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Reliability of trigger point diagnosis has not been studied properly yet

PainSci » bibliography » Myburgh et al 2008
Tags: diagnosis, muscle pain, massage, radiculopathy, trigger points doubts, muscle, pain problems, manual therapy, treatment, modalities, neuropathy, pain, spine

Four articles on PainSci cite Myburgh 2008: 1. The Complete Guide to Trigger Points & Myofascial Pain2. Is Diagnosis for Pain Problems Reliable?3. Trigger Point Doubts4. Palpatory Pareidolia & Diagnosis by Touch

PainSci commentary on Myburgh 2008: ?This page is one of thousands in the 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 wherever possible.

This 2008 review of the reliability of trigger point diagnosis resoundingly concluded that the question simply hasn’t been properly studied. The authors urge clinicians and scientists to “move toward simpler, global assessments of patient status.” Translation: “Nothing to see here, move along!”

This is essentially the same conclusion as a 2009 review by Lucas et al.

~ Paul Ingraham

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 determine the reproducibility of manual palpation in identifying trigger points based on a systematic review of available literature.

DATA SOURCES: Medline (1965-2007), CINHAL (1982-2007), ISI Web of Science (1945-2007), and MANTIS (1966-2007) databases and reference lists of articles.

STUDY SELECTION: Reproducibility studies relating to identification and diagnosis of trigger points through palpation. Acceptable studies were required to specifically consider either inter- or intrarater reliability of trigger point identification through manual palpation and include kappa statistics as part of their statistical assessment.

DATA EXTRACTION: Three independent reviewers considered the studies for inclusion and rated their methodologic quality based on the Standards for Reporting of Diagnostic Accuracy guidelines for the reporting of diagnostic studies.

DATA SYNTHESIS: Eleven studies were initially included; however, 5 were subsequently excluded based on the inclusion and exclusion criteria. Only 2 studies were judged to be of high quality, and the level of evidence criteria suggested that, at best, moderate evidence could be found from which to make pronouncements on the literature. Only local tenderness of the trapezius (kappa range, .15-.62) and pain referral of the gluteus medius (kappa range, .298-.487) and quadratus lumborum (kappa range, .36-.501) were found to be reproducible.

CONCLUSIONS: The methodologic quality of the majority of studies for the purpose of establishing trigger point reproducibility is generally poor. More high-quality studies are needed to comment on this procedure. Clinicians and scientists are urged to move toward simpler, global assessments of patient status.

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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:

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