title: ULTRASOUND IMAGING MEASUREMENT OF THE TRANSVERSUS ABDOMINIS IN SUPINE, STANDING, AND UNDER LOADING: A RELIABILITY STUDY OF NOVICE EXAMINERS.
abstract: BACKGROUND
  Military personnel and first responders (police and firefighters) often carry large amounts of gear. This increased load can negatively affect posture and lead to back pain. The ability to quantitatively measure muscle thickness under loading would be valuable to clinicians to assess the effectiveness of core stabilization treatment programs and could aid in return to work decisions. Ultrasound imaging (USI) has the potential to provide such a measure, but to be useful it must be reliable.
  
  
  OBJECTIVE
  To assess the intrarater and interrater reliability of measurements of transversus abdominis (TrA) and internal oblique (IO) muscle thickness conducted by novice examiners using USI in supine, standing, and with an axial load.
  
  
  METHODS
  Prospective, test-retest study.
  
  
  METHODS
  Healthy, active duty military (N=33) personnel were examined by two physical therapy doctoral students (primary and secondary ultrasound technicians) without prior experience in USI. Thickness measurements of the TrA and IO muscles were performed at rest and during a contraction to preferentially activate the TrA in three positions (hook-lying, standing, and standing with body armor). Percent thickness changes and intraclass correlation coefficients (ICC) were calculated.
  
  
  RESULTS
  Using the mean of three measurements for each of the three positions in resting and contracted muscle states, the intrarater ICC (3,3) values ranged from 0.90 to 0.98. The interrater ICC (2,1) values ranged from 0.39 to 0.79. The ICC values of percent thickness changes were lower than the individual ICC values for all positions and muscle states.
  
  
  CONCLUSIONS
  There is excellent intrarater reliability of novice ultrasound technicians measuring abdominal muscle thickness using USI in three positions during the resting and contracted muscle states. However, interrater reliability of two novice technicians was poor to fair, so additional training and experience may be necessary to improve reliability.
  
  
  METHODS
  2b.
authors.affiliation: U.S. Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, TX, USA.
authors.forename: Carrie W
authors.initials: CW
authors.lastname: Hoppes
authors.affiliation: U.S. Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, TX, USA.
authors.forename: Aubrey D
authors.initials: AD
authors.lastname: Sperier
authors.affiliation: U.S. Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, TX, USA.
authors.forename: Colleen F
authors.initials: CF
authors.lastname: Hopkins
authors.affiliation: U.S. Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, TX, USA.
authors.forename: Bridgette D
authors.initials: BD
authors.lastname: Griffiths
authors.affiliation: U.S. Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, TX, USA.
authors.forename: Molly F
authors.initials: MF
authors.lastname: Principe
authors.affiliation: Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA.
authors.forename: Barri L
authors.initials: BL
authors.lastname: Schnall
authors.affiliation: Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA.
authors.forename: Johanna C
authors.initials: JC
authors.lastname: Bell
authors.affiliation: U.S. Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, TX, USA.
authors.forename: Shane L
authors.initials: SL
authors.lastname: Koppenhaver
keywords: Body Armor; Transversus Abdominis; Ultrasonography