Reliability of diaphragmatic mobility assessment: A systematic review
More details
Hide details
Neuro-Musculoskeletal and Pain Research Unit, Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
Faculty of Health Sciences, Centre of Physiotherapy, Universiti Teknologi MARA Selangor, Bandar Puncak Alam, Puncak Alam, Malaysia
Faculty of Health Sciences, Centre of Medical Imaging, Universiti Teknologi MARA Selangor, Bandar Puncak Alam, Puncak Alam, Malaysia
Saveetha College of Physiotherapy, Saveetha University, Chennai, India
Submission date: 2017-03-17
Acceptance date: 2017-05-22
Online publication date: 2018-06-04
Publication date: 2019-11-19
Corresponding author
Aatit Paungmali   

Neuro-Musculoskeletal and Pain Research Unit, Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand. Tel.: +66 53949246, Fax: +66 53936042
Pol. Ann. Med. 2018;25(2):266-271
Diaphragm Mobility (DM) assessment is gaining interest in the field of medicine and in the healthcare sector. Despite its clinical usage, the measure of reliability in assessing DM is not clearly known.

To critically appraise the evidence describing the reliability measures of DM assessment using any of the diagnostic modalities.

Material and methods:
A systematic search across five databases was carried out from January 1990 to September 2016. Quality Appraisal of Reliability Studies (QUAREL) and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system were used to assess the risk of bias and for rating the quality of the evidence. In addition, levels of evidence grading which synthesize all the included articles for grading were also used.

Results and discussion:
Four papers were included for assessing both intra-rater and inter-rater reliability using ultrasound and radiography. Three papers reported ICC measures of reliability, with one paper reporting CV% of reliability. The results demonstrate that, overall, lower levels of evidence exist among the selected articles between moderate and good for intra-rater reliability and good for inter-rater reliability measures. The synthesis of all the included articles demonstrated that, overall, moderate evidence exists

There were moderate-to-good reliability measures with a low risk of bias in both the forms of reliability for assessing diaphragmatic mobility.

The authors would like to thank the library assistance of Universiti Teknologi MARA, Puncak Alam, Malaysia.
None declared.
Kolar P, Sulc J, Kyncl M, et al. Postural function of the diaphragm in persons with and without chronic low back pain. J Orthop Sports Phys Ther. 2012;42(4):352–362.
Paulin E, Yamaguti WPS, Chammas MC, et al. Influence of diaphragmatic mobility on exercise tolerance and dyspnea in patients with COPD. Respir Med. 2007;101(10):2113–2118.
Rocha T, Souza H, Brandão DC, et al. The Manual Diaphragm Release Technique improves diaphragmatic mobility, inspiratory capacity and exercise capacity in people with chronic obstructive pulmonary disease: A randomised trial. J Physiother. 2015;61(4):182–189.
Santana PV, Prina E, Albuquerque AL, Carvalho CR, Caruso P. Identifying decreased diaphragmatic mobility and diaphragm thickening in interstitial lung disease: the utility of ultrasound imaging. J Bras Pneumol. 2016;42(2):88–94.
Haji K, Royse A, Green C, Botha J, Canty D, Royse C. Interpreting diaphragmatic movement with bedside imaging, review article. J Crit Care. 2016;34:56–65.
Kolář P, Neuwirth J, Šanda J, et al. Analysis of diaphragm movement during tidal breathing and during its activation while breath holding using MRI synchronized with spirometry. Physiol Res. 2009;58(3):383–392.
Rocha FR, Brüggemann AKV, Francisco D de S, Medeiros CS de, Rosal D, Paulin E. Diaphragmatic mobility: relationship with lung function, respiratory muscle strength, dyspnea, and physical activity in daily life in patients with COPD. J Bras Pneumol. 2017;43(1):32–37.
Toledo NSG, Kodaira SK, Massarollo PCB, Pereira OI, Mies S. Right hemidiaphragmatic mobility: assessment with US measurement of craniocaudal displacement of left branches of portal vein. Radiology. 2003;228(2):389–394.
Bruton A, Conway JH, Holgate ST. Reliability: What is it, and how is it measured? Physiotherapy. 2000;86(2):94–99.
Saltiel R V., Grams ST, Pedrini A, Paulin E. High reliability of measure of diaphragmatic mobility by radiographic method in healthy individuals. Brazilian J Phys Ther. 2013;17(2):128–136.
1Grams ST, von Saltiél R, Mayer AF, et al. Assessment of the reproducibility of the indirect ultrasound method of measuring diaphragm mobility. Clin Physiol Funct Imaging. 2014;34(1):18–25.
Lucas NP, Macaskill P, Irwig L, Bogduk N. The development of a quality appraisal tool for studies of diagnostic reliability (QAREL). J Clin Epidemiol. 2010;63(8):854–861.
May S, Chance-Larsen K, Littlewood C, Lomas D, Saad M. Reliability of physical examination tests used in the assessment of patients with shoulder problems: A systematic review. Physiotherapy. 2010;96(3):179–190.
May S, Littlewood C, Bishop A. Reliability of procedures used in the physical examination of non-specific low back pain: A systematic review. Aust J Physiother. 2006;52(2):91–102.
Lucas N, Macaskill P, Irwig L, et al. The reliability of a quality appraisal tool for studies of diagnostic reliability (QAREL). BMC Med Res Methodol. 2013;13:111.
Guyatt G, Oxman AD, Akl EA, et al. GRADE guidelines: 1. Introduction – GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011;64(4):383–394.
Van Tulder M, Furlan A, Bombardier C, Bouter L. Updated Method Guidelines for Systematic Reviews in the Cochrane Collaboration Back Review Group. Spine (Phila Pa 1976). 2003;28(12):1290–1299.
Houston JG, Morris AD, Howie CA, Reid JL, McMillan N. Technical report: Quantitative assessment of diaphragmatic movement – A reproducible method using ultrasound. Clin Radiol. 1992;46(6):405–407.
Boussuges A, Gole Y, Blanc P. Diaphragmatic motion studied by M-mode ultrasonography. Chest. 2009;135(2):391–400.
Portney LG, Watkins MP. Foundations of Clinical Research Applications to Practice. 3rd Ed. New Jersy: Prentice Hall Health; 2009.
Blaney F, English CS, Sawyer T. Sonographic measurement of diaphragmatic displacement during tidal breathing manoeuvres – a reliability study. Aust J Physiother. 1999;45:41–43.
Journals System - logo
Scroll to top