Reliability and validity of rehabilitative ultrasound images obtained using a hands-free fixed probe in measuring the muscle structures of the tibialis anterior and the gastrocnemius

Objective: This study aimed to investigate the reliability and validity of muscle thickness (MT) and pennation angle (PA) measurements of the ankle muscle, including the tibialis anterior (TA) and the medial gastrocnemius (MGCM), using a hands-free fixed probe and to compare it with the conventional linear probe. Design: Observational inter-rater reliability study. Methods: Thirty-three healthy subjects (20 male, 13 female) were included. In all subjects, ultrasound images were acquired from the TA and MGCM using a hands-free fixed probe and a conventional linear probe in random sequence by two examiners at two time-points within a 7-day interval. MT and PA were calculated on the taken images. Intra-class correlation coefficients (ICC), 95% confidence intervals, standard error of measurement and the Pearson's correlation coefficient were used to estimate reliability and validity. And also, Bland-Altman plots were generated for a visual representation of MT and PA at the TA and MGCM. Results: The ICC for all intra-rater reliability was 0.943 to 0.995 and that for all inter-rater reliability was 0.928 to 0.993, indicating excellent reliability. A significantly high correlation was observed between MT and PA at the TA and MGCM with use of the hands-free fixed probe and the conventional linear probe (r>0.938; p<0.001). Conclusions: The hands-free fixed probe provided excellent images for measurement of the MT and PA of the TA and MGCM and is a useful device for making clinical measurements of muscle structure without grasping of the probe.