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  1. S Mc Auliffe,
  2. K O'Sullivan,
  3. K Mc Creesh
  1. Clinical Therapies Department, University Of Limerick, Limerick, Ireland


Background Pathological tendons are known to increase their AP diameter. Ultrasound is an important complementary technique to MRI for assessment of musculoskeletal disorders. Although systematic reviews have confirmed its reliability for the measurement of muscle thickness, no such reviews exist to examine the reliability of US measures of tendon dimensions.

Objective To systematically review the literature on the reliability of Real-time ultrasound to assess tendon dimensions including thickness and cross sectional area in human limbs.

Design A comprehensive review of electronic databases was performed by two reviewers using agreed range of keywords. Randomised clinical trials which investigated inter or intra rater reliability of real time ultrasound was included in this review. The Quality Appraisal of Reliability Studies (QAREL) checklist was used to assess risk of bias.

Setting Included studies performed ultrasound analysis in a range of clinical settings.

Participants 698 Symptomatic and asymptomatic participants, mean age range: 17.5–73 years.

Interventions Tendon thickness of a range of upper and lower limb tendons was assessed using real time ultrasound in both transverse and longitudinal planes by physiotherapists, sonographers and other unspecified investigators.

Main outcome measurements Inter and Intra rater reliability of tendon thickness measures using estimates of both reliability and precision using intraclass correlation coefficients (ICC's) and coefficients of variation (CVs), coefficient of variation (CV%) limits of agreement (LOA), pearsons correlation coefficient (r2) and 95% confidence intervals (95% CI).

Results Assessment of the risks of bias indicated 15/16 chosen studies was of high quality. ICC values for inter and intra rater reliability ranged from (0.55–0.99), LOA ranged from (0.35–3.50 mm), r2 ranged from (0.43–0.92), 95% CI ranged from (0.43–0.98), CV% ranged from (0–14.44%).

Conclusion The use of real time ultrasound method for assessing upper and lower limb tendon thickness has moderate-to-good level reliability. The findings of which may have important implications for management of tendon disorders.

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