Flinn Shiel1, Carl Persson1, James Furness2, Vini Simas3, Rodney Pope4, Mike Climstein5, Wayne Hing6, Ben Schram6. 1. Physiotherapy Program, Faculty of Health Sciences and Medicine, Bond University, Australia. 2. Physiotherapy Program, Faculty of Health Sciences and Medicine, Bond University, Australia; Water Based Research Unit, Faculty of Health Science and Medicine, Bond University, Australia. Electronic address: jfurness@bond.edu.au. 3. Water Based Research Unit, Faculty of Health Science and Medicine, Bond University, Australia. 4. Physiotherapy Program, School of Community Health, Charles Sturt University, Australia. 5. Water Based Research Unit, Faculty of Health Science and Medicine, Bond University, Australia; Exercise Health & Performance Faculty Research Group, Faculty of Health Sciences, The University of Sydney, Australia. 6. Physiotherapy Program, Faculty of Health Sciences and Medicine, Bond University, Australia; Water Based Research Unit, Faculty of Health Science and Medicine, Bond University, Australia.
Abstract
OBJECTIVES: To systematically identify and assess methods and protocols used to reduce technical and biological errors in published studies that have investigated reliability of dual energy X-ray absorptiometry (DXA) for assessing body composition. DESIGN: Systematic review. METHODS: Systematic searches of five databases were used to identify studies of DXA reliability. Two independent reviewers used a modified critical appraisal tool to assess their methodological quality. Data was extracted and synthesised using a level of evidence approach. Further analysis was then undertaken of methods used to decrease DXA errors (technical and biological) and so enhance DXA reliability. RESULTS: Twelve studies met eligibility criteria. Four of the articles were deemed high quality. Quality articles considered biological and technical errors when preparing participants for DXA scanning. The Nana positioning protocol was assessed to have a strong level of evidence. The studies providing this evidence indicated very high test-retest reliability (ICC 0.90-1.00 or less than 1% change in mean) of the Nana positioning protocol. The National Health and Nutrition Examination Survey (NHANES) positioning protocol was deemed to have a moderate level of evidence due to lack of high quality studies. However, the available studies found the NHANES positioning protocol had very high test-retest reliability. Evidence is limited and reported reliability has varied in papers where no specific positioning protocol was used or reported. CONCLUSIONS: Due to the strong level of evidence of excellent test-retest reliability that supports use of the Nana positioning protocol, it is recommended as the first choice for clinicians when using DXA to assess body composition.
OBJECTIVES: To systematically identify and assess methods and protocols used to reduce technical and biological errors in published studies that have investigated reliability of dual energy X-ray absorptiometry (DXA) for assessing body composition. DESIGN: Systematic review. METHODS: Systematic searches of five databases were used to identify studies of DXA reliability. Two independent reviewers used a modified critical appraisal tool to assess their methodological quality. Data was extracted and synthesised using a level of evidence approach. Further analysis was then undertaken of methods used to decrease DXA errors (technical and biological) and so enhance DXA reliability. RESULTS: Twelve studies met eligibility criteria. Four of the articles were deemed high quality. Quality articles considered biological and technical errors when preparing participants for DXA scanning. The Nana positioning protocol was assessed to have a strong level of evidence. The studies providing this evidence indicated very high test-retest reliability (ICC 0.90-1.00 or less than 1% change in mean) of the Nana positioning protocol. The National Health and Nutrition Examination Survey (NHANES) positioning protocol was deemed to have a moderate level of evidence due to lack of high quality studies. However, the available studies found the NHANES positioning protocol had very high test-retest reliability. Evidence is limited and reported reliability has varied in papers where no specific positioning protocol was used or reported. CONCLUSIONS: Due to the strong level of evidence of excellent test-retest reliability that supports use of the Nana positioning protocol, it is recommended as the first choice for clinicians when using DXA to assess body composition.
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