This study investigates the intra- and interrater reliability of Pressure Pain Threshold assessments in patients with nonspecific shoulder pain, focusing on chronic and subacute stages. A sample of 26 adults was evaluated using a mechanical algometer across six anatomical points. Intrarater and interrater reliability were calculated using the intraclass correlation coefficient (ICC), standard error of measurement, and minimal detectable change (MDC). Results demonstrated almost perfect reliability for both intrarater (ICC range: 0.96–0.99) and interrater (ICC range: 0.92–0.99) assessments. Standard error of measurement and MDC values for intrarater reliability showed clinically acceptable error, except for the upper trapezius and mid-deltoid, where MDC value exceeded 25% of the grand mean, suggesting reduced precision between nonspecific shoulder pain stages. For interrater reliability, the adductor pollicis brevis, upper trapezius, and infraspinatus also showed less precision, with MDC values exceeding 25% of the grand mean, particularly in chronic patients. Despite these findings, no significant differences were observed between the subacute and chronic groups. While relative reliability was high, the findings highlight the need for caution in interpreting absolute reliability, especially for inter-rater assessments at specific muscle sites.
LucasJvan DoornPHegedusE, et al.A systematic review of the global prevalence and incidence of shoulder pain. BMC Musculoskelet Disord2022; 23: 1073.
2.
KuijpersTvan der WindtDvan der HeijdenG, et al.Systematic review of prognostic cohort studies on shoulder disorders. Pain2004; 109: 420–431.
3.
YangFLiXWangJ, et al.Efficacy of different analgesic strategies combined with conventional physiotherapy program for treating chronic shoulder pain: a systematic review and network meta-analysis. J Orthop Surg Res2024; 19: 44.
4.
BarretoRPGBramanJPLudewigPM, et al.Bilateral magnetic resonance imaging findings in individuals with unilateral shoulder pain. J Shoulder Elbow Surg2019; 28: 1699–1706.
5.
GirishGLoboLGJacobsonJA, et al.Ultrasound of the shoulder: asymptomatic findings in men. AJR Am J Roentgenol2011; 197: W713–W719.
6.
SalamhPLewisJ. It is time to put special tests for rotator cuff–related shoulder pain out to pasture. J Orthop Sports Phys Ther2020; 50: 222–225.
7.
LewisJO’SullivanP. Is it time to reframe how we care for people with non-traumatic musculoskeletal pain?Br J Sports Med2018; 52: 1543–1544.
8.
LewisJSCookCEHoffmannTC, et al.The elephant in the room: Too much medicine in musculoskeletal practice. J Orthop Sports Phys Ther2020; 50: 1–4.
9.
PavlouKSavvaCKorakakisV, et al.Blood flow restriction training in nonspecific shoulder pain: study protocol of a crossover randomised controlled trial. Sports2023; 11: 197.
10.
Ferreira-ValenteMAPais-RibeiroJLJensenMP. Validity of four pain intensity rating scales. Pain2011; 152: 2399–2404.
11.
HawkerGAMianSKendzerskaT, et al.Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res2011; 63: S240–S252. DOI: https://doi.org/10.1002/acr.20543.
12.
VaegterHBJonesMD. Exercise-induced hypoalgesia after acute and regular exercise: experimental and clinical manifestations and possible mechanisms in individuals with and without pain. Pain Rep2020; 5: e823.
13.
MoloneyNAHallTMDoodyCM. Reliability of thermal quantitative sensory testing: a systematic review. J Rehabil Res Dev2012; 49: 191–207.
14.
StausholmMBBjordalJMMoe-NilssenR, et al.Pain pressure threshold algometry in knee osteoarthritis: intra- and inter-rater reliability. Physiother Theory Pract2023; 39: 615–622.
15.
ParkGKimCWParkSB, et al.Reliability and usefulness of the pressure pain threshold measurement in patients with myofascial pain. Ann Rehabil Med2011; 35: 412–417.
16.
KnapstadMKNordahlSHGNaterstadIF, et al.Measuring pressure pain threshold in the cervical region of dizzy patients—the reliability of a pressure algometer. Physiother Res Int2018; 23: e1736.
17.
BhattacharyyaAHopkinsonLDNoletPS, et al.The reliability of pressure pain threshold in individuals with low back or neck pain: a systematic review. Br J Pain2023; 17: 579–591.
18.
BilikaPPaliourasASavvoulidouK, et al.Psychometric properties of quantitative sensory testing in healthy and patients with shoulder pain: a systematic review. J Musculoskelet Neuronal Interact2023; 23: 145–164.
Alburquerque-SendínFCamargoPRVieiraA, et al.Bilateral myofascial trigger points and pressure pain thresholds in the shoulder muscles in patients with unilateral shoulder impingement syndrome: a blinded, controlled study. Clin J Pain2013; 29: 478–486.
21.
PrevitaliDBordoniVFilardoG, et al.High rate of pain sensitization in musculoskeletal shoulder diseases: a systematic review and meta-analysis. Clin J Pain2021; 37: 237–248.
22.
BalaguierRMadeleinePVuillermeN. Is one trial sufficient to obtain excellent pressure pain threshold reliability in the low back of asymptomatic individuals? A test-retest study. PLoS One2016; 11: e0160866.
23.
PratheepNSMadeleinePArendt-NielsenL. Relative and absolute test-retest reliabilities of pressure pain threshold in patients with knee osteoarthritis. Scand J Pain2018; 18: 229–236.
24.
WaltonDMacDermidJNielsonW, et al.Reliability, standard error, and minimum detectable change of clinical pressure pain threshold testing in people with and without acute neck pain. J Orthop Sports Phys Ther2011; 41: 644–650.
25.
RibeiroILCamargoPRAlburquerque-SendínF, et al.Topographical pressure pain sensitivity maps of the shoulder region in individuals with subacromial pain syndrome. Man Ther2016; 21: 134–143..
26.
MadeleinePLundagerBVoigtM, et al.Sensory manifestations in experimental and work-related chronic neck-shoulder pain. Eur J Pain1998; 2: 251–260.
27.
Hidalgo-LozanoAFernández-de-las-PeñasCAlonso-BlancoC, et al.Muscle trigger points and pressure pain hyperalgesia in the shoulder muscles in patients with unilateral shoulder impingement: a blinded, controlled study. Exp Brain Res2010; 202: 915–925.
28.
VanderweeënLOostendorpRAVaesP, et al.Pressure algometry in manual therapy. Man Ther1996; 1: 258–265.
29.
NascimentoJAlburquerque-SendínFVigolvinoLP, et al.Absolute and relative reliability of pressure pain threshold assessments in the shoulder muscles of participants with and without unilateral subacromial impingement syndrome. J Manipulative Physiol Ther2020; 43: 57–67.
30.
BilikaPKalamatas-MavrikasPVasilisN, et al.Reliability of pressure pain threshold (PPT) and conditioned pain modulation (CPM) in participants with and without chronic shoulder pain. Healthcare2024; 12: 1734.
31.
KottnerJAudigéLBrorsonS, et al.Guidelines for reporting reliability and agreement studies (GRRAS) were proposed. J Clin Epidemiol2011; 64: 96–106.
KorakakisVWhiteleyRGiakasG. Low load resistance training with blood flow restriction decreases anterior knee pain more than resistance training alone. A pilot randomised controlled trial. Phys Ther Sport2018; 34: 121–128.
34.
HeronSRWobySRThompsonDP. Comparison of three types of exercise in the treatment of rotator cuff tendinopathy/shoulder impingement syndrome: a randomized controlled trial. Physiotherapy2017; 103: 167–173.
35.
PeolssonALöfgrenHDederingÅ, et al.Neurological outcomes after surgery and postoperative rehabilitation for cervical radiculopathy due to disc disease: a 2-year-follow-up of a randomized clinical trial. Sci Rep2023; 13: 3830.
36.
GasparPDWillisFB. Adhesive capsulitis and dynamic splinting: a controlled, cohort study. BMC Musculoskelet Disord2009; 10: 11.
37.
DonnerAEliasziwM. Sample size requirements for reliability studies. Stat Med1987; 6: 441–448.
38.
KorakakisVO’SullivanKSiderisV, et al.No differences in spinal repositioning error in patients with low back pain presenting with a directional preference into extension. Eur J Physiother2020; 22: 212–220.
39.
SacramentoLSCamargoPRSiqueira-JúniorAL, et al.Presence of latent myofascial trigger points and determination of pressure pain thresholds of the shoulder girdle in healthy children and young adults: a cross-sectional study. J Manipulative Physiol Ther2017; 40: 31–40..
40.
KangS-YChoungS-DJeonH-S. Characteristics of leg and ankle in taxi drivers. Phys Ther Korea2014; 21: 55–62.
41.
BartholomewCEdwardsLLackS. Pressure pain thresholds in adults with patellofemoral pain and patellofemoral joint osteoarthritis: a case-control study. Scand J Pain2019; 19: 713–723.
42.
BakerSJKellyNMEstonRG. Pressure pain tolerance at different sites on the quadriceps femoris prior to and following eccentric exercise. Eur J Pain1997; 1: 229–233.
43.
KorakakisVO’SullivanKSotiralisY, et al.Evaluation of the within- and between-day intra-tester and inter-tester reliability of positioning subjects into neutral and lordotic sitting postures. Eur J Physiother2019; 21: 142–152.
44.
LandisJRKochGG. The measurement of observer agreement for categorical data. Biometrics1977; 33: 159–174.
45.
WeirJP. Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM. J Strength Cond Res2005; 19: 231–240.
46.
BlandJMAltmanDG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet1986; 1: 307–310.
47.
DenegarCRBallDW. Assessing reliability and precision of measurement: an introduction to intraclass correlation and standard error of measurement. J Sport Rehabil1993; 2: 35–42.
48.
BarakattETRomanoPSRiddleDL, et al.An exploration of Maitland's concept of pain irritability in patients with low back pain. J Man Manip Ther2009; 17: 196–205.
49.
CiminoRFarellaMMichelottiA, et al.Does the ovarian cycle influence the pressure-pain threshold of the masticatory muscles in symptom-free women?J Orofac Pain2000; 14: 105–111.
50.
BajajPArendt-NielsenLBajajP, et al.Sensory changes during the ovulatory phase of the menstrual cycle in healthy women. Eur J Pain2001; 5: 135–144.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
