Reliability and Usefulness of the Pressure Pain Threshold Measurement in Patients with Myofascial Pain

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Abstract

Objective

To assess the usefulness of a pressure algometer to measure pressure pain threshold (PPT) for diagnosis of myofascial pain syndrome (MPS) in the upper extremity and trunk muscles.

Method

A group of 221 desk workers complaining of upper body pain participated in this study. Five physiatrists made the diagnosis of MPS using physical examination and PPT measurements. PPT measurements were determined for several muscles in the back and upper extremities. Mean PPT data for gender, side, and dominant hand groups were analyzed. Sensitivity and specificity of Fischer's standard method were evaluated. PPT cut-off values for each muscle group were determined using an ROC curve.

Results

Cronbach's alpha for each muscle was very high. The PPT in men was higher than in females, and the PPT in the left side was higher than in the right side for all muscles tested (p<0.05). There was no significant difference in PPT for all muscles between dominant and non-dominant hand groups. Diagnosis of MPS based on Fischer's standard showed relatively high specificity and poor sensitivity.

Conclusion

The digital pressure algometer showed high reliability. PPT might be a useful parameter for assessing a treatment's effect, but not for use in diagnosis or even as a screening method.

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Most cited references 24

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Interrater reliability of algometry in measuring pressure pain thresholds in healthy humans, using multiple raters.

Linda Chesterton, Julius Sim, Christine Wright … (2015)

To evaluate interrater reliability using 5 newly trained observers in the assessment of pressure pain threshold (PPT) using a fixed-angle algometer. The study design comprised 2 phases. Phase 1: 5 undergraduate physical therapists were trained in algometry at a predefined angle, at a rate of 5 Newtons (N)/s, to the first dorsal interosseous muscle. Each observer then underwent a competency test of the application speed. The aim was to achieve repeated applications at 5 N/s without visual feedback from the algometer. Phase 2: the 5 observers measured PPT of 13 healthy volunteers, at the first dorsal interosseous muscle. The sequence of observer measurements for each participant was randomized. Mean PPT values for each observer were analyzed using repeated measures analysis of variance, intraclass correlation coefficient (ICC2,1), and standard error of measurement, with 95% confidence intervals (CIs). No significant differences between observers' mean values were found (P=0.094), suggesting no bias. The ICC was 0.91 (95% CI 0.82, 0.97). The standard error of measurement value was 6.27 N/cm (95% CI 5.35, 7.59). Differences in PPT measurements of more than 17.39 N/cm (1.77 kg/cm) are likely to exceed the magnitude of measurement error, and could be used to indicate true change. This margin of error is, however, somewhat larger than a previously proposed minimum clinically important difference in PPT of 14.71 N/cm (1.5 kg/cm). This study provides new evidence that trained observers can apply an algometer at a consistent rate and provide highly reliable measures of PPT in healthy humans, when PPT is calculated as the mean of 3 trials.

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Gender differences in pressure pain threshold in healthy humans.

Mark G. Baxter, Panos Barlas, N Foster … (2003)

AIMS OF INVESTIGATION: To quantify the magnitude of putative gender differences in experimental pressure pain threshold (PPT), and to establish the relevance of repeated measurements to any such differences. Two separate studies were undertaken. A pressure algometer was used in both studies to assess PPT in the first dorsal interosseous muscle. Force was increased at a rate of 5 N /s. In study 1, two measurements were taken from 240 healthy volunteers (120 males, 120 females; mean age 25 years) giving a power for statistical analysis of beta=0.80 at alpha=0.01. In study two, 30 subjects (15 males, 15 females mean age 28 years) were randomly selected from study one. Fourteen repeated PPT measurements were recorded at seven, 10 min intervals. Mean PPT data for gender groups, from both studies, were analysed using analysis of covariance with repeated measures, and age as the covariate. The mean PPT for each of the two measurements in study one showed a difference between gender of 12.2 N (f=30.5 N, m=42.7 N) and 12.8 N (f=29.5 N, m=42.3 N), respectively, representing a difference of 28% with females exhibiting a lower threshold. In study two, the mean difference calculated from 14 PPT repeated measurements over a 1h period was comparable to that in study one at 12.3N (range 10.4-14.4 N) again females exhibited the lower threshold. The differences in mean PPT values between gender were found to be significant in both study one, at (P<0.0005, F=37.8, df=1) and study two (P=0.01, F=7.6, df=1). No significant differences were found in either study with repeated measurement (P=0.892 and P=0.280), or on the interaction of gender and repeated measurement after controlling for age (P=0.36 and P=0.62). Healthy females exhibited significantly lower mean PPTs in the first dorsal interosseous muscle than males, which was maintained for fourteen repeated measures within a 1 h period. This difference is likely to be above clinically relevant levels of change, and it has clear implications for the use of different gender subjects in laboratory based experimental designs utilising PPT as an outcome measure.

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Reliability and validity of a pressure algometer.

Patricia A Kinser, W Sands, Martin H. Stone (2008)

Algometers are devices that can be used to identify the pressure and/or force eliciting a pressure-pain threshold. It has been noted in pressure-pain threshold studies that the rate at which manual force is applied should be consistent to provide the greatest reliability. This study tested the reliability and construct validity of an algometer (1000-Hz sampling rate) by manually applying pressure on a force plate (500-Hz sampling rate): 10 sets of 5 applications to 80 N and 1 set of 5 applications to each force level: 20, 30, 40, 50, 60, 70, 80, 90, 100, and 110 N. The investigator had previously become familiar with and practiced with the algometer. The handheld algometer had a 1-cm2 round rubber application surface, and the maximum force reading was compared with maximum force readings by the force plate using SEM and t-tests. Force-time curves were analyzed for average slope representing rate of force application. Average Pearson (r) correlations between the maximum force reading of the algometer and force plate were excellent in both trials to 80 N (r = 0.990) and the incremental trials (r = 0.999). The application of force was reasonably constant, with slopes averaging 6.8 +/- 0.932 N x s-1. The SEE was 0.323 N. In conclusion, with previous familiarization and practice, an investigator may have high reliability in the rate of force application. The device itself was also highly correlated with readings from a force plate and, therefore, may be considered valid.

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Author and article information

Journal

Journal ID (nlm-ta): Ann Rehabil Med

Journal ID (iso-abbrev): Ann Rehabil Med

Journal ID (publisher-id): ARM

Title: Annals of Rehabilitation Medicine

Publisher: Korean Academy of Rehabilitation Medicine

ISSN (Print): 2234-0645

ISSN (Electronic): 2234-0653

Publication date (Print): June 2011

Publication date (Electronic): 30 June 2011

Volume: 35

Issue: 3

Pages: 412-417

Affiliations

Department of Rehabilitation Medicine, Hanyang University College of Medicine, Guri 471-701, Korea.

Author notes

Corresponding author: Seong Ho Jang. Department of Rehabilitation Medicine, Guri Hospital, Hanyang University College of Medicine, 249-1, Gyomun-dong, Guri 471-701, Korea. Tel: +81-31-560-2380, Fax: +81-31-564-4654, systole@ 123456naver.com

Article

DOI: 10.5535/arm.2011.35.3.412

PMC ID: 3309218

PubMed ID: 22506152

SO-VID: 9a79cced-5923-4d3e-95ee-58c85a83edea

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Reliability and Usefulness of the Pressure Pain Threshold Measurement in Patients with Myofascial Pain

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Abstract

Objective

Method

Results

Conclusion

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Most cited references 24

Interrater reliability of algometry in measuring pressure pain thresholds in healthy humans, using multiple raters.

Gender differences in pressure pain threshold in healthy humans.

Reliability and validity of a pressure algometer.

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