PainSci summary of Rathbone 2017?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible. ★★★☆☆3-star ratings are for typical studies with no more (or less) than the usual common problems. Ratings are a highly subjective opinion, and subject to revision at any time. If you think this paper has been incorrectly rated, please let me know.
This review is called a meta-analysis, which is weird, because “only 1 study met inclusion criteria for intrarater agreement and therefore no meta-analysis was performed.” So it was just a regular old review of 6 studies of how much different experts can agree on the location of myofascial trigger points. Lacking adequate data for statistical pooling, they had to “estimate” an agreement score of 𝛋=0.452 — a rather precise etimate! Of the criteria used to determine the location of trigger points, the most reliable were localized tenderness (.68) and pain recognition (.57). Those are actually decent reliability scores, but the authors conclude that “manual palpation for identification of MTrPs is unreliable.” Based on their estimated scores, this is technically correct but a bit misleading: most attempts to detect pathologies in the body are technically “unreliable,” falling well short of a score of κ=1.0 (perfect agreement), but still much better than κ=0 (coin flipping agreement).
And the error bars on those estimates were too large for a confident conclusion anyway.
Therefore, my conclusion is that this review was mostly inconclusive, but actually found evidence that trigger point reliability is probably not all that bad — as compared to most comparable assessment procedures.
original abstract†Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
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.
- “Reliability of physical examination for diagnosis of myofascial trigger points: a systematic review of the literature,” Nicholas Lucas, Petra Macaskill, Les Irwig, Robert Moran, and Nikolai Bogduk, Clinical Journal of Pain, 2009.
- “A systematic, critical review of manual palpation for identifying myofascial trigger points: evidence and clinical significance,” Corrie Myburgh, Anders Holsgaard Larsen, and Jan Hartvigsen, Archives of Physical Medicine & Rehabilitation, 2008.
- “Clinical precision of myofascial trigger point location in the trapezius muscle,” V M Sciotti, V L Mittak, L DiMarco, L M Ford, J Plezbert, E Santipadri, J Wigglesworth, and K Ball, Pain, 2001.
- “Interrater reliability in myofascial trigger point examination,” R D Gerwin, S Shannon, C Z Hong, D Hubbard, and R Gevirtz, Pain, 1997.
- “Travell, Simons and Cargo Cult Science,” Fred Wolfe, FMperplex.com.
- “The fibromyalgia and myofascial pain syndromes: a preliminary study of tender points and trigger points in persons with fibromyalgia, myofascial pain syndrome and no disease,” F Wolfe, D G Simons, J Fricton, R M Bennett, D L Goldenberg, R Gerwin, D Hathaway, G A McCain, I J Russell, and H O Sanders, Journal of Rheumatology, 1992.
- “Interrater reliability: the kappa statistic,” Mary L McHugh, Biochem Med (Zagreb), 2012.
- “The measurement of observer agreement for categorical data,” J R Landis and G G Koch, Biometrics, 1977.
These five articles on PainScience.com cite Rathbone 2017 as a source:
- PS Does Massage Therapy Work? — A review of the science of massage therapy … such as it is
- PS Trigger Points & Myofascial Pain Syndrome — A guide to the unfinished science of muscle pain, with reviews of every theory and self-treatment and therapy option
- PS Save Yourself from Low Back Pain! — Low back pain myths debunked and all your treatment options reviewed
- PS Is Diagnosis for Pain Problems Reliable? — Reliability science shows that health professionals can’t agree on many popular theories about why you’re in pain
- PS Trigger Point Doubts — Do muscle knots exist? Exploring controversies about the existence and nature of so-called “trigger points” and myofascial pain syndrome
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- A Bayesian model-averaged meta-analysis of the power pose effect with informed and default priors: the case of felt power. Gronau 2017 Comprehensive Results in Social Psychology.
- The neck and headaches. Bogduk 2014 Neurol Clin.
- Agreement of self-reported items and clinically assessed nerve root involvement (or sciatica) in a primary care setting. Konstantinou 2012 Eur Spine J.
- Effect of NSAIDs on Recovery From Acute Skeletal Muscle Injury: A Systematic Review and Meta-analysis. Morelli 2017 Am J Sports Med.
- Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis. Paige 2017 JAMA.