Inter and intra-rater reliability of the manual assessment of respiratory motion ('MARM' technique) in adults

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Ludwig, Martin
Author ORCID Profiles (clickable)
Master of Osteopathy
Unitec Institute of Technology
Bacon, Catherine
Moran, Robert
Masters Thesis
Ngā Upoko Tukutuku (Māori subject headings)
breathing dysfunction
breathing assessment
physical examination
ANZSRC Field of Research Code (2020)
Ludwig, M. (2013). Inter and intra-rater reliability of the manual assessment of respiratory motion (’MARM’ technique) in adults. (Unpublished document submitted in partial fulfilment of the requirements for the degree of Master of Osteopathy). Unitec Institute of Technology, Auckland, New Zealand. Retrieved from
AIM: The primary aim of this study was to investigate the inter- and intra-rater reliability of a "manual assessment of breathing" (MARM). A secondary aim was to explore the relationship between Breath Holding Time (BHT), Breathing Rate (BR), breathing compartment dominance (thoracic and abdominal), and two questionnaires concerned with symptoms of breathing (Nijmegen (NQ) and Self Evaluation of Breathing Questionnaires (SEBQ)). METHODS: Practitioners (n=6) received introductory level instruction in MARM assessment. They then rated the mechanical breathing pattern of 16 participants with nil to moderate breathing dysfunction. Participants completed two breathing questionnaires (NQ and SEBQ) and were also assessed for Breath Holding Time, Breathing Rate and Abdominal Excursion using Respiratory Inductive Plethysmography.RESULTS: The inter-rater and intra-rater reliability of the MARM was poor (inter-rater: ICC[2,1] range = -0.18 to 0.36; intra-rater: ICC[2,1] range = -0.51 to 0.92). Inter and intra-rater reliability of the MARM was insufficient to warrant clinical use. Moderate correlations were identified between Breathing Rate (BR) and Breath Holding Time (BHT) (r = 0.5; p = 0.04), between BHT and the Self Evaluation of Breathing Questionnaire (SEBQ) (r = 0.5; p = 0.05), and between the SEBQ and the Nijmegen Questionnaire (NQ) (r = 0.6; p = 0.01). CONCLUSIONS: Raters in this study demonstrated poor inter-rater reliability of the MARM. The intra-rater reliability is higher for some raters indicating that the MARM may be more useful for individual practice, when the same rater is undertaking assessment of breathing.
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