Somphithak Soukmisai, Chatchawan Uraiwan, Pimdee Atipong, Sucharit Wiraphong
School of Physical Therapy, Faculty of Associated Medical Sciences (AMS), Khon Kaen University (KKU), Khon Kaen, Thailand.
Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University (KKU), Khon Kaen, Thailand.
PeerJ. 2025 Jun 9;13:e19580. doi: 10.7717/peerj.19580. eCollection 2025.
Tissue hardness meter and algometer (THA) are used to assess tissue hardness (TH) and pressure pain threshold (PPT), particularly in the evaluation of myofascial trigger points (MTrPs). This study introduces a side-lying protocol designed to comprehensively measure all portions of the upper trapezius (UT) muscle.
The objective was to determine the reliability and responsiveness of THA to measure TH and PPT in patients with MTrPs in the UT muscle.
Reliability of TH and PPT measurements was assessed in a sample of 24 participants. Intra-rater and inter-rater reliability were evaluated using the intra-class correlation coefficient (ICC), while absolute reliability was established Bland-Altman analysis, including the calculation of 95% limits of agreement (95% LoA). To assess responsiveness, 36 additional participants were recruited. Both distribution-based methods (mean difference, effect size (ES), standardized response mean (SRM), standard error of measurement (SEM), and minimal detectable change at 95% confidence (MDC)) and anchor-based methods (minimal clinically important difference (MCID) and area under the curve (AUC)) were utilized in the analysis.
Intra-rater reliability was excellent for both TH and PPT (ICC: 0.95-0.97), while inter-rater reliability was moderate (ICC: 0.60). Evidence of both fixed and proportional bias was identified for both TH and PPT. For TH, the SEM and MDC were 2.66% and 7.37%, respectively, while for PPT, they were 0.12 kg/cm and 0.34 kg/cm, respectively. Following six physical therapy sessions, significant reductions in TH (mean: -7.86%; MCID: -7.43%; AUC: 0.97) and significant increases in PPT (mean: 0.20 kg/cm; MCID: 0.21 kg/cm; AUC: 0.86) were observed. Additionally, changes in PPT showed a negative correlation with improvements in the Neck Disability Index (NDI) (r = -0.35, < 0.05).
The side-lying protocol demonstrated reliable and clinically relevant TH and PPT measurements, supporting its use for monitoring treatment outcomes in patients with MTrPs in the UT muscle.
组织硬度计和痛觉计（THA）用于评估组织硬度（TH）和压痛阈值（PPT），特别是在肌筋膜触发点（MTrP）的评估中。本研究引入了一种侧卧方案，旨在全面测量斜方肌上束（UT）肌肉的所有部分。
目的是确定THA在测量UT肌肉中存在MTrP的患者的TH和PPT时的可靠性和反应性。
在24名参与者的样本中评估TH和PPT测量的可靠性。使用组内相关系数（ICC）评估评分者内和评分者间的可靠性，同时通过Bland-Altman分析确定绝对可靠性，包括计算95%一致性界限（95% LoA）。为了评估反应性，又招募了36名参与者。分析中使用了基于分布的方法（平均差异、效应大小（ES）、标准化反应均值（SRM）、测量标准误差（SEM）和95%置信度下的最小可检测变化（MDC））和基于锚定的方法（最小临床重要差异（MCID）和曲线下面积（AUC））。
评分者内可靠性对于TH和PPT均极佳（ICC：0.95 - 0.97），而评分者间可靠性为中等（ICC：0.60）。在TH和PPT中均发现了固定偏差和比例偏差的证据。对于TH，SEM和MDC分别为2.66%和7.37%，而对于PPT，它们分别为0.12 kg/cm和0.34 kg/cm。在进行六次物理治疗后，观察到TH显著降低（平均值：-7.86%；MCID：-7.43%；AUC：0.97），PPT显著增加（平均值：0.20 kg/cm；MCID：0.21 kg/cm；AUC：0.86）。此外，PPT的变化与颈部功能障碍指数（NDI）的改善呈负相关（r = -0.35，P < 0.05）。
侧卧方案显示出可靠且与临床相关的TH和PPT测量结果，支持其用于监测UT肌肉中存在MTrP的患者的治疗效果。
