Assessing reliability and validity of different stiffness measurement tools on a multi-layered phantom tissue model

Katja Bartsch, Andreas Brandl, Patrick Weber, Jan Wilke, Sabine F Bensamoun, Wolfgang Bauermeister, Werner Klingler, Robert Schleip, Katja Bartsch, Andreas Brandl, Patrick Weber, Jan Wilke, Sabine F Bensamoun, Wolfgang Bauermeister, Werner Klingler, Robert Schleip

Abstract

Changes in the mechanical properties (i.e., stiffness) of soft tissues have been linked to musculoskeletal disorders, pain conditions, and cancer biology, leading to a rising demand for diagnostic methods. Despite the general availability of different stiffness measurement tools, it is unclear as to which are best suited for different tissue types and the related measurement depths. The study aimed to compare different stiffness measurement tools' (SMT) reliability on a multi-layered phantom tissue model (MPTM). A polyurethane MPTM simulated the four layers of the thoracolumbar region: cutis (CUT), subcutaneous connective tissue (SCT), fascia profunda (FPR), and erector spinae (ERS), with varying stiffness parameters. Evaluated stiffness measurement tools included Shore Durometer, Semi-Electronic Tissue Compliance Meter (STCM), IndentoPRO, MyotonPRO, and ultrasound imaging. Measurements were made by two independent, blinded examiners. Shore Durometer, STCM, IndentoPRO, and MyotonPRO reliably detected stiffness changes in three of the four MPTM layers, but not in the thin (1 mm thick) layer simulating FPR. With ultrasound imaging, only stiffness changes in layers thicker than 3 mm could be measured reliably. Significant correlations ranging from 0.70 to 0.98 (all p < 0.01) were found. The interrater reliability ranged from good to excellent (ICC(2,2) = 0.75-0.98). The results are encouraging for researchers and clinical practitioners as the investigated stiffness measurement tools are easy-to-use and comparatively affordable.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

© 2023. The Author(s).

Figures

Figure 1
Figure 1
Multi-layered phantom tissue model.
Figure 2
Figure 2
Cross-section of L3 region. Photo: Modified from Visible Human Project of U.S. National Library of Medicine, accessed through NPAC/OLDA Visible Human Viewer with permission.
Figure 3
Figure 3
CUT cutis. SCT subcutaneous connective tissue. FPR fascia profunda. ERS erector spinae. Blank denotes “no reliable measurement possible”. ✓ denotes moderate correlation (> 0.4). ✓✓ denotes strong. correlation (> 0.7). ✓✓✓ denotes very strong correlation (> 0.9). Photos (1st to 5th row): rows 1–3: fasciaresearch.org with permission; myotonpro.com with permission, fasciareasearch.org with permission.
Figure 4
Figure 4
(A) Scatter plot of the agreement between the two raters for the MyotonPRO. (B) Bland-Altmann plot of the mean differences between the raters. The dashed line in the middle represents the mean difference; the lines above and below show the 95% limits of agreement. The values indicate the relative stiffness changes.
Figure 5
Figure 5
(A) Scatter plot of the agreement between the two raters for the IndentoPRO. (B) Bland-Altmann plot of the mean differences between the raters. Legend: see Fig. 4.

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