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The abdominal drawing-in maneuver to detect activity in the deep abdominal muscles. Is this clinical tool reliable and valid?
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS1238–eS1642
Research Report Poster Presentation Number: RR-PO-10-06-Sun Sunday 3 May 2015 13:00 Exhibit halls 401–403 THE ABDOMINAL DRAWING-IN MANEUVER TO DETECT ACTIVITY IN THE DEEP ABDOMINAL MUSCLES. IS THIS CLINICAL TOOL RELIABLE AND VALID? K. Kaping, B. Äng, Barr E. Rasmussen Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Stockholm, Sweden Background: Physical therapists worldwide use the abdominal drawing-in maneuver (ADIM) as a diagnostic tool to manually assess activity of the lateral abdominal muscles, especially the transversus abdominis (TrA) in subjects with low-back pain (LBP). The validity and reliability of the manually assessed ADIM is yet unknown. Purpose: The purpose of this study was to evaluate the concurrent and discriminative validity as well as the reliability of the abdominal drawing-in maneuver. Methods: The present single blinded cross-sectional study enrolled 38 subjects seeking care for their LBP. An additional 15 healthy subjects were recruited in order to enhance the variability and to obtain reference data for proper evaluation of reliability. The manual ADIM was assessed as passed or failed following a standard assessment procedure. Ultrasound imaging (USI) was used as the concurrent reference (gold standard) for the manually assessed ADIM by calculating a ratio of the change in muscle thickness between the rested and contracted states; the association between USI and the manual test was calculated. Twenty-four subjects were examined for inter-observer reliability by two observers. Results: The concurrent correlation between the manual ADIM and the USI ratios revealed poor associations (r = 0.13–0.40). The discriminative validity of manual ADIM to predict LBP reached a sensitivity/specificity of 0.30/0.73, while the ADIM–USI ratio to predict LBP reached a sensitivity/specificity of 0.19/0.87. The inter-observer reliability for the manual ADIM revealed a substantial agreement κ = 0.71, CI (95%) 0.41–1.00. Conclusion(s): Our results show that the inter-observer reliability of the manually assessed ADIM was high, but the validity for examining abdominal muscles or detecting variances beyond normal healthy variances was low. Further studies are needed to confirm our results. Implications: It still is not clear what the manually assessed ADIM actually reflects and how or if, it should be used in clinical settings to address activity of the deep abdominals as the same variances of pass vs. fail seem to exist in the group of healthy subjects with no such pain problems. ADIM should therefore be further studied to give physical therapists better directions if this diagnostic tool is valid or not.
eS1259
Keywords: Motor control; Low back pain; Test Funding acknowledgements: Financial support from the Swedish Confederation of Physiotherapists-Minnesfonden is gratefully acknowledged. Ethics approval: The regional ethical review board approved the study (Dnr 2011/1859-31). http://dx.doi.org/10.1016/j.physio.2015.03.1164 Research Report Poster Presentation Number: RR-PO-10-07-Sun Sunday 3 May 2015 12:15 Exhibit halls 401–403 INTER- AND INTRA-OBSERVER RELIABILITY OF THREE MOVEMENT CONTROL TESTS FOR THE LUMBO-PELVIC COMPLEX Barr E. Rasmussen, H. Granström, B. Äng Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Stockholm, Sweden Background: Impaired movement control of the lumbopelvic complex has been proposed as a cause of non-specific low-back pain (NSLBP). Studies report improvements in pain and function following rehabilitation comprising motor control exercises. Reliable and valid tests designed to discern weak links in a kinetic chain are of importance for optimal rehabilitation. Purpose: This test–retest study sought to determine the inter- and intra-observer reliability of three movement screening tests for the lumbo-pelvic complex: the standing knee lift test, the static lunge test and the dynamic lunge test. Methods: Thirty-eight subjects, 21 with NSLBP and 17 healthy, were video-recorded performing the tests. Four physiotherapists scored the video-recordings as pass or fail, all in a standardized manner. Reliability was calculated with free-margin multi-observer kappa (K free) and prevalenceand-bias-adjusted kappa (PABAK). Results: Kappa for the different items ranged between K free = 0.32 and 0.91 for inter-observer reliability and PABAK = 0.42 and 1.00 for intra-observer reliability. Items showing the highest values across the test were: back extension for inter- and intra-observer reliability and arm-lowering for intra-observer reliability in the knee lift test, arm lowering for inter- and intra-observer reliability in the static lunge test and shoulders moving backwards for inter- and intra-observer reliability in the dynamic lunge test. Hip-hitch in the knee lift test showed fair agreement but with an unacceptable lower 95% confidence interval. Conclusion(s): The three movement screening tests show between fair and very good intra- and inter-observer agreement for certain items in the tests used for identifying weak links in the lumbo-pelvic complex.
Research Report Poster Presentation Number: RR-PO-10-06-Sun Sunday 3 May 2015 13:00 Exhibit halls 401–403 THE ABDOMINAL DRAWING-IN MANEUVER TO DETECT ACTIVITY IN THE DEEP ABDOMINAL MUSCLES. IS THIS CLINICAL TOOL RELIABLE AND VALID? K. Kaping, B. Äng, Barr E. Rasmussen Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Stockholm, Sweden Background: Physical therapists worldwide use the abdominal drawing-in maneuver (ADIM) as a diagnostic tool to manually assess activity of the lateral abdominal muscles, especially the transversus abdominis (TrA) in subjects with low-back pain (LBP). The validity and reliability of the manually assessed ADIM is yet unknown. Purpose: The purpose of this study was to evaluate the concurrent and discriminative validity as well as the reliability of the abdominal drawing-in maneuver. Methods: The present single blinded cross-sectional study enrolled 38 subjects seeking care for their LBP. An additional 15 healthy subjects were recruited in order to enhance the variability and to obtain reference data for proper evaluation of reliability. The manual ADIM was assessed as passed or failed following a standard assessment procedure. Ultrasound imaging (USI) was used as the concurrent reference (gold standard) for the manually assessed ADIM by calculating a ratio of the change in muscle thickness between the rested and contracted states; the association between USI and the manual test was calculated. Twenty-four subjects were examined for inter-observer reliability by two observers. Results: The concurrent correlation between the manual ADIM and the USI ratios revealed poor associations (r = 0.13–0.40). The discriminative validity of manual ADIM to predict LBP reached a sensitivity/specificity of 0.30/0.73, while the ADIM–USI ratio to predict LBP reached a sensitivity/specificity of 0.19/0.87. The inter-observer reliability for the manual ADIM revealed a substantial agreement κ = 0.71, CI (95%) 0.41–1.00. Conclusion(s): Our results show that the inter-observer reliability of the manually assessed ADIM was high, but the validity for examining abdominal muscles or detecting variances beyond normal healthy variances was low. Further studies are needed to confirm our results. Implications: It still is not clear what the manually assessed ADIM actually reflects and how or if, it should be used in clinical settings to address activity of the deep abdominals as the same variances of pass vs. fail seem to exist in the group of healthy subjects with no such pain problems. ADIM should therefore be further studied to give physical therapists better directions if this diagnostic tool is valid or not.
eS1259
Keywords: Motor control; Low back pain; Test Funding acknowledgements: Financial support from the Swedish Confederation of Physiotherapists-Minnesfonden is gratefully acknowledged. Ethics approval: The regional ethical review board approved the study (Dnr 2011/1859-31). http://dx.doi.org/10.1016/j.physio.2015.03.1164 Research Report Poster Presentation Number: RR-PO-10-07-Sun Sunday 3 May 2015 12:15 Exhibit halls 401–403 INTER- AND INTRA-OBSERVER RELIABILITY OF THREE MOVEMENT CONTROL TESTS FOR THE LUMBO-PELVIC COMPLEX Barr E. Rasmussen, H. Granström, B. Äng Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Stockholm, Sweden Background: Impaired movement control of the lumbopelvic complex has been proposed as a cause of non-specific low-back pain (NSLBP). Studies report improvements in pain and function following rehabilitation comprising motor control exercises. Reliable and valid tests designed to discern weak links in a kinetic chain are of importance for optimal rehabilitation. Purpose: This test–retest study sought to determine the inter- and intra-observer reliability of three movement screening tests for the lumbo-pelvic complex: the standing knee lift test, the static lunge test and the dynamic lunge test. Methods: Thirty-eight subjects, 21 with NSLBP and 17 healthy, were video-recorded performing the tests. Four physiotherapists scored the video-recordings as pass or fail, all in a standardized manner. Reliability was calculated with free-margin multi-observer kappa (K free) and prevalenceand-bias-adjusted kappa (PABAK). Results: Kappa for the different items ranged between K free = 0.32 and 0.91 for inter-observer reliability and PABAK = 0.42 and 1.00 for intra-observer reliability. Items showing the highest values across the test were: back extension for inter- and intra-observer reliability and arm-lowering for intra-observer reliability in the knee lift test, arm lowering for inter- and intra-observer reliability in the static lunge test and shoulders moving backwards for inter- and intra-observer reliability in the dynamic lunge test. Hip-hitch in the knee lift test showed fair agreement but with an unacceptable lower 95% confidence interval. Conclusion(s): The three movement screening tests show between fair and very good intra- and inter-observer agreement for certain items in the tests used for identifying weak links in the lumbo-pelvic complex.