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Reproducibility and concurrent validity of manual palpation with rehabilitative ultrasound imaging for assessing deep abdominal muscle activity: Analysis with preferential ratios

Reproducibility and concurrent validity of manual palpation with rehabilitative ultrasound imaging for assessing deep abdominal muscle activity: Analysis with preferential ratios
Reproducibility and concurrent validity of manual palpation with rehabilitative ultrasound imaging for assessing deep abdominal muscle activity: Analysis with preferential ratios
The abdominal drawing-in maneuver (ADIM) is a clinical tool used for identifying preferential activity of deep abdominal muscles. However, concurrent validity and reproducibility of palpation during the ADIM has not been formally investigated. The aims of this study were (1) to assess intra- and interrater reliability of manual palpation during the ADIM, and (2) to determine the concurrent validity of manual palpation during the ADIM by calculating preferential activation ratio cut-off as assessed with ultrasound imaging (RUSI). Thirty-two subjects (n = 16 patients with nonspecific low back pain and 16 comparable healthy individuals) performed the ADIM in a supine hook-lying position. Two experienced assessors evaluated the presence or absence of preferential contraction of the deep abdominal muscles by palpation during the ADIM on 2 different days. Intrarater (test-retest) and interrater reliability of palpation were calculated using Cohen’s kappa coefficients. Muscle thickness of the transverse abdominis (TrA), internal oblique (IO), and external oblique (EO) muscles at rest and during the ADIM were also measured. TrA-Contraction Ratio (TrA-CR), TrA-Preferential Activation Ratio (TrA-PAR), and Modified-TrA-PR (M-TrA-PAR) were calculated. The concurrent validity of manual palpation was determined using the correlation between manual palpation and imaging and by calculating ROC curve (operating characteristics curve), Youden index, and sensitivity and specificity. Intra- and interrater reliability of manual palpation during the ADIM was excellent (k: 0.82–1.00) and good to excellent (k: 0.71–1.00), respectively. Interrater reliability for muscle thickness ranged from good to excellent (ICC3,1 0.79–0.91). Manual palpation and TrA ratio showed low to moderate correlations (r: 0.36–0.60). When evaluating the diagnostic accuracy of manual palpation, the best predictive model (ROC value: 0.89; p < 0.001) for correct a preferential contraction of TrA was obtained when the M-TrA-PAR was ≥0.08 (sensitivity: 0.95–1.00; specificity: 0.62). Good to excellent intra- and interrater reliability of manual palpation was found during the ADIM in both patients and healthy groups. Manual palpation showed concurrent validity for identifying the preferential activity of the TrA muscle supporting its use in clinical practice.
Core stability, Rehabilitative ultrasound imaging, Reliability, Transversus abdominis
2075-4418
Valentín-Mazarracin, Irene
d79ce538-6c12-4e1a-891b-5b4c68632c03
Nogaledo-Martín, Miriam
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López-de-Uralde-Villanueva, Ibai
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Fernández-de-las-Peñas, Cesar
1a8c5ad5-b405-45fd-8ac3-665ed22a8c88
Stokes, Maria
71730503-70ce-4e67-b7ea-a3e54579717f
Arias-Buría, Jose L.
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Díaz-Arribas, Maria J.
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Plaza-Manzano, Gustavo
d9f895c7-8ab0-468e-b0e1-858e722e4b9c
Valentín-Mazarracin, Irene
d79ce538-6c12-4e1a-891b-5b4c68632c03
Nogaledo-Martín, Miriam
1bf5d1f0-000a-47e4-b577-0f1de94d9ed9
López-de-Uralde-Villanueva, Ibai
7f9c5745-ed96-4938-b74f-caf0a1f1b7b2
Fernández-de-las-Peñas, Cesar
1a8c5ad5-b405-45fd-8ac3-665ed22a8c88
Stokes, Maria
71730503-70ce-4e67-b7ea-a3e54579717f
Arias-Buría, Jose L.
440132e2-28a5-4ff4-b206-e86343fd451a
Díaz-Arribas, Maria J.
d0494fda-2b63-4067-b0d2-58042a40bcfc
Plaza-Manzano, Gustavo
d9f895c7-8ab0-468e-b0e1-858e722e4b9c

Valentín-Mazarracin, Irene, Nogaledo-Martín, Miriam, López-de-Uralde-Villanueva, Ibai, Fernández-de-las-Peñas, Cesar, Stokes, Maria, Arias-Buría, Jose L., Díaz-Arribas, Maria J. and Plaza-Manzano, Gustavo (2021) Reproducibility and concurrent validity of manual palpation with rehabilitative ultrasound imaging for assessing deep abdominal muscle activity: Analysis with preferential ratios. Diagnostics, 11 (2), [298]. (doi:10.3390/diagnostics11020298).

Record type: Article

Abstract

The abdominal drawing-in maneuver (ADIM) is a clinical tool used for identifying preferential activity of deep abdominal muscles. However, concurrent validity and reproducibility of palpation during the ADIM has not been formally investigated. The aims of this study were (1) to assess intra- and interrater reliability of manual palpation during the ADIM, and (2) to determine the concurrent validity of manual palpation during the ADIM by calculating preferential activation ratio cut-off as assessed with ultrasound imaging (RUSI). Thirty-two subjects (n = 16 patients with nonspecific low back pain and 16 comparable healthy individuals) performed the ADIM in a supine hook-lying position. Two experienced assessors evaluated the presence or absence of preferential contraction of the deep abdominal muscles by palpation during the ADIM on 2 different days. Intrarater (test-retest) and interrater reliability of palpation were calculated using Cohen’s kappa coefficients. Muscle thickness of the transverse abdominis (TrA), internal oblique (IO), and external oblique (EO) muscles at rest and during the ADIM were also measured. TrA-Contraction Ratio (TrA-CR), TrA-Preferential Activation Ratio (TrA-PAR), and Modified-TrA-PR (M-TrA-PAR) were calculated. The concurrent validity of manual palpation was determined using the correlation between manual palpation and imaging and by calculating ROC curve (operating characteristics curve), Youden index, and sensitivity and specificity. Intra- and interrater reliability of manual palpation during the ADIM was excellent (k: 0.82–1.00) and good to excellent (k: 0.71–1.00), respectively. Interrater reliability for muscle thickness ranged from good to excellent (ICC3,1 0.79–0.91). Manual palpation and TrA ratio showed low to moderate correlations (r: 0.36–0.60). When evaluating the diagnostic accuracy of manual palpation, the best predictive model (ROC value: 0.89; p < 0.001) for correct a preferential contraction of TrA was obtained when the M-TrA-PAR was ≥0.08 (sensitivity: 0.95–1.00; specificity: 0.62). Good to excellent intra- and interrater reliability of manual palpation was found during the ADIM in both patients and healthy groups. Manual palpation showed concurrent validity for identifying the preferential activity of the TrA muscle supporting its use in clinical practice.

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Reproducibility and Concurrent Validity of Manual Palpation with Rehabilitative Ultrasound Imaging for assessing Deep Abdominal Muscle Activity - Accepted Manuscript
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Accepted/In Press date: 10 February 2021
e-pub ahead of print date: 13 February 2021
Keywords: Core stability, Rehabilitative ultrasound imaging, Reliability, Transversus abdominis

Identifiers

Local EPrints ID: 447052
URI: http://eprints.soton.ac.uk/id/eprint/447052
ISSN: 2075-4418
PURE UUID: f97db38e-041c-47ac-a8c8-a13aa3dd69ce
ORCID for Maria Stokes: ORCID iD orcid.org/0000-0002-4204-0890

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Date deposited: 02 Mar 2021 17:31
Last modified: 26 Nov 2021 02:46

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Contributors

Author: Irene Valentín-Mazarracin
Author: Miriam Nogaledo-Martín
Author: Ibai López-de-Uralde-Villanueva
Author: Cesar Fernández-de-las-Peñas
Author: Maria Stokes ORCID iD
Author: Jose L. Arias-Buría
Author: Maria J. Díaz-Arribas
Author: Gustavo Plaza-Manzano

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