Background To gain insight into the role of plantar intrinsic foot muscles in fall-related gait parameters in older adults, it is fundamental to assess foot muscles separately. Ultrasonography is considered a promising instrument to quantify the strength capacity of individual muscles by assessing their morphology. The main goal of this study was to investigate the intra-assessor reliability and measurement error for ultrasound measures for the morphology of selected foot muscles and the plantar fascia in older adults using a tablet-based device. The secondary aim was to compare the measurement error between older and younger adults and between two different ultrasound machines. Methods Ultrasound images of selected foot muscles and the plantar fascia were collected in younger and older adults by a single operator, intensively trained in scanning the foot muscles, on two occasions, 1–8 days apart, using a tablet-based and a mainframe system. The intra-assessor reliability and standard error of measurement for the cross-sectional area and/or thickness were assessed by analysis of variance. The error variance was statistically compared across age groups and machines. Results Eighteen physically active older adults (mean age 73.8 (SD: 4.9) years) and ten younger adults (mean age 21.9 (SD: 1.8) years) participated in the study. In older adults, the standard error of measurement ranged from 2.8 to 11.9%. The ICC ranged from 0.57 to 0.97, but was excellent in most cases. The error variance for six morphology measures was statistically smaller in younger adults, but was small in older adults as well. When different error variances were observed across machines, overall, the tablet-based device showed superior repeatability. Conclusions This intra-assessor reliability study showed that a tablet-based ultrasound machine can be reliably used to assess the morphology of selected foot muscles in older adults, with the exception of plantar fascia thickness. Although the measurement errors were sometimes smaller in younger adults, they seem adequate in older adults to detect group mean hypertrophy as a response to training. A tablet-based ultrasound device seems to be a reliable alternative to a mainframe system. This advocates its use when foot muscle morphology in older adults is of interest.
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Rationale: Although ultrasound has been reported as valid and reliable tool to assess muscle size in older adults1, little is known about intra-rater reliability (intra-RR) and inter-rater reliability (inter-RR) of BodyMetrix in specific to assess small muscles. Therefore, in this study we aimed to assess intra-RR and inter-RR of biceps muscle size (thickness) in elderly.Methods: Thirty elderly (81.9±6.3 years; 80% women; BMI 26.7±5.3 kg/m2) living in a Portuguese nursing home/residence were included. To assess procedural intra-RR and inter-RR, ultrasound measurements were performed by two raters (R1, R2, beginners level) by BodyMetrixTM BX2000, on the biceps of the right arm. R1 repeated the ultrasound measurement once. To assess measurement intra-RR and inter-RR, images were analyzed by three raters (R1, R2, and R3 [experienced level]). Agreement was analyzed by intraclass correlation coefficient. ICC values of 0.50 to 0.75 were considered moderate to good, and >0.75 as good to excellent. Statistical significance was set at p<0.05.Results: Mean muscle thickness at 1st and 2nd measurement (R1) was 23.4±4.5 and 23.7±3.8 mm, respectively. For procedural intra-RR, ICC was 0.630. For inter-RR of image 1 (R1) vs. image 2 (R2), ICC was 0.622. For inter-RR of image 2 (R2) vs. image 3 (R1) ICC was 0.534. For measurement reliability, ICCs for intra-RR of R1 and R2 were 0.865 and 0.766, respectively. ICCs for inter-RR of R1 vs. R2, R2 vs. R3, and R1 vs. R3 were 0.865, 0.800, and 0.815, respectively. All ICCs were statistically significant (p≤0.001).Conclusion: The results of our study indicate that procedural reliability of biceps muscle size as assessed by BodyMetrix in elderly is moderate to good, and measurement reliability is good to excellent. Increasing the level of experience may further improve procedural reliability.
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PURPOSE: In 2018, the SARCUS working group published a first article on the standardization of the use of ultrasound to assess muscle. Recommendations were made for patient positioning, system settings and components to be measured. Also, shortcomings in knowledge were mentioned. An important issue that still required standardization was the definition of anatomical landmarks for many muscles.METHODS: A systematic search was performed in Medline, SCOPUS and Web of Sciences looking for all articles describing the use of ultrasound in the assessment of muscle not described in the first recommendations, published from 01/01/2018 until 31/01/2020. All relevant terms used for older people, ultrasound and muscles were used.RESULTS: For 39 muscles, different approaches for ultrasound assessment were found that likely impact the values measured. Standardized anatomical landmarks and measuring points were proposed for all muscles/muscle groups. Besides the five already known muscle parameters (muscle thickness, cross-section area, pennation angle, fascicle length and echo-intensity), four new parameters are discussed (muscle volume, stiffness, contraction potential and microcirculation). The former SARCUS article recommendations are updated with this new information that includes new muscle groups.CONCLUSIONS: The emerging field of ultrasound assessment of muscle mass only highlights the need for a standardization of measurement technique. In this article, guidelines are updated and broadened to provide standardization instructions for a large number of muscles.
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