European Spine Journal

, Volume 18, Issue 7, pp 1059–1065 | Cite as

An investigation of the reproducibility of ultrasound measures of abdominal muscle activation in patients with chronic non-specific low back pain

  • Leonardo Oliveira Pena CostaEmail author
  • Chris G. Maher
  • Jane Latimer
  • Paul W. Hodges
  • Debra Shirley
Original Article


Ultrasound (US) measures are used by clinicians and researchers to evaluate improvements in activity of the abdominal muscles in patients with low back pain. Studies evaluating the reproducibility of these US measures provide some information; however, little is known about the reproducibility of these US measures over time in patients with low back pain. The objectives of this study were to estimate the reproducibility of ultrasound measurements of automatic activation of the lateral abdominal wall muscles using a leg force task in patients with chronic low back pain. Thirty-five participants from an existing randomised, blinded, placebo-controlled trial participated in the study. A reproducibility analysis was undertaken from all patients using data collected at baseline and after treatment. The reproducibility of measurements of thickness, muscle activation (thickness changes) and muscle improvement/deterioration after intervention (differences in thickness changes from single images made before and after treatment) was analysed. The reproducibility of static images (thickness) was excellent (ICC2,1 = 0.97, 95% CI = 0.96–0.97, standard error of the measurement (SEM) = 0.04 cm, smallest detectable change (SDC) = 0.11 cm), the reproducibility of thickness changes was moderate (ICC2,1 = 0.72, 95% CI 0.65–0.76, SEM = 15%, SDC 41%), while the reproducibility of differences in thickness changes from single images with statistical adjustment for duplicate measures was poor (ICC2,1 = 0.44, 95% CI 0.33–0.58, SEM = 21%, SDC = 66.5%). Improvements in the testing protocol must be performed in order to enhance reproducibility of US as an outcome measure for abdominal muscle activation.


Ultrasound Abdominal muscles Reproducibility Agreement Reliability 



This study was funded by the Physiotherapy Research Foundation, Australian Physiotherapy Association. Leonardo O. P. Costa is a PhD student supported by CAPES—Ministério da Educação—Brazil and Pontifícia Universidade Católica de Minas Gerais—Brazil; Chris G. Maher and Paul W. Hodges hold research fellowships funded by the National Health and Medical Research Council of Australia.


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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Leonardo Oliveira Pena Costa
    • 1
    Email author
  • Chris G. Maher
    • 1
  • Jane Latimer
    • 1
  • Paul W. Hodges
    • 2
  • Debra Shirley
    • 3
  1. 1.The George Institute for International HealthThe University of SydneySydneyAustralia
  2. 2.NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health of Rehabilitation SciencesThe University of QueenslandBrisbaneAustralia
  3. 3.Faculty of Health SciencesThe University of SydneySydneyAustralia

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