Department of Sports Medicine, Institute for Human Movement Science, Faculty for Psychology and Human Movement Science, University of Hamburg, Hamburg, Germany.
Conservative and Rehabilitative Orthopedics, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany.
Sci Rep. 2024 Aug 29;14(1):20044. doi: 10.1038/s41598-024-70982-7.
Reduced shear strain and deformability of the thoracolumbar fascia has been linked to low back pain. A number of ultrasound examination methods have been developed for laboratory rather than clinical practice. The aim of this study was to examine the reliability and discriminative validity (patients vs. healthy individuals) of an ultrasound (US) measurement method for the quantification of thoracolumbar fascia deformation (TLFD). A cross-sectional study with US assessment and rater blinding was conducted in a manual therapy clinic and a university laboratory. 16 acute low back pain (aLBP) patients and 15 healthy individuals performed a standardized trunk extension task. US measurements of TLFD were carried out independently by two raters by imaging the TLF in the starting and ending positions of the movement. Intra-rater and inter-rater reliability were calculated using intraclass correlation coefficients (ICCs) and minimal detectable changes (MDC) were calculated. Receiver operating characteristic (ROC) curve analysis was used to determine the cut-off for TLFD to discriminate the study groups. Kappa statistics were performed to assess rater agreement in discrimination. Intra-rater reliability was excellent (ICC: .92, MDC: 5.54 mm, p < .001) and inter-rater reliability was good (ICC: .78, MDC: 8.70 mm, p < .001). The cut-off for TLFD was 6 mm with a sensitivity of 100% and a specificity of 93.75% and the raters agreed moderately (κ = 0.74, p < .001) when distinguishing patients and controls. The reliability of the US method for assessing TLFD is moderate to excellent, and the ability to discriminate aLBP patients from healthy individuals is moderate. The method could be used to capture an additional parameter in morphological aLBP screenings.
胸腰筋膜的剪切应变和变形能力降低与下腰痛有关。已经开发出许多超声检查方法，但这些方法主要用于实验室，而非临床实践。本研究旨在检查一种超声（US）测量方法评估胸腰筋膜变形（TLFD）的可靠性和判别效度（患者与健康个体）。这是一项横断面研究，在手法治疗诊所和大学实验室进行了超声评估和评估者盲法检查。16 名急性下腰痛（aLBP）患者和 15 名健康个体进行了一项标准化的躯干伸展任务。两位评估者在运动的起始和结束位置对 TLF 进行超声测量，以独立进行 TLFD 的 US 测量。使用组内相关系数（ICC）和最小可检测变化（MDC）计算了内部评估者和外部评估者的可靠性。使用受试者工作特征（ROC）曲线分析确定 TLFD 的截止值以区分研究组。卡帕统计用于评估评估者在区分中的一致性。内部评估者可靠性极好（ICC：.92，MDC：5.54mm，p<0.001），外部评估者可靠性良好（ICC：.78，MDC：8.70mm，p<0.001）。TLFD 的截止值为 6mm，灵敏度为 100%，特异性为 93.75%，当区分患者和对照组时，评估者的一致性为中度（κ=0.74，p<0.001）。用于评估 TLFD 的 US 方法的可靠性为中度到极好，区分 aLBP 患者和健康个体的能力为中度。该方法可用于在形态学 aLBP 筛查中捕获附加参数。
