. Assessment of gluteus maximus muscle area with different image analysis programs.

Objective

To determine the effectiveness of a percutaneous gluteal stimulation system (GSTIM) by comparing assessments of axial computed tomography (CT) scans for the pelvic area.

Design

Comparing the measurements of the cross-sectional area (CSA) of the gluteus maximus muscle between raters and 2 image analysis programs.

Setting

Retrospective axial CT scans of the pelvic area.

Participants

Men (N=9) with complete (below T6) spinal cord injury (SCI) and at least 2 years postinjury participated in the study (range, 29-75y; mean age, 51.8y).

Intervention

Comparing gluteus maximus CSA before and after a period of GSTIM.

Main Outcome Measure

Measurements made by 2 expert and 2 nonexpert raters were used to compare the repeatability and reliability of measuring muscle CSA. The longitudinal study presented is from repeated CT scans obtained over a 2-year period for 1 representative participant who received a GSTIM system.

Results

For repeatability, nonexpert raters measured a mean CSA of 35.2cm² (range, 20-45cm²), while experts measured 21cm² (range, 10-35cm²). A composite of all raters using the same program had SDs of 2.5 to 2.6cm² for a program available through the National Institutes of Health and 2.5 to 4.4cm² for a commercially available program. For reliability, differences between the 2 programs had mean differences in SD between 2.2 and 3.7cm².

Conclusions

The same rater and program (preferably the more reliable ImageJ) is recommended for the course of a longitudinal study. Otherwise, significant error would be introduced. Furthermore, significant increases in the CSA of gluteal muscle compared with preintervention (baseline) measurements were observed for the participant receiving GSTIM.     

Chest computed tomography is a valid measure of body composition in individuals with advanced lung disease

There is growing interest in evaluating body composition using routine clinical computed tomography (CT) scans; however, the validity of this technique in lung transplant patients has not been described. The study objectives were to determine the reliability of measuring fat compartments from thoracic CT and evaluate the validity of muscle and fat cross‐sectional area (CSA) from thoracic CT by comparing to bioelectrical impedance analysis (BIA). Thoracic CT scans from lung transplant assessments were obtained for analysis. Total thoracic muscle CSA, pectoral muscle CSA, subcutaneous adipose tissue (SAT), and mediastinal adipose tissue (MAT) were manually segmented by two independent raters. Reliability was analysed using intra‐class correlation coefficient (ICC). Correlations were determined between CT measures with fat‐free mass index (FFMI), body fat mass index (BFMI) and per cent body fat (%BF) from BIA; and anthropometrics [body mass index (BMI) and waist circumference (WC)]. High inter‐ and intra‐rater reliability were found for SAT and MAT (ICCs = 0.99). Pectoral and total muscle CSA were correlated with FFMI (r = .41, p = .003 and r = .57, p < .001, respectively). SAT was associated with whole‐body fat from BIA and with BMI and WC (r = .61 to .80, p < .001). MAT was associated with BMI (r = .58, p < .001) and WC (r = .61, p < .001). This study supports the reliability and validity of using thoracic CT to measure muscle and fat. Future studies are needed to investigate whether these CT‐based measures are predictive of clinical and post‐transplant outcomes in advanced lung disease.