D.M. Walton, PT, PhD, Manipulative Therapy Program, School of Physical Therapy, Western University, 1201 Western Rd, Room EC1443, London, Ontario, Canada N6G 1A1.
L. Levesque, PT, MClSc, Manipulative Therapy Program, School of Physical Therapy, Western University.
Phys Ther. 2014 Jun;94(6):827-37. doi: 10.2522/ptj.20130369. Epub 2014 Feb 20.
BACKGROUND: Quantitative sensory testing, including pressure pain threshold (PPT), is seeing increased use in clinical practice. In order to facilitate clinical utility, knowledge of the properties of the tool and interpretation of results are required. OBJECTIVES: This observational study used a clinical sample of people with mechanical neck pain to determine: (1) the influence of number of testing repetitions on measurement properties, (2) reliability and minimum clinically important difference, and (3) associations between PPT and key psychological constructs. DESIGN: This study was observational with both cross-sectional and prospective elements. METHODS: Experienced clinicians measured PPT in patients with mechanical neck pain following a standardized protocol. Subcohorts also provided repeated measures and completed scales of key psychological constructs. RESULTS: The total sample was 206 participants, but not all participants provided data for all analyses. Interrater and 1-week test-retest reliability were excellent (intraclass correlation coefficients [2,1]=.75-.95). Potentially important differences in reliability and PPT scores were found when using only 1 or 2 repeated measures compared with all 3. The PPT over a distal location (tibialis anterior muscle) was not adequately responsive in this sample, but the local site (upper trapezius muscle) was responsive and may be useful as part of a protocol to evaluate clinical change. Sensitivity values (range=0.08-0.50) and specificity values (range=0.82-0.97) for a range of change scores are presented. Depression, catastrophizing, and kinesiophobia were able to explain small but statistically significant variance in local PPT (3.9%-5.9%), but only catastrophizing and kinesiophobia explained significant variance in the distal PPT (3.6% and 2.9%, respectively). LIMITATIONS: Limitations of the study include multiple raters, unknown recruitment rates, and unknown measurement properties at sites other than those tested here. CONCLUSIONS: The results suggest that PPT is adequately reliable and that 3 measurements should be taken to maximize measurement properties. The variance explained by the psychological variables was small but significant for 3 constructs related to catastrophizing, depression, and fear of movement. Clinical implications for application and interpretation of PPT are discussed.
背景：定量感觉测试，包括压痛阈（PPT），在临床实践中应用越来越广泛。为了便于临床应用，需要了解工具的特性并对结果进行解释。
目的：本观察性研究使用机械性颈痛患者的临床样本，确定：（1）测试重复次数对测量特性的影响；（2）可靠性和最小临床重要差异；（3）PPT 与关键心理结构之间的关联。
设计：本研究为观察性研究，具有横断面和前瞻性元素。
方法：经验丰富的临床医生按照标准化方案测量机械性颈痛患者的 PPT。亚组还提供了重复测量并完成了关键心理结构量表。
结果：总样本为 206 名参与者，但并非所有参与者都为所有分析提供了数据。组内相关系数（2,1）为 0.75-0.95，提示观察者间和 1 周的测试-再测试可靠性均极佳。与使用 1 或 2 次重复测量相比，使用所有 3 次重复测量时，可靠性和 PPT 评分可能存在重要差异。在该样本中，远端部位（胫骨前肌）的 PPT 反应不足，但局部部位（上斜方肌）反应良好，可能作为评估临床变化的方案的一部分有用。提供了各种变化评分的敏感性值（范围为 0.08-0.50）和特异性值（范围为 0.82-0.97）。抑郁、灾难化和运动恐惧可解释局部 PPT 的小但具有统计学意义的差异（3.9%-5.9%），但只有灾难化和运动恐惧可以解释远端 PPT 的显著差异（分别为 3.6%和 2.9%）。
局限性：本研究的局限性包括多个评估者、未知的招募率以及此处未测试的其他部位的未知测量特性。
结论：结果表明，PPT 具有足够的可靠性，应进行 3 次测量以最大限度地提高测量特性。与灾难化、抑郁和运动恐惧相关的 3 个结构的心理变量解释的方差虽小，但具有统计学意义。讨论了 PPT 的应用和解释的临床意义。
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