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Scandinavian Journal of Pain

Official Journal of the Scandinavian Association for the Study of Pain

Editor-in-Chief: Werner, Mads

CiteScore 2018: 0.85

SCImago Journal Rank (SJR) 2018: 0.494
Source Normalized Impact per Paper (SNIP) 2018: 0.427

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Volume 16, Issue 1


Multifactorial assessment of measurement errors affecting intraoral quantitative sensory testing reliability

Estephan J. Moana-Filho
  • Corresponding author
  • Division of TMD and Orofacial Pain, School of Dentistry, University of Minnesota, 6-320d Moos Tower, 515 Delaware St. SE, Minneapolis, MN 55455, United States
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  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Aurelio A. Alonso
  • Center for Translational Pain Medicine, Department of Anesthesiology, Duke University School of Medicine, Durham, United States
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  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Flavia P. Kapos
  • Department of Epidemiology, School of Public Health, University of Washington, Seattle, United States
  • Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, United States
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  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Vladimir Leon-Salazar / Scott H. Durand / James S. Hodges / Donald R. Nixdorf
  • Division of TMD and Orofacial Pain, School of Dentistry, University of Minnesota, 6-320d Moos Tower, 515 Delaware St. SE, Minneapolis, MN 55455, United States
  • Department of Neurology, Medical School, University of Minnesota, Minneapolis, United States
  • HealthPartners Institute for Education and Research, Bloomington, United States
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  • De Gruyter OnlineGoogle Scholar
Published Online: 2017-07-01 | DOI: https://doi.org/10.1016/j.sjpain.2017.03.007


Background and purpose (aims)

Measurement error of intraoral quantitative sensory testing (QST) has been assessed using traditional methods for reliability, such as intraclass correlation coefficients (ICCs). Most studies reporting QST reliability focused on assessingone source of measurement error at a time, e.g., inter- or intra-examiner (test–retest) reliabilities and employed two examiners to test inter-examiner reliability. The present study used a complex design with multiple examiners with the aim of assessing the reliability of intraoral QST taking account of multiple sources of error simultaneously.


Four examiners of varied experience assessed 12 healthy participants in two visits separated by 48 h. Seven QST procedures to determine sensory thresholds were used: cold detection (CDT), warmth detection (WDT), cold pain (CPT), heat pain (HPT), mechanical detection (MDT), mechanical pain (MPT) and pressure pain (PPT). Mixed linear models were used to estimate variance components for reliability assessment; dependability coefficients were used to simulate alternative test scenarios.


Most intraoral QST variability arose from differences between participants (8.8–30.5%), differences between visits within participant (4.6–52.8%), and error (13.3–28.3%). For QST procedures other than CDT and MDT, increasing the number of visits with a single examiner performing the procedures would lead to improved dependability (dependability coefficient ranges: single visit, four examiners = 0.12–0.54; four visits, single examiner = 0.27–0.68). A wide range of reliabilities for QST procedures, as measured by ICCs, was noted for inter- (0.39–0.80) and intra-examiner (0.10–0.62) variation.


Reliability of sensory testing can be better assessed by measuring multiple sources of error simultaneously instead of focusing on one source at a time. In experimental settings, large numbers of participants are needed to obtain accurate estimates of treatment effects based on QST measurements. This is different from clinical use, where variation between persons (the person main effect) is not a concern because clinical measurements are done on a single person.


Future studies assessing sensorytestingreliabilityinboth clinicaland experimental settings would benefit from routinely measuring multiple sources of error. The methods and results of this study can be used by clinical researchers to improve assessment of measurement error related to intraoral sensorytesting. This should lead to improved resource allocation when designing studies that use intraoral quantitative sensory testing in clinical and experimental settings.

© 2017 Scandinavian Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

This article offers supplementary material which is provided at the end of the article.

Keywords: Multisensory perception; Nervous system; Neuroscience/neurobiology; Oral diagnosis; Pain


Research reported in this publication was supported by the National Institutes of Health grants UL1-TR000114 and K12-RR23247. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

DOI of refers to article: http://dx.doi.org/10.1016/j.sjpain.2017.04.066.


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About the article

Received: 2016-11-03

Revised: 2017-03-11

Accepted: 2017-03-29

Published Online: 2017-07-01

Published in Print: 2017-07-01

Ethical issues: The University of Minnesota (UMN) Institutional Review Board approved the study’s protocol (approval #1004M80212) and all participants gave oral and written informed consent before entering the study. Data were collected in May 2010.

Conflict of interest: The authors declare that there is no conflict of interest.

Citation Information: Scandinavian Journal of Pain, Volume 16, Issue 1, Pages 93–98, ISSN (Online) 1877-8879, ISSN (Print) 1877-8860, DOI: https://doi.org/10.1016/j.sjpain.2017.03.007.

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