# Reliability of Ultrasonographic Assessment of Sternal Micromotions by Physiotherapists in Patients with Median Sternotomy

## TL;DR

This study shows that physiotherapists can reliably use ultrasound to assess sternal movements in patients after chest surgery, which could improve post-surgical care.

## Contribution

Demonstrates that physiotherapists with brief training can reliably use ultrasound to assess sternal micromotions post-surgery.

## Key findings

- Ultrasound assessments of sternal micromotions showed excellent inter-rater and intra-rater reliability with ICCs > 0.75.
- SEM and MDC90 values indicated low measurement error and high precision in most conditions.
- Ultrasound is a reliable, cost-effective tool for monitoring sternal stability post-surgery.

## Abstract

Introduction: Median sternotomy carries post-surgical risks like sternal instability, requiring careful monitoring. Ultrasonography provides a real-time, quantitative assessment of sternal micromovements and has emerged as a promising tool for clinical evaluation. However, its reliability for assessing sternal micromovements post-surgery remains unclear. This study evaluated the inter-rater, intra-rater, and test–retest reliability of ultrasound performed by physiotherapists. Methods: Ultrasound was used to measure the distance between sternal edges in sternotomized patients along the X-axis and Y-axis. Measurements were taken under a resting position, during cough, and in two supine-to-sitting postural transitions (one using a rotational modality and the other with an individual device). Real-time ultrasound imaging acquisition was followed by off-line data elaboration. Assessments were conducted by multiple physiotherapists after a brief training period. Reliability was determined using intraclass correlation coefficients (ICCs), along with the standard error of measurement (SEM) and minimum detectable change (MDC90). ICC values > 0.75 were classified as excellent. Results: A total of 33 subjects with median sternotomy were included (5 women, age 66 ± 7 years). All reliability measurements (24 total) were rated as excellent in each condition examined, with intra-rater ICCs exceeding 0.90, except for on the X-axis during the postural transition using the individual device for supine-to-sitting. SEM values ranged from 0.23 to 0.64 mm, while MDC90 values ranged from 0.54 to 1.50 mm. Conclusions: Ultrasound demonstrated excellent reliability for assessing sternal micromotions when performed by physiotherapists with brief training. Given its reliability, cost-effectiveness, and ease of use, ultrasound sternal micromotions assessment could be integrated into post-surgical rehabilitation to enhance patient care.