Overall Clinical Bottom Line: After a complete appraisal of nine articles, we conclude that the addition of rehabilitative ultrasound imaging (RUSI) to traditional methods of teaching muscle contractions (transverse abdominis (TrA), multifidus, pelvic floor and external anal sphincter) utilizing verbal and tactile cueing is no more beneficial in enhancing retention of these skills in symptomatic (low back pain, pelvic floor dysfunction or fecal incontinence) subjects. From these articles, we were unable to deduce if RUSI enhanced restoration of function (pain and/or continence) more than traditional techniques alone. However, evidence supported the use of RUSI in asymptomatic subjects for retaining the ability to perform a multifidus muscle contraction both seven days and four weeks after training. Due to the lack of evidence that RUSI significantly enhances acquisition and retention of the desired muscle contractions in symptomatic subjects, the benefits of RUSI currently do not mitigate the high cost of RUSI equipment. However, no harm has been reported using RUSI. If RUSI equipment were readily available in a clinic, we would utilize it to re-educate muscles during the cognitive phase of learning.
Clinical Scenario: We have been treating patients with lumbar instability and pelvic floor dysfunction. Our primary teaching methods have included verbal and tactile cueing to facilitate the proper muscle contractions and to provide patients with knowledge of results. We recently learned about using RUSI to provide visual feedback to facilitate acquisition of these contractions (TrA, multifidus, and pelvic floor muscles). We would like to know if the literature supports the use of RUSI over traditional verbal and tactile feedback to facilitate retention of performing the desired muscle contraction and to help decrease pain and disability.
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