Molina-Hernández Nerea, Chicharro José López, Becerro-de-Bengoa-Vallejo Ricardo, Losa-Iglesias Marta Elena, Rodríguez-Sanz David, Vicente-Campos Davinia, Marugán-Rubio Daniel, Gutiérrez-Torre Samuel Eloy, Calvo-Lobo César
Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain.
Grupo FEBIO, Universidad Complutense de Madrid, Madrid, Spain.
Quant Imaging Med Surg. 2023 Oct 1;13(10):6656-6667. doi: 10.21037/qims-23-329. Epub 2023 Aug 17.
The diaphragm is considered the main muscle involved in breathing and also linked to trunk stabilization functions. Up to date, rehabilitative ultrasound imaging (RUSI) has been the most used technique to evaluate unilaterally the transcostal diaphragm thickness. Nevertheless, the inspiratory activity of both hemi-diaphragms is bilaterally performed at the same time, and its simultaneous evaluation with a thoracic orthosis could improve its assessment as well as its re-education with visual biofeedback of both hemi-diaphragms at the same time. The purpose was to evaluate the reliability and repeatability of simultaneous thickness measurements of both hemi-diaphragms bilaterally during normal breathing using a thoracic orthosis that allowed bilateral fixation of both right and left ultrasound probes.
The study was conducted in 46 healthy subjects, whose diaphragm thickness was measured bilaterally and simultaneously in the anterior axillary line during relaxed breathing with a designed thoracic orthosis and 2 ultrasound tools. Intra-examiner (same examiner), inter-examiner (2 examiners), intra-session (1 hour) and inter-session (1 week) reliability and repeatability between each pair of measurements of diaphragm muscle thickness were analyzed during normal breathing.
Reliability and repeatability for intra-session evaluations using the thoracic orthosis were excellent to evaluate simultaneous thickness of both hemi-diaphragms by bilateral probes fixation (intraclass correlation coefficient =0.919-0.997; standard error of measurement =0.002-0.007 cm; minimum detectable change =0.006-0.020 cm), without systematic errors (P>0.05) between each pair of measurements. Nevertheless, inter-session evaluations varied from good to excellent using the bilateral probes fixation (intraclass correlation coefficient =0.614-0.984; standard error of measurement =0.006-0.028 cm; minimum detectable change =0.017-0.079 cm), although some systematic errors were presented (P<0.05).
Good to excellent reliability and repeatability was shown for simultaneous thickness measurements of both hemi-diaphragms bilaterally during normal breathing. Despite systematic errors were presented for some inter-examiner assessments, the use of the thoracic orthosis that allowed bilateral fixation of ultrasound probes could be recommended for simultaneous hemi-diaphragms breathing re-education by visual biofeedback.
膈肌被认为是参与呼吸的主要肌肉，也与躯干稳定功能相关。迄今为止，康复超声成像（RUSI）一直是最常用的单侧评估肋膈角处膈肌厚度的技术。然而，两侧半膈肌的吸气活动是同时双侧进行的，使用胸段矫形器对其进行同步评估，可能会改善对其的评估，以及同时对两侧半膈肌进行视觉生物反馈再训练。目的是评估在正常呼吸过程中，使用一种允许双侧固定左右超声探头的胸段矫形器，双侧同时测量两侧半膈肌厚度的可靠性和可重复性。
该研究在46名健康受试者中进行，使用一种设计的胸段矫形器和2个超声工具，在安静呼吸时于双侧腋前线同时测量膈肌厚度。分析了正常呼吸过程中，每对膈肌厚度测量值之间的检查者内（同一名检查者）、检查者间（2名检查者）、测量时段内（1小时）和测量时段间（1周）的可靠性和可重复性。
使用胸段矫形器进行测量时段内评估时，通过双侧探头固定来评估两侧半膈肌的同步厚度，其可靠性和可重复性极佳（组内相关系数=0.919 - 0.997；测量标准误=0.002 - 0.007厘米；最小可检测变化=0.006 - 0.020厘米），每对测量值之间无系统误差（P>0.05）。然而，使用双侧探头固定进行测量时段间评估时，结果从良好到极佳不等（组内相关系数=0.614 - 0.984；测量标准误=0.006 - 0.028厘米；最小可检测变化=0.017 - 0.079厘米），尽管存在一些系统误差（P<0.05）。
在正常呼吸过程中，双侧同时测量两侧半膈肌厚度显示出良好到极佳的可靠性和可重复性。尽管一些检查者间评估存在系统误差，但对于通过视觉生物反馈进行两侧半膈肌同步呼吸再训练，可推荐使用允许双侧固定超声探头的胸段矫形器。
