Abstract
Background: There is scarce evidence on learning outcomes of physiotherapists receiving formal muscle ultrasound training focused on the intensive care setting. The aim was to evaluate the theoretical knowledge, hands-on skills, satisfaction and reliability of critical care physiotherapists participating in a muscle ultrasound (MUS) educational programme. Methods: A cross-sectional study involving 19 critical care physiotherapists with little to no prior experience in ultrasound who completed standardized 20-hours in MUS was performed over 2-week time period; including knobology, patient positioning, anatomical landmarks, image acquisition and limb muscle measurements. Theoretical knowledge, hands-on skills acquisition and satisfaction were assessed. Inter and intra-rater reliability on landmarks, thickness and pennation angle of quadriceps between participants was evaluated using intraclass correlation coefficient (ICC). Reliability among instructors measured prior to the course was also reported as reference. Results: The percentage score (mean±SD) of knowledge questionnaires was 69±0.11 (pre-course), 89±0.10 (post-course) and 92±0.09 (hands-on skills). Course satisfaction scores were ranged from 90% to 100%. Participants obtained pooled inter-rater reliability (median ICC [IQR]) of 0.70 [0.59 to 0.79] for thickness, 0.47 [0.46 to 0.92] for landmarks, 0.00 [0.00 to 0.05] for pennation angle; and intra-rater reliability of 0.76 [0.51 to 0.91] for thickness, and 0.35 [0.29 to 0.52] for pennation angle. Instructors obtained inter-rater ICC values of 0.90 for thickness, 0.67 for landmarks and 0.41 for pennation angle; and intra-rater ICC values of 0.94 for thickness and 0.75 for pennation angle. Conclusions: Increasing on theoretical knowledge, high hands-on performance acquisition, and good satisfaction of physiotherapists were observed. Reliability was moderate to excellent for thickness and landmarks, and absent to weak for pennation angle. Landmarking and pennation angle remain challenges for physiotherapist training in the application of muscle ultrasound. Further studies are needed to identify variables that could modify the reliability during MUS training.