Reliability of standardized ultrasound measurements of quadriceps muscle thickness in neurological critically ill patients: a comparison to computed tomography measures.

Tourel, Charline; Burnol, Laetitia; Lanoiselé, Julien; Molliex, Serge; Viallon, Magalie; Croisille, Pierre; Morel, J.

doi:10.2340/16501977-2638

Cited by 17 publications

(22 citation statements)

References 16 publications

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“…Although inter- and intrarater reliability obtained by the instructors was consistent with previous reliability studies of muscle architecture, 15 , 16 , 17 , 18 , 39 , 40 , 41 , 42 varied reliability was obtained between participants. Overall, the highest inter- and intrarater reliability was 0.96 and 0.96, respectively, and the lowest inter- and intrarater reliability was 0.00 and 0.19, respectively.…”

Section: Discussionsupporting

confidence: 87%

“…Ultrasound for the assessment of peripheral skeletal muscle architecture in critical illness has revealed excellent reliability levels, including parameters such as thickness, cross-sectional area, and echogenicity. 12 In particular, the reliability of ultrasound measurement of quadriceps thickness in ICU patients has been widely reported to range from 0.76-1.00; 15 , 16 , 17 , 18 , 39 , 40 , 41 , 42 notable, in the eMUSICS program it was consistently 0.70 for participants and 0.90 for instructors. Although reliability of pennation angle has not been reported for ICU patients, studies in non-ICU populations have reported weak to moderate reliability and high variability, ranging from 0.38-0.74.…”

Section: Discussionmentioning

confidence: 99%

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Evaluating a Muscle Ultrasound Education Program: Theoretical Knowledge, Hands-on Skills, Reliability, and Satisfaction of Critical Care Physiotherapists

González-Seguel

Pinto-Concha

Ríos-Castro

et al. 2021

Archives of Rehabilitation Research and Clinical Translation

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Objective To evaluate learning results of critical care physiotherapists participating in a muscle ultrasound (MUS) educational program. Design Cross-sectional study. Setting A custom-made 20-hour MUS course was performed over a 2-week time period, including knobs familiarization, patient positioning, anatomic landmarks, image acquisition, and limb muscle measurements. Participants Nineteen critical care physiotherapists with little to no prior experience in ultrasound (N=19). Interventions Not applicable. Main Outcome Measures Theoretical knowledge, hands-on skills acquisition, and satisfaction were assessed. Inter- and intrarater reliability on landmarks, thickness, and pennation angle of quadriceps between participants was evaluated using intraclass correlation coefficients (ICCs). Reliability among instructors measured prior to the course was also reported as a reference. Results The percentage score (mean±SD) of knowledge questionnaires was 69±11 (pre-course), 89±10 (post-course), and 92±9 (hands-on skills). Course satisfaction scores ranged from 90%-100%. Pooled interrater reliability of participants (median ICC [interquartile range]) was good (0.70 [0.59-0.79]) for thickness, moderate (0.47 [0.46-0.92]) for landmarks, and absent (0.00 [0.00-0.05]) for pennation angle and the intrarater reliability was good (0.76 [0.51-0.91]) for thickness and weak (0.35 [0.29-0.52]) for pennation angle. Interrater ICC values for instructors were excellent (0.90) for thickness, good (0.67) for landmarks, and moderate (0.41) for pennation angle and intrarater ICC values were excellent (0.94) for thickness and good (0.75) for pennation angle. Conclusions Although our sample was quite small and homogeneous, increased theoretical knowledge, high hands-on performance acquisition, and good satisfaction of physiotherapists were observed. Reliability was moderate to excellent for thickness and landmarks and absent to weak for pennation angle. Landmarking and pennation angle remain challenges for physiotherapist training in the application of MUS. Further studies are needed to identify variables that could modify reliability during MUS training.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Evaluating a Muscle Ultrasound Education Program: Theoretical Knowledge, Hands-on Skills, Reliability, and Satisfaction of Critical Care Physiotherapists

González-Seguel

Pinto-Concha

Ríos-Castro

et al. 2021

Archives of Rehabilitation Research and Clinical Translation

View full text Add to dashboard Cite

show abstract

“…Although inter and intra-rater reliability obtained by the instructors was consistent with preceding reliability studies of muscle architecture [15][16][17][18][39][40][41][42], there was varied reliability obtained between participants. Overall, the highest inter and intra-rater reliability was found in the group 3 ranged from 0.69 to 0.96 and 0.90 to 0.96, respectively.…”

Section: Discussionsupporting

confidence: 76%

“…Particularly, the reliability of ultrasound measurement of quadriceps thickness in ICU patients has been widely reported ranged from 0.76 to 1.00 [15][16][17][18][39][40][41][42], and consistently in the eMUSICS programme was 0.70 by participants and 0.90 by instructors. Although reliability of pennation angle has not been reported for ICU patients, studies in non-ICU population have reported weak to moderate reliability and high variability, ranged from 0.38 to 0.74 [43][44][45].…”

Section: Discussionmentioning

confidence: 99%

Evaluating a muscle ultrasound education programme: theoretical knowledge, hands-on skills, reliability and satisfaction of critical care physiotherapists

González-Seguel

Pinto-Concha²,

Ríos-Castro

et al. 2021

Preprint

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Background: There is scarce evidence on learning outcomes of physiotherapists receiving formal muscle ultrasound training focused on the intensive care setting. The aim was to evaluate the theoretical knowledge, hands-on skills, satisfaction and reliability of critical care physiotherapists participating in a muscle ultrasound (MUS) educational programme. Methods: A cross-sectional study involving 19 critical care physiotherapists with little to no prior experience in ultrasound who completed standardized 20-hours in MUS was performed over 2-week time period; including knobology, patient positioning, anatomical landmarks, image acquisition and limb muscle measurements. Theoretical knowledge, hands-on skills acquisition and satisfaction were assessed. Inter and intra-rater reliability on landmarks, thickness and pennation angle of quadriceps between participants was evaluated using intraclass correlation coefficient (ICC). Reliability among instructors measured prior to the course was also reported as reference. Results: The percentage score (mean±SD) of knowledge questionnaires was 69±0.11 (pre-course), 89±0.10 (post-course) and 92±0.09 (hands-on skills). Course satisfaction scores were ranged from 90% to 100%. Participants obtained pooled inter-rater reliability (median ICC [IQR]) of 0.70 [0.59 to 0.79] for thickness, 0.47 [0.46 to 0.92] for landmarks, 0.00 [0.00 to 0.05] for pennation angle; and intra-rater reliability of 0.76 [0.51 to 0.91] for thickness, and 0.35 [0.29 to 0.52] for pennation angle. Instructors obtained inter-rater ICC values of 0.90 for thickness, 0.67 for landmarks and 0.41 for pennation angle; and intra-rater ICC values of 0.94 for thickness and 0.75 for pennation angle. Conclusions: Increasing on theoretical knowledge, high hands-on performance acquisition, and good satisfaction of physiotherapists were observed. Reliability was moderate to excellent for thickness and landmarks, and absent to weak for pennation angle. Landmarking and pennation angle remain challenges for physiotherapist training in the application of muscle ultrasound. Further studies are needed to identify variables that could modify the reliability during MUS training.

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“…Although 2 studies used computed tomography (CT) imaging and 3 studies used ultrasound (with different protocol) to measure muscle mass, this was standardized by calculating the percentage change of muscle mass (Table 3). CT is the gold standard for skeletal muscle mass assessment [53], while ultrasound is widely used in the critical care literature with excellent reliability [54,55]. The finding of shorter duration of MV associated with higher protein delivery in the EN subgroup is weak due to possible biases as evidence by funnel plot asymmetry.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

The effect of higher versus lower protein delivery in critically ill patients: a systematic review and meta-analysis of randomized controlled trials

et al. 2021

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Background The optimal protein dose in critical illness is unknown. We aim to conduct a systematic review of randomized controlled trials (RCTs) to compare the effect of higher versus lower protein delivery (with similar energy delivery between groups) on clinical and patient-centered outcomes in critically ill patients. Methods We searched MEDLINE, EMBASE, CENTRAL and CINAHL from database inception through April 1, 2021.We included RCTs of (1) adult (age ≥ 18) critically ill patients that (2) compared higher vs lower protein with (3) similar energy intake between groups, and (4) reported clinical and/or patient-centered outcomes. We excluded studies on immunonutrition. Two authors screened and conducted quality assessment independently and in duplicate. Random-effect meta-analyses were conducted to estimate the pooled risk ratio (dichotomized outcomes) or mean difference (continuous outcomes). Results Nineteen RCTs were included (n = 1731). Sixteen studies used primarily the enteral route to deliver protein. Intervention was started within 72 h of ICU admission in sixteen studies. The intervention lasted between 3 and 28 days. In 11 studies that reported weight-based nutrition delivery, the pooled mean protein and energy received in higher and lower protein groups were 1.31 ± 0.48 vs 0.90 ± 0.30 g/kg and 19.9 ± 6.9 versus 20.1 ± 7.1 kcal/kg, respectively. Higher vs lower protein did not significantly affect overall mortality [risk ratio 0.91, 95% confidence interval (CI) 0.75–1.10, p = 0.34] or other clinical or patient-centered outcomes. In 5 small studies, higher protein significantly attenuated muscle loss (MD −3.44% per week, 95% CI −4.99 to −1.90; p < 0.0001). Conclusion In critically ill patients, a higher daily protein delivery was not associated with any improvement in clinical or patient-centered outcomes. Larger, and more definitive RCTs are needed to confirm the effect of muscle loss attenuation associated with higher protein delivery. PROSPERO registration number: CRD42021237530

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Reliability of standardized ultrasound measurements of quadriceps muscle thickness in neurological critically ill patients: a comparison to computed tomography measures.

Cited by 17 publications

References 16 publications

Evaluating a Muscle Ultrasound Education Program: Theoretical Knowledge, Hands-on Skills, Reliability, and Satisfaction of Critical Care Physiotherapists

Evaluating a Muscle Ultrasound Education Program: Theoretical Knowledge, Hands-on Skills, Reliability, and Satisfaction of Critical Care Physiotherapists

Evaluating a muscle ultrasound education programme: theoretical knowledge, hands-on skills, reliability and satisfaction of critical care physiotherapists

The effect of higher versus lower protein delivery in critically ill patients: a systematic review and meta-analysis of randomized controlled trials

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