Test-Retest Reliability of Decomposition-Based Quantitative Electromyography Derived Motor Unit Number Estimates
MetadataShow full item record
Establishing a valid, reliable, and objective method for determining the number of functioning motor units in a muscle is important clinically, as it would provide a quantitative means of documenting changes in neuromuscular health over time. This thesis addressed the reliability of motor unit number estimates (MUNEs) derived using decomposition-based quantitative electromyography (DQEMG) from the extensor digitorum brevis (EDB) and abductor hallucis (AH) muscles. Additionally, the effect of the mean surface motor unit potential (SMUP) parameter averaging method (arithmetic/ensemble), the size-related parameter used to calculate MUNE (amplitude/area), and the type of SMUP marker editing (automatic/manual) was investigated in terms of MUNE values. Two separate analyses on a single data set collected from twenty healthy subjects on two occasions were conducted. MUNEs were calculated by dividing a size-related parameter (amplitude/area) of the compound muscle action potential (CMAP) by the same size-related parameter of a representative mean SMUP. First, paired t-tests investigated differences in MUNEs calculated using arithmetic and ensemble averaged SMUP parameters. Within- and between-day reliability of the two measurements was established using intra-class correlation coefficients (ICCs), coefficients of variation (CV), mean absolute differences (MAD), and Bland Altman limits of agreement (LOA). Second, MUNEs (using both parameters) derived from automated and manually edited SMUPs were compared. The effect of the size-related parameter and editing type was identified using a two-factor, repeated measures analysis of variance. Reliability was determined as described above. Arithmetic averaged SMUP parameters produced smaller MUNEs than those derived from ensemble averaging (p<0.001). SMUP area produced higher MUNEs than SMUP amplitude (p<0.05), except when using arithmetic averaged parameters in AH. Interaction effects between editing type and size parameter were present in both muscles (F>6.68, p<0.001). Between-day MUNEs had lower CVs and MADs, higher ICCs, and narrower LOAs than within-day MUNEs. MUNEs derived from arithmetic averaged SMUP parameters showed the highest reliability (ICCs>0.91). MUNEs calculated from automated SMUP marker placements were highly correlated (r>0.86) and displayed comparable reliabilities to those derived from manual marker placement (ICCs>0.90). To optimize the reproducibility of MUNEs calculated using DQEMG, while minimizing processing time, between-day automated estimates using arithmetic averaged SMUP amplitude is recommended.