Kaping Karsten, Äng Björn O, Rasmussen-Barr Eva
Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden Rehabtjänst, Stockholm, Sweden.
Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden Centre for Clinical Research Dalarna, Falun, Sweden Karolinska University Hospital, Stockholm, Sweden.
BMJ Open. 2015 Dec 9;5(12):e008711. doi: 10.1136/bmjopen-2015-008711.
The abdominal drawing-in manoeuvre (ADIM) is a common clinical tool for manually assessing whether a preferential activation of the deep abdominal muscles in patients with low back pain (LBP) is 'correct' or not. The validity and reliability of manual assessment of the ADIM are, however, as yet unknown. This study evaluated the concurrent and discriminative validity and reliability of the manually assessed ADIM.
Single-blinded cross-sectional study.
General population in Stockholm County, Sweden.
The study sample comprised 38 participants seeking care for LBP, and 15 healthy subjects.
The manual ADIM was assessed as correct or not following a standard procedure. Ultrasound imaging (USI) was used as the concurrent reference (gold standard) for the manually assessed ADIM by calculating a ratio of the change in muscle thickness between the resting and the contracted states: the correlation between manual test and USI was calculated. Discriminative validity was analysed by calculating sensitivity and specificity. A sample of 24 participants was analysed with κ coefficients for interobserver reliability between two raters.
The concurrent validity between the manual ADIM and the ADIM-USI ratios showed poor correlations (r=0.13-0.40). The discriminative validity of the manually assessed ADIM to predict LBP showed a sensitivity/specificity of 0.30/0.73, while the ADIM-USI ratio to predict LBP showed 0.19/0.87. The interobserver reliability for the manually assessed ADIM revealed substantial agreement: K=0.71, CI (95%) 0.41 to 1.00.
Although the interobserver reliability of the manually assessed ADIM was high, the concurrent and discriminative validity were both low for examining the preferential activity of the deep abdominal muscles. Neither the manually assessed ADIM nor the ultrasound testing discriminated between participants with LBP and healthy subjects regarding preferential activity of the transversus muscle as this ability/inability was also present in healthy subjects.
腹部内收动作（ADIM）是一种常用的临床工具，用于手动评估腰痛（LBP）患者深部腹肌的优先激活是否“正确”。然而，ADIM手动评估的有效性和可靠性尚不清楚。本研究评估了手动评估ADIM的同时效度、区分效度和可靠性。
单盲横断面研究。
瑞典斯德哥尔摩县的普通人群。
研究样本包括38名寻求LBP治疗的参与者和15名健康受试者。
按照标准程序将手动ADIM评估为正确或不正确。通过计算静息状态和收缩状态之间肌肉厚度变化的比率，将超声成像（USI）用作手动评估ADIM的同时参考（金标准）：计算手动测试与USI之间的相关性。通过计算敏感性和特异性来分析区分效度。对24名参与者的样本进行分析，计算两名评估者之间的观察者间可靠性的κ系数。
手动ADIM与ADIM-USI比率之间的同时效度显示出较差的相关性（r=0.13-0.40）。手动评估ADIM预测LBP的区分效度显示敏感性/特异性为0.30/0.73，而ADIM-USI比率预测LBP显示为0.19/0.87。手动评估ADIM的观察者间可靠性显示出高度一致性：K=0.71，95%置信区间为0.41至1.00。
尽管手动评估ADIM的观察者间可靠性较高，但在检查深部腹肌的优先活动时，其同时效度和区分效度均较低。就腹横肌的优先活动而言，无论是手动评估的ADIM还是超声测试，都无法区分LBP参与者和健康受试者，因为健康受试者也存在这种有或没有该能力的情况。
