Reliability of Pain Measurements Using Computerized Cuff Algometry: A DoloCuff Reliability and Agreement Study

Olsen, Jack Kvistgaard; Fener, Dilay Kesgin; Wæhrens, Eva Ejlersen; Christensen, Anton Wulf; Jespersen, Anders; Danneskiold‐Samsøe, Bente; Bartels, Else Marie

doi:10.1111/papr.12514

Cited by 15 publications

(8 citation statements)

References 35 publications

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“…Both the current and previous studies indicate that estimation of PPT is reliable regardless of the evaluated body region. In contrast, only a few studies have evaluated the reliability of cuff-PPTol in the short term, showing moderate to excellent reliability (0.74 to 0.96) [36,37]. This study reports similar ICC confidence intervals for cuff-PPTol-7, although the previous studies established a pain tolerance threshold with a computerized cuff at NRS 10 out of 10.…”

Section: Short-term Reliabilitysupporting

confidence: 44%

Long-term consistency of clinical sensory testing measures for pain assessment

et al. 2023

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Background: Understanding the stability of quantitative sensory tests (QSTs) over time is important to aid clinicians in selecting a battery of tests for assessing and monitoring patients. This study evaluated the short-and long-term reliability of selected QSTs. Methods: Twenty healthy women participated in three experimental sessions: Baseline, 2 weeks, and 6 months. Measurements included pressure pain thresholds (PPT) in the neck, upper back, and leg; Pressure-cuff pain tolerance around the upper-arm; conditioned pain modulation during a pressure-cuff stimulus; and referred pain following a suprathreshold pressure stimulation. Intraclass correlation coefficients (ICC) and minimum detectable change (MDC) were calculated. Results: Reliability for PPT was excellent for all sites at 2 weeks (ICC, 0.96-0.99; MDC, 22-55 kPa) and from good to excellent at 6 months (ICC, 0.88-0.95; MDC, 47-91 kPa). ICC for pressure-cuff pain tolerance indicated excellent reliability at both times (0.91-0.97). For conditioned pain modulation, reliability was moderate for all sites at 2 weeks (ICC, 0.57-0.74; MDC, 24%-35%), while it was moderate at the neck (ICC, 0.54; MDC, 27%) and poor at the upper back and leg at 6 months. ICC for referred pain areas was excellent at 2 weeks (0.90) and good at 6 months (0.86). Conclusions: PPT, pressure pain tolerance, and pressure-induced referred pain should be considered reliable procedures to assess the pain-sensory profile over time. In contrast, conditioned pain modulation was shown to be unstable. Future studies prospectively analyzing the pain-sensory profile will be able to better calculate appropriate sample sizes.

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Section: Short-term Reliabilitysupporting

confidence: 44%

Long-term consistency of clinical sensory testing measures for pain assessment

et al. 2023

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“…In fact, we examined seven clinically-relevant inter-evaluator reliability studies that have been published since 2015 and found that for 4 of the 7 studies, it was unclear how benchmarks of reliability were determined (i.e., what constituted a good versus bad score) [ 18 – 21 ]. The three remaining studies each used a different source for inter-evaluator reliability interpretation guidelines, and thus used slightly different grading scales [ 22 – 24 ]. Additionally, reliability indices alone cannot tell us the error inherent to a group of evaluators attempting to measure a variable of interest.…”

Section: Introductionmentioning

confidence: 99%

Reliability in evaluator-based tests: using simulation-constructed models to determine contextually relevant agreement thresholds

Beckler

Thumser

Schofield

et al. 2018

BMC Med Res Methodol

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BackgroundIndices of inter-evaluator reliability are used in many fields such as computational linguistics, psychology, and medical science; however, the interpretation of resulting values and determination of appropriate thresholds lack context and are often guided only by arbitrary “rules of thumb” or simply not addressed at all. Our goal for this work was to develop a method for determining the relationship between inter-evaluator agreement and error to facilitate meaningful interpretation of values, thresholds, and reliability.MethodsThree expert human evaluators completed a video analysis task, and averaged their results together to create a reference dataset of 300 time measurements. We simulated unique combinations of systematic error and random error onto the reference dataset to generate 4900 new hypothetical evaluators (each with 300 time measurements). The systematic errors and random errors made by the hypothetical evaluator population were approximated as the mean and variance of a normally-distributed error signal. Calculating the error (using percent error) and inter-evaluator agreement (using Krippendorff’s alpha) between each hypothetical evaluator and the reference dataset allowed us to establish a mathematical model and value envelope of the worst possible percent error for any given amount of agreement.ResultsWe used the relationship between inter-evaluator agreement and error to make an informed judgment of an acceptable threshold for Krippendorff’s alpha within the context of our specific test. To demonstrate the utility of our modeling approach, we calculated the percent error and Krippendorff’s alpha between the reference dataset and a new cohort of trained human evaluators and used our contextually-derived Krippendorff’s alpha threshold as a gauge of evaluator quality. Although all evaluators had relatively high agreement (> 0.9) compared to the rule of thumb (0.8), our agreement threshold permitted evaluators with low error, while rejecting one evaluator with relatively high error.ConclusionsWe found that our approach established threshold values of reliability, within the context of our evaluation criteria, that were far less permissive than the typically accepted “rule of thumb” cutoff for Krippendorff’s alpha. This procedure provides a less arbitrary method for determining a reliability threshold and can be tailored to work within the context of any reliability index.

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“…To our knowledge, there are currently no studies that have formally assessed the test–retest reliability of other commonly employed experimental models of tonic muscle pain, such as the cold‐pressor test (Angius et al, 2015; Slysz & Burr, 2021) and ischaemic contractions (Jones et al, 2014; O'Leary et al, 2017). Conversely, the reliability of the pain response elicited from techniques such as cuff and point pressure algometry, which provide a measure of pain pressure threshold have been well established (for example, Chesterton et al, 2007; Graven‐Nielsen et al, 2015; Kvistgaard Olsen et al, 2017; Nussbaum & Downes, 1998). However, the ability of these methods to assess muscle pain specifically is confounded by the unavoidable stimulation of cutaneous nociceptors and low‐threshold non‐nociceptors alongside muscle nociceptors (Graven‐Nielsen & Arendt‐Nielsen, 2003).…”

Section: Discussionmentioning

confidence: 99%

Intra‐ and interindividual reliability of muscle pain induced by an intramuscular injection of hypertonic saline injection into the quadriceps

Smith

Norbury

Hunt

et al. 2023

European Journal of Pain

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BackgroundIntramuscular injections of hypertonic saline are commonly used to induce experimental muscle pain, but reliability data on this technique are lacking. This study investigated the intra‐ and interindividual reliability of pain measures from a hypertonic saline injection into the vastus lateralis.MethodsFourteen healthy participants (6 female) attended three laboratory visits where they received an intramuscular injection of 1 mL hypertonic saline into the vastus lateralis. Changes in pain intensity were recorded on an electronic visual analogue scale, and pain quality was assessed after pain had resolved. Reliability was assessed with the coefficient of variation (CV), minimum detectable change (MDC) and intraclass correlation coefficient (ICC) with 95% CIs.ResultsMean pain intensity displayed high levels of intraindividual variability (CV = 16.3 [10.5–22.0]%) and ‘poor’ to ‘very good’ relative reliability (ICC = 0.71 [0.45–0.88]) but had a MDC of 11 [8–16] au (out of 100). Peak pain intensity exhibited high levels of intraindividual variability (CV = 14.8 [8.8–20.8]%) with ‘moderate’ to ‘excellent’ levels of relative reliability (ICC = 0.81 [0.62–0.92]), whereas the MDC was 18 [14–26] au. Measures of pain quality exhibited good reliability. Interindividual variability in pain measures was high (CV > 37%).ConclusionsIntramuscular injections of 1 mL of hypertonic saline into the vastus lateralis display substantial levels of interindividual variability, but MDC is below the clinically important changes in pain. This model of experimental pain is suitable for studies involving repeated exposures.SignificanceMany pain research studies have performed intramuscular injections of hypertonic saline to investigate responses to muscle pain. However, the reliability of this technique is not well established. We examined the pain response over three repeated sessions of a hypertonic saline injection. The pain induced by hypertonic saline has considerable interindividual variability but has largely acceptable intraindividual reliability. Therefore, the injections of hypertonic saline to induce muscle pain are a reliable model of experimental muscle pain.

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Reliability of Pain Measurements Using Computerized Cuff Algometry: A DoloCuff Reliability and Agreement Study

Abstract: Inter-rater reliability was excellent for PT, PTol, and TSI. Similarly, the intrarater reliability for PT and PTol was excellent, while borderline excellent/good for TSI. Therefore, the DoloCuff can be used to obtain reliable measures of pressure pain parameters in healthy subjects.

Cited by 15 publications

References 35 publications

Long-term consistency of clinical sensory testing measures for pain assessment

Long-term consistency of clinical sensory testing measures for pain assessment

Reliability in evaluator-based tests: using simulation-constructed models to determine contextually relevant agreement thresholds

Intra‐ and interindividual reliability of muscle pain induced by an intramuscular injection of hypertonic saline injection into the quadriceps

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