實時性超音波造影量化腹直肌間距之信度研究

The Reliability of Measuring of Inter-recti Distance Using Real-time Ultrasonography

廖麗君(Lih-Jiun Liaw) ； 劉欣玫(Sin-Mei Liu) ； 蕭世芬(Shih-Fen Hsiao)

《物理治療》 31卷3期 (2006/06) Pp. 213-218

摘要

背景與目的：懷孕或產後婦女之腹直肌間距(inter-recti distance, IRD)多以指幅寬度與游標卡尺來量測，但這些測量方法容易受到脂肪與皮膚厚度的影響，且需在腹肌略微收縮下才能夠施測。本研究之目的在於探討以超音波造影來測量腹直肌間距同一測試者之再測信度以及不同測試者問之信度。方法：本研究在獲得人體試驗審查委員會通過後，共徵得42位年輕、健康之自願者接受測試（26位女性）。兩腹直肌間之距離由兩名有兩年以上臨床經驗之物理治療師利用超音波造影設備（7.5MHz直線性探頭）來測量。所有受試者皆接受一位治療師不同日再測試；其中31位再由另一位治療師於同日再測試。受試者於仰臥的姿勢下，接受測試者以手握探頭隨機觀察肚臍上、下緣以及距肚臍上、下緣上下方各1時共四個位置之腹直肌與白線影像。在影像定格後，以超音波設備之游標測試系統直接在螢幕上讀取腹直肌間距。結果：四個不同位置之腹直肌間距的比較發現：同一測試者再測信度之級內相關係數值(intraclass correlation coefficient, ICC)≧0.85(0.85-0.95)；而不同測試者間之ICC值≧0.78(0.78-0.89)，皆呈現高信度；不同位置之腹直肌間距之同一測試者兩次測量之測量標準誤值(standard error of measurement , SEM)皆≦0.1公分（範圍：0.07-0.1公分）；而個案真實改善程度值(smallest real difference, SRD)在0.20-0.29公分之範圍。結論：本研究的結果與經驗顯示，以超音波重複測量腹直肌間距之一致性高且誤差值小，是一個值得嘗試的非侵入性、並具有良好信度之臨床評估工具，可用以量化腹直肌分離現象，並可作為物理治療師指導產婦或孕婦運動時監測腹肌收縮狀況之利器。

關鍵字

超音波造影 ； 腹直肌間距 ； 信度

並列摘要

Background and Purposes: Diastasis rectus abdominis (DRA) is common in postpartum women and is thought to affect the mechanics and function of abdominal muscles. The increased interrecti distance (IRD) is traditionally measured by finger width or caliper, with poor reliability and technical difficulties. The purpose of this study is to establish the inter-rater and intra-rater reliability of the ultrasonography assessment of the IRD. Methods: Fourty-two college students (26 women and 16 men) were included in the study. For the purpose of intra-rater reliability, the IRD was measured by two raters on each subject within a 2-day period. Inter-rater reliability of IRD measurement was repeated during two assessments 15 minutes apart. The IRD was measured with a 7.5 MHz linear array ultrasound probe at four locations above and below the umbilicus (upper and lower margins, and 1 inch above and below the margins of the umbilicus) at a relaxed, supine lying position. The measurement of IRD was taken from the medial borders of bilateral rectus abdominis when the probe was positioned vertically across the linea abla. Results: The ICC(subscript 2,1) values of the inter-rater reliability of the IRD at 4 different locations were ranged between 0.78 to 0.89 (all ICC≥0.78). The ICC(subscript 3,1) values of the intra-rater reliability of the IRD at the 4 locations were ranged between 0.85 to 0.95 (all ICC≥0.85). The SEM for the intra-session testing ranged from 0.07 to 0.10 cm. The smallest real differences (SRDs) were determined to be 0.20 to 0.29 cm. Conclusion: Excellent reliability could be obtained when inter-reci distance was measured by ultrasonography. The ultrasonography could be a useful and convenient tool in quantifying IRD.

並列關鍵字

Ultrasonography ； Inter-recti distance ； Reliability