Libiani Gianluca, Arcolin Ilaria, Guenzi Marco, Milani Giacomo, Pistono Massimo, Corna Stefano, Godi Marco, Giardini Marica
Division of Physical Medicine and Rehabilitation of Veruno Institute, Istituti Clinici Scientifici Maugeri IRCCS, Gattico-Veruno, 28013 Piedmont, Italy.
Division of Cardiac Rehabilitation of Veruno Institute, Istituti Clinici Scientifici Maugeri IRCCS, Gattico-Veruno, 28013 Piedmont, Italy.
J Clin Med. 2025 May 28;14(11):3770. doi: 10.3390/jcm14113770.
Median sternotomy carries post-surgical risks like sternal instability, requiring careful monitoring. Ultrasonography provides a real-time, quantitative assessment of sternal micromovements and has emerged as a promising tool for clinical evaluation. However, its reliability for assessing sternal micromovements post-surgery remains unclear. This study evaluated the inter-rater, intra-rater, and test-retest reliability of ultrasound performed by physiotherapists. Ultrasound was used to measure the distance between sternal edges in sternotomized patients along the X-axis and Y-axis. Measurements were taken under a resting position, during cough, and in two supine-to-sitting postural transitions (one using a rotational modality and the other with an individual device). Real-time ultrasound imaging acquisition was followed by off-line data elaboration. Assessments were conducted by multiple physiotherapists after a brief training period. Reliability was determined using intraclass correlation coefficients (ICCs), along with the standard error of measurement (SEM) and minimum detectable change (MDC90). ICC values > 0.75 were classified as excellent. A total of 33 subjects with median sternotomy were included (5 women, age 66 ± 7 years). All reliability measurements (24 total) were rated as excellent in each condition examined, with intra-rater ICCs exceeding 0.90, except for on the X-axis during the postural transition using the individual device for supine-to-sitting. SEM values ranged from 0.23 to 0.64 mm, while MDC90 values ranged from 0.54 to 1.50 mm. Ultrasound demonstrated excellent reliability for assessing sternal micromotions when performed by physiotherapists with brief training. Given its reliability, cost-effectiveness, and ease of use, ultrasound sternal micromotions assessment could be integrated into post-surgical rehabilitation to enhance patient care.
正中胸骨切开术存在如胸骨不稳定等术后风险，需要仔细监测。超声检查可对胸骨微运动进行实时、定量评估，已成为临床评估中有前景的工具。然而，其评估术后胸骨微运动的可靠性仍不明确。本研究评估了物理治疗师进行超声检查时的评分者间、评分者内及重测信度。超声用于测量胸骨切开术患者胸骨边缘沿X轴和Y轴的距离。测量在静息位、咳嗽时以及两种仰卧位到坐位的姿势转换过程中（一种使用旋转方式，另一种使用个体装置）进行。实时超声成像采集后进行离线数据处理。在简短培训期后由多名物理治疗师进行评估。使用组内相关系数（ICC）以及测量标准误差（SEM）和最小可检测变化（MDC90）来确定信度。ICC值>0.75被归类为优秀。总共纳入了33例正中胸骨切开术患者（5名女性，年龄66±7岁）。在每个检查条件下，所有信度测量（共24项）均被评为优秀，评分者内ICC超过0.90，但在使用个体装置进行仰卧位到坐位姿势转换时X轴上除外。SEM值范围为0.23至0.64毫米，而MDC90值范围为0.54至1.50毫米。由经过简短培训的物理治疗师进行超声检查时，超声在评估胸骨微运动方面显示出优秀的信度。鉴于其信度、成本效益和易用性，超声胸骨微运动评估可纳入术后康复以改善患者护理。
