PainSci summary of Sciotti 2001?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.
One of the earlier studies of trigger point diagnostic reliability. It proceeds based on the assumption that interrater reliability had already been established (debatable at the time, and debated ever since). The goal here was to test the precision of trigger point detection. They tested four clinicians that “trained extensively together prior to the study,” examining 20 subjects. They used a special camera system to record the exact location of each putative trigger point “without providing feedback to subsequent clinicians,” and the data was analyzed after all assessment were completed. Any two of the four testers had more than 80% agreement with each other about location, with high precision as well, accurate to within 6.5-7.5mmm, “the physical dimensions of the clinician's own fingertips.” They concluded that “two trained examiners can reliably localize latent TrPs.”
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.
Myofascial trigger points (TrPs) have been clinically described as discrete areas of muscle tenderness presenting in taut bands of skeletal muscle. Using well-defined clinical criteria, prior investigations have demonstrated interrater reliability «o rly?» in the diagnosis of TrPs within a given muscle. No reports exist, however, with respect to the precision with which experienced clinicians can determine the anatomic locations of TrPs within a muscle. This paper details a study wherein four trained clinicians achieved statistically significant reliability (see below) in estimating the precise locations of latent TrPs in the trapezius muscle of volunteer subjects (n=20). To do so, the clinicians trained extensively together prior to the study. The precise anatomic location of each subject's primary TrP was measured in a blinded fashion using a 3 dimensional (3-D) camera system. Use of this measurement system permitted the anatomic co-ordinates of each TrP to be located without providing feedback to subsequent clinicians. The clinicians each used a pressure algometer along with patient feedback to document the sensitivity of each suspected TrP site, however unlike routine clinical practice, the algometry was performed with a double-blinded approach hence the results were only examined post-hoc. At the time of data collection (algometry readings unknown), 16 of the 20 subjects were judged to present with a latent TrP. Subsequently, when subjected to a criterion pressure threshold value of <3.0 kg.cm(-2), 12 of these TrPs were classified as being clinically sensitive. To assess the 3-D measurement precision, and the reliability of the TrP estimates, statistical measures of the SEM and the Generalizability coefficient (G-coeff) were determined for all suspected TrP sites in the superior-inferior, medial-lateral and anterior-posterior directions. The best results were determined by pooling the measurements of all 4 clinicians, however, based upon exceeding a criterion reliability threshold of 80%, the use of just two testers was found to produce reliable results. The two-tester condition yielded a precision of 7.5, 7.6 and 6.5 mm (SEM) with reliability (G-coeff) of 0.92, 0.86 and 0.83, respectively. Given the double-blinded methodology, the use of pressure algometry was also found to demonstrate internal validity. The algometer responses associated with TrP estimates varied inversely with respect to the clinical group's reliability in identify the TrP locations. To summarize, for the trapezius muscle, this study demonstrates that two trained examiners can reliably localize latent TrPs with a precision that essentially approaches the physical dimensions of the clinician's own fingertips. Finally, it should be recognized that the ability to precisely document TrP location appears critical to the success of future studies that may be designed to investigate the etiology and pathogenesis of this commonly diagnosed clinical disorder.
- “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.
- “Interrater Agreement of Manual Palpation for Identification of Myofascial Trigger Points: A Systematic Review and Meta-Analysis,” Alasdair T L Rathbone, Liza Grosman-Rimon, and Dinesh A Kumbhare, The Clinical Journal of Pain, 2017.
- “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 two articles on PainScience.com cite Sciotti 2001 as a source:
- 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 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.