Israel Defense Force, Medical Corps, Ramat Gan, Israel.
Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Pain Med. 2021 Oct 8;22(10):2283-2289. doi: 10.1093/pm/pnab148.
Myofascial trigger point diagnosis is a clinical palpatory skill dependent on the patient's subjective response. The inter- and intra-rater reliability of trigger point physical evaluation in the lower leg muscles has rarely been reported. Previous reliability studies suffered from the Kappa paradox.
To evaluate the inter- and intra-rater reliability of trigger point recognition in the lower leg muscles implying a specific method to overcome the first Kappa paradox.
A reliability study with pre-second examiner exclusion to correct prevalence index.
Physical therapy outpatient clinic, Beer-Sheva, Israel.
In sum, 86 soldiers aged 18-30 referred for physical therapy with a diagnosis of musculoskeletal pain consented to take part in this study; 26 were excluded for lacking trigger points, leaving 60 subjects for analysis (31 women, 29 men).
Both legs were evaluated, and the results were analyzed separately for symptomatic (N = 87) and asymptomatic legs (N = 31). Each subject was evaluated three times, twice by one examiner, and once by a second examiner. Dichotomous findings including palpable taut-band, tenderness, referred pain, and relevance of referred pain were recorded.
Inter-rater reliability for active trigger points ranged from 0.49 to 0.75 (median: 0.52) and intra-rater reliability ranged from 0.41 to 0.84 (median: 0.65) and. For total trigger points intra-rater reliability ranged from 0.52 to 0.79 (median: 0.67), and inter-rater reliability ranged from 0.44 to 0.77 (median: 0.66).
Physical examination is a reliable method of trigger point evaluation in lower leg muscles, and it can be used as a diagnostic method for trigger point evaluation.
肌筋膜触发点诊断是一种依赖于患者主观反应的临床触诊技能。小腿肌肉触发点物理评估的组内和组间可靠性很少有报道。以前的可靠性研究受到 Kappa 悖论的影响。
评估小腿肌肉触发点识别的组内和组间可靠性，提出一种克服第一个 Kappa 悖论的特定方法。
采用第二次检查前排除观察者的可靠性研究，以纠正流行率指数。
以色列贝尔谢巴的物理治疗门诊。
共有 86 名年龄在 18-30 岁的士兵因肌肉骨骼疼痛接受物理治疗，并同意参加这项研究；26 名因缺乏触发点而被排除在外，60 名受试者（31 名女性，29 名男性）被纳入分析。
评估双侧小腿，对有症状（N=87）和无症状（N=31）的小腿分别进行分析。每位受试者评估 3 次，由 1 名检查者评估 2 次，由第 2 名检查者评估 1 次。记录触诊到紧张带、压痛、牵涉痛和牵涉痛相关性的阳性发现。
主动触发点的组间可靠性为 0.49-0.75（中位数：0.52），组内可靠性为 0.41-0.84（中位数：0.65）。对于总触发点，组内可靠性为 0.52-0.79（中位数：0.67），组间可靠性为 0.44-0.77（中位数：0.66）。
小腿肌肉的触诊检查是一种可靠的触发点评估方法，可以作为触发点评估的诊断方法。
