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Year : 2019  |  Volume : 3  |  Issue : 3  |  Page : 709-714

The interoperator agreement and reliability of measurement of diaphragmatic movement by ultrasonography in patients with chronic obstructive pulmonary disease

1 Department of Chest Diseases, Police Hospital, Cairo, Egypt
2 Department of Chest Diseases, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt

Correspondence Address:
M.D Eman Sobh
Chest Diseases Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt; Chest Diseases Department, Al-Zahraa University Hospital, 11517 Al-Abbaseya, Cairo
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sjamf.sjamf_87_19

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Introduction Diaphragmatic motion (excursion) measurement by ultrasonography (US) has been used to evaluate diaphragmatic functions in several conditions including chronic obstructive pulmonary disease (COPD). The main limitation of US is that it is operator dependent. Aim The aim of this study was to assess the intraoperator and interoperator agreement and reliability of US measurement of diaphragmatic movement in COPD by pulmonologists. Patients and methods This study included 50 patients with COPD between May 2017 and August 2017 in a tertiary hospital. Readings of diaphragmatic excursion were recorded separately during inspiration and expiration using B-mode US. All measurements were recorded by two operators: one experienced and one MD student who received training to perform diaphragm US. Mean and SD of variation and intraclass correlation coefficient (ICC) in the measurement were calculated for assessment of variability and reliability, respectively. Results Fifty patients with COPD were included in the study. The mean difference between the readings of both operators was 0.014±0.094 for quiet breathing, −0.0102±0.058 for deep breathing, and −0.0598±0.430 for sniffing, and this difference was statistically nonsignificant. There was good to excellent agreement between both operators for all readings (intraclass coefficient values were 0.998, 0.999, and 0.901 for quiet breathing, deep breathing, and sniffing, respectively). Three readings were taken by the same operator during different phases of breathing (tidal, deep, and sniffing), and Cronbach’s α for readings of operator A were 0.968, 0.935, and 0.983 for quiet breathing, deep breathing, and sniffing, respectively, and 0.995, 0.948, and 0.980 for quiet breathing, deep breathing, and sniffing, respectively, by operator B, which indicate excellent reliability. Conclusion The measurement of diaphragmatic excursion using US in patients with COPD was reproducible and reliable test in all breathing phases when performed by pulmonologists.

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