Clinical utility of ultrasound imaging for measuring anterior thigh thickness after anterior cruciate ligament injury in an individual patient to assess postsurgery outcome

The present study investigated the clinical utility of ultrasound imaging (USI) for assessing changes in an individual’s quadriceps muscle and subcutaneous fat (SF) thickness of the anterior thigh and their relative proportions. A patient was studied prior to and after anterior cruciate ligament reconstruction (ACLR) surgery and during rehabilitation. This case study involved an 18-year-old female recreational athlete with a complete tear of the anterior cruciate ligament (ACL). Tissue thickness (SF and quadriceps muscle) was measured from transverse USI of the anterior thigh before surgery, at weekly intervals during 12 weeks of postsurgery, and then every 2 weeks for the following 12 weeks (total of 21 measurement sets). Statistically significant differences presurgery to postrehabilitation were found for muscle thickness () and SF tissue thickness () measurements. There was no difference in muscle to fat ratio (). Changes in measurements greater than the reported minimal detectable change (MDC) demonstrate the sensitivity of the USI technique as an objective tool to assess clinically useful changes in an individual’s anterior thigh muscle thickness post-ACLR surgery and during rehabilitation

Anterior thigh composition measured using ultrasound imaging to quantify relative thickness of muscle and non-contractile tissue: a potential biomarker for musculoskeletal health

This study aimed to use ultrasound imaging to provide objective data on the effects of ageing and gender on relative thickness of quadriceps muscle and non-contractile tissue thickness (subcutaneous fat, SF, combined with perimuscular fascia). In 136 healthy males and females (aged 18-90 years n=63 aged 18-35 years; n=73 aged 65-90). Images of the anterior thigh (dominant) were taken in relaxed supine using B-mode ultrasound imaging. Thickness of muscle, SF and perimuscular fascia were measured, and percentage thickness of total anterior thigh thickness calculated. Independent t-tests compared groups. Correlation between tissue thickness and BMI was examined using Pearson’s coefficient. Muscle thickness was: 39±8mm in young males, 29±6mm in females, 25±4mm in older males and 20±5mm in females. Percentage muscle to thigh thickness was greater in young participants (p=0.001). Percentage SF and fascia was 17±6% in young and 26±8% in older males, 32±7% in young and 44±7% in older females. BMI was similar for age and correlated moderately with non-contractile tissue (r=0.54; p<0.001) and poorly with muscle (r=-0.01; p=0.93). In conclusion, this novel application of ultrasound imaging as a simple and rapid means of assessing thigh composition (relative thickness of muscle and non-contractile tissue) may help inform health status, e.g. in older people at risk of frailty and loss of mobility, and aid monitoring effects of weight loss or gain, deconditioning and exercise

The tribulations of trials: Lessons learnt recruiting 777 older adults into REtirement in ACTion (REACT), a trial of a community, group-based active ageing intervention targeting mobility disability

This is the author accepted manuscriptBackground: Challenges of recruitment to randomised controlled trials (RCTs) and successful strategies to overcome them should be clearly reported to improve recruitment into future trials. REtirement in ACTion (REACT) is a UK-based multi-centre RCT recruiting older adults at high risk of mobility disability to a 12-month group-based exercise and behaviour maintenance programme or to a minimal Healthy Ageing control intervention. Methods:The recruitment target was 768 adults, aged 65 years and older scoring 4 to 9 on the Short Physical Performance Battery (SPPB). Recruitment methods included: a) invitations mailed by General Practitioners (GPs); b) invitations distributed via third sector organisations; c) public relations (PR) campaign. Yields, efficiency and costs were calculated. Results: The study recruited 777 (33.9% men) community-dwelling, older adults (mean age 77.55 years (SD 6.79), mean SPPB score 7.37 (SD 1.56)), 95.11% white (n=739) and broadly representative of UK quintiles of deprivation. Over a 20-month recruitment period, 25,559 invitations were issued. Eighty-eight percent of participants were recruited via GP invitations, 5.4% via the PR campaign, 3% via word-of-mouth and 2.5% via third sector organisations. Mean recruitment cost per participant was £78.47, with an extra £26.54 per recruit paid to GPs to cover research costs. Conclusions: REACT successfully recruited to target. Response rates were lower than initially predicted and recruitment timescales required adjustment. Written invitations from General Practitioners were the most efficient method for recruiting older adults at risk of mobility disability. Targeted efforts could achieve more ethnically diverse cohorts. All trials should be required to provide recruitment data to enable evidence-based planning of future trials.National Institute for Health Research, Public Health Research Programm

Non-invasive bio-markers of motor performance with ageing

Objective tests of motor function suitable for older people in epidemiological studies and community settings are lacking. The current study aimed to establish non-invasive biomarkers using conventional and novel tests that do not rely entirely on volition, and identify suitable analysis techniques for complex data. It was hypothesised that novel technologies would improve the discriminant validity of motor function testing. In 138 self-reported healthy males and females (65 young, mean age±SD = 25.7±4.8 years; 73 older, 74.9±5.9 years), nine tests (25 parameters) included: hand grip and quadriceps strength; respiratory muscle strength (peak flow); thigh composition (ultrasound imaging); muscle mechanical properties (Myoton technology); upper limb kinematics (Motor Task Manager); timed up and go; stair climbing; balance. Three questionnaires and one mobility assessment were administered including the health related quality of life (SF36). Four experiments tested hypotheses regarding the influence of recording conditions on mechanical properties to validate the novel MyotonPRO device.Reliability of all tests was confirmed and, as expected, data indicated reduced function with ageing (all p<0.05), with the majority showing gender differences. Some mechanical properties were significantly influenced by testing site, muscle length, contractile status and prior activity. Seven of the 25 parameters (5novel) had high discriminant ability for classifying healthy adults into age/gender groups analysed by linear discriminant function using a stepwise approach. Novel technologies, notably mechanical properties of muscle and thigh composition (relative contribution of muscle and subcutaneous fat on ultrasound scans), improved classification accuracy (from 75% to 89%) when combined with conventional tests, supporting the hypothesis and providing potential screening tools independent of participant effort. High discriminant ability (73 to 80%) was also found for classification based on functional measures. This research has advanced the approach to functional assessment and analysis by producing a comprehensive battery of non-invasive biomarkers with high discriminant ability for indicating musculoskeletal health, providing reference data for comparison with clinical populations. The most sensitive novel biomarkers did not require volition, highlighting potential powerful tests for vulnerable older people with pain or cognitive impairment

Validity of ultrasound imaging versus magnetic resonance imaging for measuring anterior thigh muscle, subcutaneous fat, and fascia thickness

The aim of the present study was to determine the validity of ultrasound (US) imaging versus magnetic resonance imaging (MRI) for measuring anterior thigh muscle, subcutaneous adipose tissue (SAT), and fascia thickness. Twenty healthy, moderately active participants (aged 49.1 ± 9.74 (36–64) years), underwent imaging of the anterior thigh, using ultrasound and MRI modalities on the same day. Images were analyzed offline to assess the level of agreement between US and MRI measurements. Pearson’s correlation coefficient showed an excellent relationship between US imaging and MRI for measuring muscle (r = 0.99, p < 0.01), SAT (r = 0.99, p < 0.01), and non-contractile tissue (SAT combined with perimuscular fascia) thickness (r = 0.99, p < 0.01). Perimuscular fascia thickness measurement showed a poor correlation between modalities (r = 0.39, p < 0.01). Intra-class correlation coefficients (ICC3,1) also showed excellent correlation of the measurements with ICC = 0.99 for muscle thickness, SAT, and non-contractile tissue, but not for perimuscular fascia, which showed poor agreement ICC = 0.36. Bland and Altman plots demonstrated excellent agreement between US imaging and MRI measurements. Criterion validity was demonstrated for US imaging against MRI, for measuring thickness of muscle and SAT, but not perimuscular fascia alone on the anterior thigh. The US imaging technique is therefore applicable for research and clinical purposes for muscle and SAT

Objective measurement of muscle mechanical properties using a myometric device in people with Parkinson's disease in a clinical setting in Africa

Objective: to examine the feasibility and reliability of using a myometric device to objectively measure mechanical properties of muscles in people with Parkinson’s disease in an outpatient setting.Background: clinically, muscle stiffness and tone are assessed subjectively by manual passive movements of a limb [1]. An objective clinical measure of muscle stiffness (rigidity) and tone in Parkinson’s disease (PD) is needed. The feasibility and reliability of a novel hand-held myometric device has been established in other populations, mainly in research environments [2,3,4] but yet to be tested in clinical environments and in the African population with PD.Method: thirty adults with Parkinson’s disease [66.3±8.9 (mean±SD) years, range 47-82 years], Hoehn and Yahr Stages I-III, were studied in an outpatient neurology clinic and physiotherapy department of a teaching hospital in Ghana. Biceps brachii (BB), flexor carpi radialis (FCR) and tibialis anterior (TA) were tested in relaxed supine. A hand-held myometric device that measures mechanical properties of muscle recorded three tissue parameters: stiffness (N/m), non-neural tone (frequency, Hz) and elasticity (log decrement). Group means and standard deviations (±SD) were calculated. The intra-rater reliability of two sets of data was examined within the same session using intraclass correlation coefficients (ICCs), to see whether one set would be sufficient.Results: all 30 participants were recruited and studied within eight weeks, and the technology was acceptable to the patients and therapist. The intra-rater reliability was excellent for BB and TA muscles as all ICCs were above 0.92, and good for FCR with ICCs above 0.73 [Table 1]. The device presented real-time data for each parameter and example values for the group (n=30) on the most affected side were: BB stiffness 240±13N/m, tone 13.6±1.5 Hz and elasticity 1.49±0.31 [Table 2].Conclusion: the technique is feasible and can easily be used in the clinical setting in patients with PD. The technology was reliable for measuring two sets of data, indicating that only one set of measurements is sufficient for clinical practice. Further studies are warranted to obtain healthy control data in Ghana and to assess the effects of physiotherapy treatments on muscle parameters