Valentín-Mazarracin Irene, Nogaledo-Martín Miriam, López-de-Uralde-Villanueva Ibai, Fernández-de-Las-Peñas César, Stokes María, Arias-Buría José L, Díaz-Arribas María J, Plaza-Manzano Gustavo
Complete Health of Lawrenceville, Princeton, NJ 08648, USA.
Centro de Fisioterapia Qsana, 28021 Madrid, Spain.
Diagnostics (Basel). 2021 Feb 13;11(2):298. doi: 10.3390/diagnostics11020298.
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 ( = 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 (: 0.82-1.00) and good to excellent (: 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 (: 0.36-0.60). When evaluating the diagnostic accuracy of manual palpation, the best predictive model (ROC value: 0.89; < 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.
腹部内收动作（ADIM）是一种用于识别腹部深层肌肉优先活动的临床工具。然而，ADIM过程中触诊的同时效度和可重复性尚未得到正式研究。本研究的目的是：（1）评估ADIM过程中手动触诊的评分者内和评分者间信度；（2）通过计算超声成像评估的优先激活率临界值（RUSI）来确定ADIM过程中手动触诊的同时效度。32名受试者（16例非特异性下腰痛患者和16名健康对照个体）在仰卧位钩状卧位下进行ADIM。两名经验丰富的评估者在2个不同日期通过触诊评估ADIM过程中腹部深层肌肉优先收缩的有无。使用Cohen's kappa系数计算触诊的评分者内（重测）和评分者间信度。还测量了腹横肌（TrA）、腹内斜肌（IO）和腹外斜肌（EO）在静息和ADIM过程中的肌肉厚度。计算TrA收缩率（TrA-CR）、TrA优先激活率（TrA-PAR）和改良TrA-PR（M-TrA-PAR）。通过手动触诊与成像之间的相关性以及计算ROC曲线（操作特征曲线）、约登指数、敏感性和特异性来确定手动触诊的同时效度。ADIM过程中手动触诊的评分者内和评分者间信度分别为优秀（κ：0.82 - 1.00）和良好至优秀（κ：0.71 - 1.00）。肌肉厚度的评分者间信度范围为良好至优秀（组内相关系数ICC3,1 0.79 - 0.91）。手动触诊与TrA比率显示出低至中等的相关性（r：0.36 - 0.60）。在评估手动触诊的诊断准确性时，当M-TrA-PAR≥0.08时，获得了预测TrA正确优先收缩的最佳预测模型（ROC值：0.89；P < 0.001）（敏感性：0.95 - 1.00；特异性：0.62）。在患者组和健康组的ADIM过程中，均发现手动触诊具有良好至优秀的评分者内和评分者间信度。手动触诊在识别TrA肌肉的优先活动方面显示出同时效度，支持其在临床实践中的应用。
