Reliability and validity of ultrasonography in evaluating the thickness, excursion, stiffness, and strain rate of respiratory muscles in non-hospitalized individuals: a systematic review

Abstract

Objective To summarize the reliability and validity of ultrasonography in evaluating the stiffness, excursion, stiffness, or strain rate of diaphragm, intercostals and abdominal muscles in healthy or non-hospitalized individuals. Literature search PubMed, Embase, SPORTDiscus, CINAHL and Cochrane Library were searched from inception to May 30, 2022. Study selection criteria Case–control, cross-sectional, and longitudinal studies were included if they investigated the reliability or validity of various ultrasonography technologies (e.g., brightness-mode, motion-mode, shear wave elastography) in measuring the thickness, excursion, stiffness, or strain rate of any respiratory muscles. Data synthesis Relevant data were summarized based on healthy and different patient populations. The methodological quality by different checklist depending on study design. The quality of evidence of each psychometric property was graded by the Grading of Recommendations, Assessment, Development and Evaluations, respectively. Results This review included 24 studies with 787 healthy or non-hospitalized individuals (e.g., lower back pain (LBP), adolescent idiopathic scoliosis (AIS), and chronic obstructive pulmonary disease (COPD)). Both inspiratory (diaphragm and intercostal muscles) and expiratory muscles (abdominal muscles) were investigated. Moderate-quality evidence supported sufficient (intra-class correlation coefficient > 0.7) within-day intra-rater reliability of B-mode ultrasonography in measuring right diaphragmatic thickness among people with LBP, sufficient between-day intra-rater reliability of M-mode ultrasonography in measuring right diaphragmatic excursion in non-hospitalized individuals. The quality of evidence for all other measurement properties in various populations was low or very low. High-quality evidence supported sufficient positive correlations between diaphragm excursion and forced expiratory volume in the first second or forced vital capacity (r > = 0.3) in healthy individuals. Conclusions Despite the reported sufficient reliability and validity of using ultrasonography to assess the thickness, excursion, stiffness, and strain rate of respiratory muscles in non-hospitalized individuals, further large-scale studies are warranted to improve the quality of evidence regarding using ultrasonography for these measurements in clinical practice. Researchers should establish their own reliability before using various types of ultrasonography to evaluate respiratory muscle functions. Trial registration PROSPERO NO. CRD42022322945.

Diaphragm Ultrasound in Different Clinical Scenarios: A Review with a Focus on Older Patients

“…Diaphragm ultrasound has been studied mainly in stable COPD patients, where its parameters show significant correlations with respiratory function tests and may be helpful in stratifying the severity of the disease [ 86 , 87 , 88 ]. In particular, a recent systematic review has highlighted that high-quality evidence from the literature supports the presence of a positive correlation between diaphragm excursion, assessed by ultrasound, and forced expiratory volume in the first second (FEV1) or forced vital capacity (FVC), assessed by spirometry [ 88 ]. Reduced diaphragm mobility, both on quiet breathing and on maximal voluntary inspiration, is, in fact, an expression of hyperinflation, and shows correlations with pulmonary volumes and the Tiffeneau index (FEV1/FVC) [ 89 , 90 , 91 , 92 ].…”