title: Diaphragm and peripheral muscle thickness on ultrasound: intra-rater reliability and variability of a methodology using non-standard recumbent positions.
abstract: OBJECTIVE
  Reliable measurement of diaphragm and peripheral muscle thickness, using diagnostic ultrasound, has only been validated in the erect posture. However, in many clinical populations, including critically ill patients, the erect posture presents logistic difficulties. This study aimed to validate ultrasound measurement of diaphragm and peripheral muscle thickness in the recumbent position.
  
  
  METHODS
  An observational methodology of repeated but blind ultrasound and anthropometric measurements was applied, to assess inta-rater reliability. Thirteen healthy volunteers (aged 20-73years) participated. A pneumotachograph was used to target lung volume, as diaphragm thickness was measured from ultrasound at end-expiration, and both 25% and 50% of inspiratory capacity, while semi-recumbent. The thicknesses of the mid-upper arm, mid-forearm and mid-thigh musculature were also measured bilaterally while supine.
  
  
  RESULTS
  Diaphragm thickness could be reliably measured at end-expiration (intra-class correlation coefficient (ICC)=0.990, 95% confidence interval: 0.918-0.998), 25% of inspiratory capacity (ICC=0.959 (0.870-0.988)) and 50% of inspiratory capacity (ICC=0.994 (0.980-0.998)). Peripheral muscle thickness measurements were also reliable (ICC=0.998-1.0). Supine anthropometric measurements of limb segment lengths and girths were highly reproducible.
  
  
  CONCLUSIONS
  This ultrasound technique has good reliability in recumbent positions, making it useful for application to clinical populations when the erect posture is not practical.
authors.affiliation: Faculty of Health Sciences, School of Medicine, Discipline of Critical Care Medicine, Flinders University Flinders Medical Centre, Intensive and Critical Care Unit, Bedford Park, South Australia. claire.baldwin@health.sa.gov.au
authors.forename: Claire E
authors.initials: CE
authors.lastname: Baldwin
authors.forename: Jennifer D
authors.initials: JD
authors.lastname: Paratz
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Bersten
mesh_terms: D000009:Abdominal Muscles / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D003964:Diaphragm / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging; D015588:Observer Variation; D015203:Reproducibility of Results; D016683:Supine Position; D014463:Ultrasonography