British journal of pain · 2026
Reliability and standard error of measurement of pressure pain thresholds at articular landmarks.
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Tomschi Fabian, Hilberg Thomas
Аннотация
BACKGROUND: Pressure pain threshold (PPT) testing is a widely used quantitative sensory testing method to assess mechanical pain sensitivity. While reference values for PPT at articular-/joint-related and osseous landmarks are available, data on measurement reliability remain limited. This study aimed to determine the intra- and inter-rater reliability of PPT measurements and to report the standard error of measurement (SEM) for joint PPT.
METHODS: Healthy participants aged 18-40 years were included in a two-part study. In Part A (N = 40), intra-rater reliability was assessed through three repeated PPT measurements by the same examiner. In Part B (N = 40), inter-rater reliability was evaluated with two different examiners. PPT was measured at joints (elbow, knee, ankle) and reference landmarks (sternum, forehead) using a digital algometer. ICCs (2,k model) and SEM were calculated for each landmark.
RESULTS: Intra-rater reliability was excellent at all landmarks (ICCs ≥ 0.926) except the elbow with a good reliability (ICC = 0.848). Inter-rater reliability was excellent at the sternum (ICC = 0.950) and good at the ankle, knee, elbow, and forehead (ICCs ≥ 0.813). SEM values varied across landmarks, with lowest values observed at reference landmarks sites (e.g., sternum and forehead). ICCs are similar between sexes.
CONCLUSIONS: PPT measurements at articular (joints) and bony reference landmarks show good to excellent reliability. These findings support the use of joint PPT in standardized pain sensitivity assessments and provide a basis for clinical and research applications. However, findings are limited to pain-free participants and should be replicated in broader populations.
METHODS: Healthy participants aged 18-40 years were included in a two-part study. In Part A (N = 40), intra-rater reliability was assessed through three repeated PPT measurements by the same examiner. In Part B (N = 40), inter-rater reliability was evaluated with two different examiners. PPT was measured at joints (elbow, knee, ankle) and reference landmarks (sternum, forehead) using a digital algometer. ICCs (2,k model) and SEM were calculated for each landmark.
RESULTS: Intra-rater reliability was excellent at all landmarks (ICCs ≥ 0.926) except the elbow with a good reliability (ICC = 0.848). Inter-rater reliability was excellent at the sternum (ICC = 0.950) and good at the ankle, knee, elbow, and forehead (ICCs ≥ 0.813). SEM values varied across landmarks, with lowest values observed at reference landmarks sites (e.g., sternum and forehead). ICCs are similar between sexes.
CONCLUSIONS: PPT measurements at articular (joints) and bony reference landmarks show good to excellent reliability. These findings support the use of joint PPT in standardized pain sensitivity assessments and provide a basis for clinical and research applications. However, findings are limited to pain-free participants and should be replicated in broader populations.