Point-of-care kinesiological ultrasound certification process based on statistical and clinical criteria for skeletal muscle assessment

Intensive care unit patients often experience significant muscle mass loss, necessitating precise monitoring to guide interventions. Training and certifying physiotherapists help ensure agreement in measurements, reducing errors during assessments. The objective of this study is to certify a team of physiotherapists using both statistical and clinical criteria to ensure consistent ultrasound measurements of muscle architecture. This observational study evaluated the Kinesiological Muscle Ultrasound VISA certification program for physiotherapists. The program included three hours of theoretical instruction and three hours of supervised practice. Certification was granted based on both clinical and statistical criteria, with measurement agreement analyzed using the Bland-Altman method. Three training cycles were required to certify all physiotherapists. Notably, only 63% of measurements that satisfied the statistical criterion also met the clinical criteria. At the conclusion of the training program, the mean differences between expert and trainee measurements were: -0.05 cm (95% CI: -0.08 to -0.01) for right vastus intermedius thickness, -0.06 cm (95% CI: -0.09 to -0.03) for left vastus intermedius thickness, -0.06 cm (95% CI: -0.08 to -0.04) for right rectus femoris thickness, -0.02 cm (95% CI: -0.05 to 0.008) for left rectus femoris thickness, 0.009 cm² (95% CI: -0.05 to 0.07) for the right cross-sectional area, and - 0.09 cm² (95% CI: -0.16 to -0.01) for the left cross-sectional area of the rectus femoris. Employing both statistical and clinical criteria, along with agreement analysis between expert and trainee measurements, was a pivotal strategy for addressing the training needs of physiotherapists.