Reliability of diaphragmatic mobility assessment using a real time ultrasound among non-specific low back pain

Background and Objective: Ultrasound measurement of Diaphragmatic Mobility (DM) has been shown to be a reliable measurement tool among healthy subjects. However, the measures of reliability are needed prior to clinical use of this device among Non-Specific Low Back Pain (NS-LBP). Therefore, the aim of the study was to investigate the relative and absolute reliability of DM using Real Time Ultrasound (RTUS) among subjects with NS-LBP. Materials and Methods: Nine subjects with NS-LBP (23.33 ± 1.58) years old were recruited. A qualified examiner performed measurement of DM using RTUS by placing transducer on the right subcostal region in semi-fowler’s position with 30 degree elevation of the trunk. The test-retest measures were re-assessed with 24 hour interval between sessions. Results: There was no systematic errors between the test-retest measures (p>0.05). Intra rater reliability showed ICC value of 0.92, which indicates an excellent reliability. The SEMs of the measurement was 2.56 mm and the MDC of 7.09mm. Conclusion:The RTUS for assessing DM provides an excellent intra-rater reliability which may be used as an assessment technique for clinical evaluation of DM in adults with NS-LBP. The SEMs and MDC reported may also allow for accurate interpretation of DM assessments in NS-LBP

Reliability of diaphragmatic mobility assessment: A systematic review

Introduction: Diaphragm Mobility (DM) assessment is gaining interest in the field of medicine and in the healthcare sector. Despite its clinical usage, the measure of reliability in assessing DM is not clearly known. Aim: To critically appraise the evidence describing the reliability measures of DM assessment using any of the diagnostic modalities. Material and methods: A systematic search across five databases was carried out from January 1990 to September 2016. Quality Appraisal of Reliability Studies (QUAREL) and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system were used to assess the risk of bias and for rating the quality of the evidence. In addition, levels of evidence grading which synthesize all the included articles for grading were also used. Results and discussion: Four papers were included for assessing both intra-rater and inter-rater reliability using ultrasound and radiography. Three papers reported ICC measures of reliability, with one paper reporting CV% of reliability. The results demonstrate that, overall, lower levels of evidence exist among the selected articles between moderate and good for intra-rater reliability and good for inter-rater reliability measures. The synthesis of all the included articles demonstrated that, overall, moderate evidence exists. Conclusions: There were moderate-to-good reliability measures with a low risk of bias in both the forms of reliability for assessing diaphragmatic mobility