Jump to ContentJump to Main Navigation
Show Summary Details
More options …

Scandinavian Journal of Pain

Official Journal of the Scandinavian Association for the Study of Pain

Editor-in-Chief: Breivik, Harald


CiteScore 2017: 0.84

SCImago Journal Rank (SJR) 2017: 0.401
Source Normalized Impact per Paper (SNIP) 2017: 0.452

Online
ISSN
1877-8879
See all formats and pricing
More options …
Volume 9, Issue 1

Issues

Reliability of pressure pain threshold testing in healthy pain free young adults

Robert Waller / Leon Straker / Peter O’Sullivan / Michele Sterling / Anne Smith
Published Online: 2015-10-01 | DOI: https://doi.org/10.1016/j.sjpain.2015.05.004

Abstract

Background and aims

Investigation of the multidimensional correlates of pressure pain threshold (PPT) requires the study of large cohorts, and thus the use of multiple raters, for sufficient statistical power. Although PPT testing has previously been shown to be reliable, the reliability of multiple raters and investigation for systematic bias between raters has not been reported.

The aim of this study was to evaluate the intrarater and interrater reliability of PPT measurement by handheld algometer at the wrist, leg, cervical spine and lumbar spine. Additionally the study aimed to calculate sample sizes required for parallel and cross-over studies for various effect sizes accounting for measurement error.

Methods

Five research assistants (RAs) each tested 20 pain free subjects at the wrist, leg, cervical and lumbar spine. Intraclass correlation coefficient (ICC), standard error of measurement (SEM) and systematic bias were calculated.

Results

Both intrarater reliability (ICC = 0.81–0.99) and interrater reliability (ICC = 0.92–0.95) were excellent and intrarater SEM ranged from 79 to 100 kPa. There was systematic bias detected at three sites with no single rater tending to consistently rate higher or lower than others across all sites.

Conclusion

The excellent ICCs observed in this study support the utility of using multiple RAs in large cohort studies using standardised protocols, with the caveat that an absence of any confounding of study estimates by rater is checked, due to systematic rater bias identified in this study.

Implications

Thorough training of raters using PPT results in excellent interrater reliability. Clinical trials using PPT as an outcome measure should utilise a priori sample size calculations.

Keywords: PPT (Pressure pain threshold); Reliability; Multiple raters; Standard error of measurement

References

  • [1]

    Walton DM, Macdermid JC, Nielson W, Teasell RW, Reese H, Levesque L. Reliability, standard error, and minimum detectable change of clinical pressure pain threshold testing in people with and without acute neck pain. J Orthop Sports Phys Ther 2011;41:644–50.PubMedCrossrefWeb of ScienceGoogle Scholar

  • [2]

    slater H, Arendtnielsen L, Wright A, Gravennielsen T. Sensory and motor effects of experimental muscle pain in patients with lateral epicondylalgia and controls with delayed onset muscle soreness. Pain 2005;114:118–30.CrossrefPubMedGoogle Scholar

  • [3]

    Zhou Q, Fillingim RB, Riley lii JL, Malarkey WB, Verne GN. Central and peripheral hypersensitivity in the irritable bowel syndrome. Pain 2010;148:454–61.Web of ScienceCrossrefPubMedGoogle Scholar

  • [4]

    Suokas AK, Walsh DA, McWilliams DF, Condon L, Moreton B, Wylde V, Arendt Nielsen L, Zhang W. Quantitative sensory testing in painful osteoarthritis: a systematic review and meta-analysis. Osteoarthr Cartil 2012;20:1075–85.PubMedCrossrefGoogle Scholar

  • [5]

    O’Neill S, Manniche C, Graven-Nielsen T, Arendt-Nielsen L. Generalized deep-tissue hyperalgesia in patients with chronic low-back pain. Eur J Pain 2007;11:415–20.PubMedCrossrefWeb of ScienceGoogle Scholar

  • [6]

    Kardouni JR, Shaffer S.W., Pidcoe P.E., Finucane S.D., Cheatham S.A., Michener L.A. Immediate changes in pressure pain sensitivity after thoracic spinal manipulative therapy in patients with subacromial impingement syndrome: a randomized controlled study. Manual Therapy 2015;20:540–6.CrossrefWeb of SciencePubMedGoogle Scholar

  • [7]

    Macedo LB, Josué AM, Maia PHB, Câmara AE, Brasileiro JS. Effect of burst TENS and conventional TENS combined with cryotherapy on pressure pain threshold: randomised, controlled, clinical trial. Physiotherapy 2015;101: 155–60.Web of SciencePubMedCrossrefGoogle Scholar

  • [8]

    Ylinen J, Takala E-P, Kautiainen H, Nykänen M, Häkkinen A, Pohjolainen T, Karppi S-L, Airaksinen O. Effect of long-term neck muscle training on pressure pain threshold: a randomized controlled trial. Eur J Pain 2005;9:673–81.PubMedCrossrefGoogle Scholar

  • [9]

    Bakar Y, Sertel M, Öztürk A, Yümin ET, Tatarli N, Ankarali H. Short term effects of classic massage compared to connective tissue massage on pressure pain threshold and muscle relaxation response in women with chronic neck pain: a preliminary study. J Manipulative Physiol Ther 2014;37:415–21.PubMedCrossrefWeb of ScienceGoogle Scholar

  • [10]

    Fuentes CJ, Armijo-Olivo S, Magee DJ, Gross DP. A preliminary investigation into the effects of active interferential current therapy and placebo on pressure pain sensitivity: a random crossover placebo controlled study. Physiotherapy 2011;97:291–301.CrossrefPubMedWeb of ScienceGoogle Scholar

  • [11]

    Venancio RC, Pelegrini S, Gomes DQ, Nakano EY, Liebano RE. Effects of carrier frequency of interferential current on pressure pain threshold and sensory comfort in humans. Arch Phys Med Rehabil 2013;94:95–102.CrossrefWeb of SciencePubMedGoogle Scholar

  • [12]

    Rolke R, Baron R, Maier C, Tolle TR, Treede RD, Beyer A, Binder A, Birbaumer N, Birklein F, Botefur IC, Braune S, Flor H, Huge V, Klug R, Landwehrmeyer GB, Magerl W, Maihofner C, Rolko C, Schaub C, Scherens A, Sprenger T, Valet M, Wasserka B. Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): standardized protocol and reference values. Pain 2006;123:231–43.PubMedCrossrefGoogle Scholar

  • [13]

    Chesterton LS, Sim J, Wright CC, Foster NE. Interrater reliability of algometry in measuring pressure pain thresholds in healthy humans, using multiple raters. Clin J Pain 2007;23:760–6.CrossrefPubMedWeb of ScienceGoogle Scholar

  • [14]

    Nussbaum EL, Downes L. Reliability of clinical pressure-pain algometric measurements obtained on consecutive days. Phys Ther 1998;78:160–9.PubMedCrossrefGoogle Scholar

  • [15]

    Tunks E, McCain GA, Hart LE, Teasell RW, Goldsmith CH, Rollman GB, McDermid AJ, DeShance PJ. The Reliability or examination for tenderness in patients with my of ascial pain, chronic fibromyalgia and controls. J Rheumatol 1995;22:944–52.Google Scholar

  • [16]

    Stratford PW, Goldsmith CH. Use of the standard error as a reliability index of interest: an applied example using elbow flexor strength data. Phys Ther 1997;77:745–50.CrossrefPubMedGoogle Scholar

  • [17]

    Weir JP. Quantifying test–retest reliability using the intraclass correlation coefficient and the SEM. J Strength Cond Res 2005;19:231–40.PubMedGoogle Scholar

  • [18]

    Guyatt G, Walter S, Norman G. Measuring change over time: assessing the usefulness of evaluative instruments. J Chroni Dis 1987;40:171–8.CrossrefGoogle Scholar

  • [19]

    Faul F, Erdfelder E, Buchner A, Lang A-G. Statistical power analyses using G*Power3.1:tests for correlation and regression analyses. Behav Res Methods 2009;41:1149–60.CrossrefPubMedGoogle Scholar

  • [20]

    Persson AL, Brogardh C, Sjolund BH. Tender or no tender: test-retest repeatability of pressure pain thresholds in the trapezius and deltoid muscles of healthy women. J Rehab Med 2004;36:17–27.CrossrefGoogle Scholar

  • [21]

    Geber C, Klein T, Azad S, Birklein F, Gierthmühlen J, Huge V, Lauchart M, Nitzsche D, Stengel M, Valet M, Baron R, Maier C, Tölle T, Treede R-D. Test-retest and interobserver reliability of quantitative sensory testing according to the protocol of the German Research Network on Neuropathic Pain (DFNS): a multicentre study. Pain 2011;152:548–56.PubMedCrossrefGoogle Scholar

  • [22]

    Delaney GAM, McKee ACM. Inter and intra-rate reliability of the pressure pain threshold meter in measurement of myofascial trigger point sensitivity. Am J Phys Med Rehabil 1993;72:136–9.CrossrefGoogle Scholar

  • [23]

    Reeves JL, Jaeger B, Graff-Radford SB. Reliability of the pressure algometer as a measure of myofascial trigger point sensitivity. Pain 1986;24:313–21.PubMedCrossrefGoogle Scholar

About the article

School of Physiotherapy Exercise Science, Curtin University, GPO Box 1987, Perth, Western Australia 6845, Australia. Tel.: +61 8 9266 3662;fax: +61 8 9266 3699


Received: 2015-03-24

Revised: 2015-05-27

Accepted: 2015-05-28

Published Online: 2015-10-01

Published in Print: 2015-10-01


Ethical statement: All aspects of the study were approved by Curtin University Human Research Ethics Committee.

Conflict of interest: The authors have no conflict of interest.


Citation Information: Scandinavian Journal of Pain, Volume 9, Issue 1, Pages 38–41, ISSN (Online) 1877-8879, ISSN (Print) 1877-8860, DOI: https://doi.org/10.1016/j.sjpain.2015.05.004.

Export Citation

© 2015 Scandinavian Association for the Study of Pain.Get Permission

Citing Articles

Here you can find all Crossref-listed publications in which this article is cited. If you would like to receive automatic email messages as soon as this article is cited in other publications, simply activate the “Citation Alert” on the top of this page.

[1]
Robert Waller, Anne J. Smith, Peter B. O’Sullivan, Helen Slater, Michele Sterling, and Leon M. Straker
The Clinical Journal of Pain, 2019, Volume 35, Number 1, Page 56
[2]
Quoc C. Vuong, Angela Owen, Kehinde Akin-Akinyosoye, Vera Araujo-Soares, and Mariella Pazzaglia
PLOS ONE, 2018, Volume 13, Number 11, Page e0207023

Comments (0)

Please log in or register to comment.
Log in