Alasdair T L Rathbone1, Liza Grosman-Rimon, Dinesh A Kumbhare. 1. *Schulich School of Medicine and Dentistry, University of Western Ontario, London †Toronto Rehabilitation Institute, Musculoskeletal Rehabilitation Program, University Health Network (UHN) ‡Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada.
Abstract
OBJECTIVE: To achieve a statistical estimate of the agreement of manual palpation for identification of myofascial trigger points (MTrPs) and secondarily to investigate potential factors impacting the agreement of this technique. METHODS: We searched MEDLINE(R) and Embase for studies examining the reproducibility of manual palpation for the identification of MTrPs from the year 2007 to present. In addition, we utilized studies identified by 2 comprehensive systematic reviews that covered the period before 2007. The included studies were original peer-reviewed research articles and included Cohen κ measures or data with which to calculate Cohen κ. Studies were excluded if they lacked a measure of variability or information required to calculate variability. Studies that examined palpation through body cavities were also excluded. Of the 18 potentially relevant articles only 6 met inclusion criteria including 363 patients. Modified QUADAS tool was used to assess study validity. Subgroup comparisons were made utilizing Q and Z tests. RESULTS: An estimate of κ=0.452 (95% confidence interval, 0.364-0.540) was obtained for interrater agreement of manual palpation of MTrPs. Localized tenderness (κ=0.676) and pain recognition (κ=0.575) were the most reliable criteria. Only 1 study met inclusion criteria for intrarater agreement and therefore no meta-analysis was performed. DISCUSSION: Use of manual palpation for identification of MTrPs is unreliable, and future investigation should focus on integration with more reliable techniques.
OBJECTIVE: To achieve a statistical estimate of the agreement of manual palpation for identification of myofascial trigger points (MTrPs) and secondarily to investigate potential factors impacting the agreement of this technique. METHODS: We searched MEDLINE(R) and Embase for studies examining the reproducibility of manual palpation for the identification of MTrPs from the year 2007 to present. In addition, we utilized studies identified by 2 comprehensive systematic reviews that covered the period before 2007. The included studies were original peer-reviewed research articles and included Cohen κ measures or data with which to calculate Cohen κ. Studies were excluded if they lacked a measure of variability or information required to calculate variability. Studies that examined palpation through body cavities were also excluded. Of the 18 potentially relevant articles only 6 met inclusion criteria including 363 patients. Modified QUADAS tool was used to assess study validity. Subgroup comparisons were made utilizing Q and Z tests. RESULTS: An estimate of κ=0.452 (95% confidence interval, 0.364-0.540) was obtained for interrater agreement of manual palpation of MTrPs. Localized tenderness (κ=0.676) and pain recognition (κ=0.575) were the most reliable criteria. Only 1 study met inclusion criteria for intrarater agreement and therefore no meta-analysis was performed. DISCUSSION: Use of manual palpation for identification of MTrPs is unreliable, and future investigation should focus on integration with more reliable techniques.
Authors: Felipe C K Duarte; Daniel W D West; Lukas D Linde; Samah Hassan; Dinesh A Kumbhare Journal: Curr Rheumatol Rep Date: 2021-07-08 Impact factor: 4.592
Authors: Andrea Cotti; Massimiliano Del Corso; Roberto Diana; Luigi Cornale; Alessandra Sudanese; Antonio Stecco; Mirco Branchini Journal: J Man Manip Ther Date: 2019-10-31