Department of Physical Therapy, College of Health Sciences, University of Kentucky, 900 South Limestone Street, Lexington, KY 40536 USA.
Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Kentucky.
Phys Ther. 2020 Aug 31;100(9):1701-1711. doi: 10.1093/ptj/pzaa068.
Previous studies have demonstrated that muscle ultrasound (US) can be reliably performed at the patient bedside by novice assessors with minimal training. The primary objective of this study was to determine the interrater reliability of muscle US image acquisition by physical therapists and physical therapist students. Secondarily, this study was designed to elucidate the process for training physical therapists to perform peripheral skeletal muscle US.
This was a cross-sectional observational study. Four novices and 1 expert participated in the study. Novice sonographers engaged in a structured training program prior to implementation. US images were obtained on the biceps brachii, quadriceps femoris, and tibialis anterior muscles in 3 groups: patients in the intensive care unit, patients on the hospital ward, and participants in the outpatient gym who were healthy. Reliability of image acquisition was analyzed compared with the expert sonographer.
Intraclass correlation coefficient values ranged from 0.76 to 0.97 with an average for all raters and all muscles of 0.903, indicating excellent reliability of image acquisition. In general, the experienced physical therapist had higher or similar intraclass correlation coefficient values compared with the physical therapist students in relation to the expert sonographer.
Excellent interrater reliability for US was observed regardless of the level of experience, severity of patient illness, or patient setting. These findings indicate that the use of muscle US by physical therapists can accurately capture reliable images in patients with a range of illness severity and different clinical practice settings across the continuum of care.
Physical therapists can utilize US to obtain images to assess muscle morphology.
Physical therapists can use noninvasive US as an imaging tool to assess the size and quality of peripheral skeletal muscle. This study demonstrates that physical therapists can receive training to reliably obtain muscle images in patients admitted to the intensive care unit who may be at risk for muscle wasting and may benefit from early rehabilitation.
先前的研究表明，经过最少的培训，新手评估者可以可靠地在患者床边进行肌肉超声（US）检查。本研究的主要目的是确定物理治疗师和物理治疗学生进行肌肉 US 图像采集的组内可靠性。其次，本研究旨在阐明培训物理治疗师进行周围骨骼肌 US 的过程。
这是一项横断面观察性研究。四名新手和一名专家参与了研究。新手超声医师在实施前参加了结构化培训计划。在三组中获取肱二头肌、股四头肌和胫骨前肌的 US 图像：重症监护病房的患者、医院病房的患者和在门诊健身房的健康参与者。将图像采集的可靠性与专家超声医师进行了分析比较。
组内相关系数值范围为 0.76 至 0.97，所有评估者和所有肌肉的平均值为 0.903，表明图像采集具有极好的可靠性。一般来说，与专家超声医师相比，经验丰富的物理治疗师的组内相关系数值在与物理治疗学生相关的情况下更高或相似。
无论经验水平、患者疾病严重程度或患者设置如何，都观察到肌肉 US 的极好组内可靠性。这些发现表明，物理治疗师可以使用 US 准确地捕获不同疾病严重程度和不同临床实践环境下连续护理中患者的可靠图像。
物理治疗师可以使用 US 获取图像来评估肌肉形态。
物理治疗师可以使用非侵入性 US 作为一种成像工具来评估周围骨骼肌的大小和质量。本研究表明，物理治疗师可以接受培训，以便在可能有肌肉萎缩风险并可能受益于早期康复的重症监护病房患者中可靠地获取肌肉图像。
