De Coninck Kyra, Hambly Karen, Dickinson John W, Passfield Louis
School of Sport and Exercise Sciences, University of Kent, Medway Building, Chatham Maritime, Chatham, Kent, ME4 4AG, UK.
BMC Musculoskelet Disord. 2018 Jun 1;19(1):180. doi: 10.1186/s12891-018-2088-5.
Chronic lower back pain is still regarded as a poorly understood multifactorial condition. Recently, the thoracolumbar fascia complex has been found to be a contributing factor. Ultrasound imaging has shown that people with chronic lower back pain demonstrate both a significant decrease in shear strain, and a 25% increase in thickness of the thoracolumbar fascia. There is sparse data on whether medical practitioners agree on the level of disorganisation in ultrasound images of thoracolumbar fascia. The purpose of this study was to establish inter-rater reliability of the ranking of architectural disorganisation of thoracolumbar fascia on a scale from 'very disorganised' to 'very organised'.
An exploratory analysis was performed using a fully crossed design of inter-rater reliability. Thirty observers were recruited, consisting of 21 medical doctors, 7 physiotherapists and 2 radiologists, with an average of 13.03 ± 9.6 years of clinical experience. All 30 observers independently rated the architectural disorganisation of the thoracolumbar fascia in 30 ultrasound scans, on a Likert-type scale with rankings from 1 = very disorganised to 10 = very organised. Internal consistency was assessed using Cronbach's alpha. Krippendorff's alpha was used to calculate the overall inter-rater reliability.
The Krippendorf's alpha was .61, indicating a modest degree of agreement between observers on the different morphologies of thoracolumbar fascia.The Cronbach's alpha (0.98), indicated that there was a high degree of consistency between observers. Experience in ultrasound image analysis did not affect constancy between observers (Cronbach's range between experienced and inexperienced raters: 0.95 and 0.96 respectively).
Medical practitioners agree on morphological features such as levels of organisation and disorganisation in ultrasound images of thoracolumbar fascia, regardless of experience. Further analysis by an expert panel is required to develop specific classification criteria for thoracolumbar fascia.
慢性下背痛仍被视为一种了解不足的多因素疾病。最近，胸腰筋膜复合体被发现是一个促成因素。超声成像显示，慢性下背痛患者的剪切应变显著降低，胸腰筋膜厚度增加25%。关于医学从业者是否就胸腰筋膜超声图像中的紊乱程度达成一致，数据稀少。本研究的目的是建立胸腰筋膜结构紊乱程度从“非常紊乱”到“非常有序”的评分者间信度。
采用评分者间信度的完全交叉设计进行探索性分析。招募了30名观察者，包括21名医生、7名物理治疗师和2名放射科医生，平均临床经验为13.03±9.6年。所有30名观察者独立对30幅超声扫描图像中的胸腰筋膜结构紊乱程度进行评分，采用李克特量表，评分范围为1 =非常紊乱至10 =非常有序。使用克朗巴哈系数评估内部一致性。使用克里彭多夫系数计算总体评分者间信度。
克里彭多夫系数为0.61，表明观察者对胸腰筋膜不同形态的一致性程度适中。克朗巴哈系数（0.98）表明观察者之间具有高度一致性。超声图像分析经验并未影响观察者之间的一致性（有经验和无经验评分者的克朗巴哈系数范围分别为0.95和0.96）。
无论经验如何，医学从业者对胸腰筋膜超声图像中的组织和紊乱程度等形态特征达成了一致。需要专家小组进行进一步分析，以制定胸腰筋膜的具体分类标准。
