Development of a Musculoskeletal Ultrasound Protocol to Examine Upper Extremity Rehabilitation Outcomes in Systemic Sclerosis

Abstract

Objectives: This study developed a musculoskeletal ultrasound (MSUS) protocol to evaluate rehabilitation outcomes in systemic sclerosis. Materials and Methods: Three MSUS methods (gray-scale, Doppler, strain elastography) and two acquisition techniques (long- vs short-axis; transducer on skin vs floating on gel) were examined in the forearm before and after rehabilitation treatment. For gray-scale, tissue thickness measures and intrarater and interrater reliability were calculated (intraclass correlation coefficients [ICCs]), and paired t tests examined differences among techniques. Results: Five people with diffuse cutaneous systemic sclerosis participated. The most valid and reliable gray-scale technique was with the transducer in long-axis, floating on gel. Doppler and strain elastography did not detect changes. Both dermal and subcutaneous thickness measurement error was small; intrarater and interrater reliability was good to excellent. Preliminary data indicate that treatment may lead to dermal thinning. Conclusion: A replicable protocol was established and may be an adjunct to rehabilitation outcome measurement in systemic sclerosis.

Rehabilitation Interventions in Systemic Sclerosis: A Systematic Review and Future Directions

“…While SSc rehabilitation treatments incorporate specific elements, such as thermal modalities, massage, and stretching, few studies discuss why these components are essential or investigate how they work. For example, to examine if negative pressure treatment affects skin thickness in SSc, Murphy and colleagues developed a protocol to use musculoskeletal ultrasound to examine changes in skin thickness after an occupational therapist-delivered treatment (42). Testing mechanism of action in rehabilitation treatments will help design and better target interventions in the future.…”

Skin involvement in early diffuse cutaneous systemic sclerosis: an unmet clinical need

“…The two main methods in this category are high-frequency ultrasonography and optical-coherence tomography (OCT). Ultrasonography reliably measures skin thickness, according to results from several cross-sectional studies 57 – 60 , and a 2021 study advocated ultrasonography as an outcome measure 61 . Ultrasonographic measurement of skin thickness with a 4–15 MHz linear probe correlated well with histological assessment ( r = 0.6926, P = 0.009) and with local (forearm) mRSS ( r = 0.7961, P = 0.001) in 13 patients with SSc (nine of whom had dcSSc) who underwent forearm skin biopsy 62 .…”