Reliability of temporal summation, thermal and pressure pain thresholds in a healthy cohort and musculoskeletal trauma population

Nicola Middlebrook, Nicola R Heneghan, David W Evans, Alison Rushton, Deborah Falla, Nicola Middlebrook, Nicola R Heneghan, David W Evans, Alison Rushton, Deborah Falla

Abstract

Traumatic injuries affect approximately 978 million people worldwide with 56.2 million requiring inpatient care. Quantitative sensory testing (QST) can be useful in predicting outcome following trauma, however the reliability of multiple QST including temporal summation (TS), heat and cold pain thresholds (HPT, CPT) and pressure pain thresholds (PPT) is unknown. We assessed intra (between day) and inter-rater (within day) reliability of QST in asymptomatic participants (n = 21), and inter-rater (within day) reliability in participants presenting with acute musculoskeletal trauma (n = 25). Intra-class correlations with 95% confidence intervals (ICC 3,2), standard error of measurement (SEM) and Bland Altman Plots for limits of agreement were calculated. For asymptomatic participants, reliability was good to excellent for HPT (ICC range 0.76-0.95), moderate to good for PPT (ICC range 0.52-0.93), with one site rated poor (ICC 0.41), and poor to excellent for TS scores (ICC range 0.20-0.91). For musculoskeletal trauma participants reliability was good to excellent for HPT and PPT (ICC range 0.76-0.86), and moderate to good reliability for TS (ICC range 0.69-0.91). SEM for HPT for both sets of participants was ~1°C and an average of 7N for asymptomatic participants and less than 8N for acute musculoskeletal trauma participants for PPT. This study demonstrates moderate to excellent intra and inter-rater reliability for HPT and PPT in asymptomatic participants and good to excellent inter-rater reliability for acute musculoskeletal trauma participants, with TS showing more variability for both sets of participants. This study provides foundations for future work evaluating the sensory function over time following acute musculoskeletal trauma.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1
Intra-rater (A & B) and Inter-rater (C & D) Bland Altman Plots with limits of agreement for heat pain thresholds for the asymptomatic participants. Limits of agreement are presented as the dotted lines with the mean difference illustrated by the black line.
Fig 2
Fig 2
Intra-rater (A & B) and Inter-rater (C & D) Bland Altman Plots with limits of agreement for cold pain thresholds for the asymptomatic participants. Limits of agreement are presented as the dotted lines with the mean difference illustrated by the black line.
Fig 3
Fig 3
Intra-rater (A & B) and Inter-rater (C & D) Bland Altman Plots with limits of agreement for pressure pain thresholds for the asymptomatic participants. Limits of agreement are presented as the dotted lines with the mean difference illustrated by the black line.
Fig 4
Fig 4
Inter-rater Bland Altman Plots with limits of agreement for heat pain thresholds (A), pressure pain thresholds (B) and cold pain thresholds (C) for the acute musculoskeletal trauma participants. Limits of agreement are presented as the dotted lines with mean difference the black line.

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