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Open AccessArticle

Enhancing Trigger Point Dry Needling Safety by Ultrasound Skin-to-Rib Measurement: An inter-Rater Reliability Study

1
Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, 6928 Manno, Switzerland
2
Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, 6928 Manno, Switzerland
3
Private physical therapy practitioner, 6850 Mendrisio, Switzerland
4
Research Methodology Competence Centre, Department of Business Economics, Health and Social Care; University of Applied Sciences and Arts of Southern Switzerland, 6928 Manno, Switzerland
5
Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), 28922 Alcorcón, Madrid, Spain
6
Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, 28922 Alcorcón, Madrid, Spain
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(6), 1958; https://doi.org/10.3390/jcm9061958
Received: 18 May 2020 / Revised: 10 June 2020 / Accepted: 19 June 2020 / Published: 23 June 2020
Dry needling (DN) is a minimally invasive treatment technique widely used by physical therapists to treat myofascial trigger points (MTrP). Even if its safety has been commonly declared and the majority of adverse events are considered mild, serious adverse events cannot be excluded and DN treatments of several trunk muscles can potentially result in pneumothorax. Ultrasound imaging (US) skin-to-rib measurement could ensure the safety of this treatment procedure. Therefore, the aim of this study was to determine the inter-rater reliability of depth measurement of different trunk muscles (i.e., rhomboid, lower trapezius, iliocostalis, and pectoralis major) between an expert and two novice physiotherapists. Skin-to-rib distance of 26 asymptomatic and normal weights subjects was consecutively, independently, and randomly measured for each muscle by the three examiners (1 expert and 2 novice physical therapists) with a handheld US wireless probe. Intraclass correlation coefficient (ICC3,k) and standard error of measurement (SEM) were used to assess inter-rater reliability. Inter-rater reliability of skin-to-rib measurements between the three examiners was good to excellent or excellent for every muscle, with an ICC3,k ranging from 0.92 and 0.98 (95% CI 0.86–0.99). The SEM never exceeded 10% of the skin-to-rib distance. In conclusion, skin-to-rib US measurements of the trunk muscles can be reliably performed by novice physical therapists using a handheld US device. These measures could be used as an innovative and reliable technique to improve the safety of some potential dangerous DN treatments. View Full-Text
Keywords: trigger points; dry needling; adverse events; safety; skin-to-rib; reliability; ultrasound trigger points; dry needling; adverse events; safety; skin-to-rib; reliability; ultrasound
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Folli, A.; Schneebeli, A.; Ballerini, S.; Mena, F.; Soldini, E.; Fernández-de-las-Peñas, C.; Barbero, M. Enhancing Trigger Point Dry Needling Safety by Ultrasound Skin-to-Rib Measurement: An inter-Rater Reliability Study. J. Clin. Med. 2020, 9, 1958.

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