Highlights
- •There was acceptable intra- and interexaminer reliability in identifying myofascial trigger points (MTPs) for clinical practice.
- •The reliability of MTP classification was acceptable only for intraexaminer assessment.
- •Interexaminer reliability in identifying MTPs was lower on the symptomatic side.
Abstract
Objective
To determine inter- and intraexaminer reliability of examiners without clinical experience
in identifying and classifying myofascial trigger points (MTPs) in the shoulder muscles
of subjects asymptomatic and symptomatic for unilateral subacromial impact syndrome
(SIS).
Design
Within-day inter- and intraexaminer reliability study.
Setting
Physical therapy department of a university.
Participants
Fifty-two subjects participated in the study, 26 symptomatic and 26 asymptomatic for
unilateral SIS.
Interventions
Two examiners, without experience for assessing MTPs, independent and blind to the
clinical conditions of the subjects, assessed bilaterally the presence of MTPs (present
or absent) in 6 shoulder muscles and classified them (latent or active) on the affected
side of the symptomatic group. Each examiner performed the same assessment twice in
the same day.
Main Outcome Measures
Reliability was calculated through percentage agreement, prevalence- and bias-adjusted
kappa (PABAK) statistics, and weighted kappa.
Results
Intraexaminer reliability in identifying MTPs for the symptomatic and asymptomatic
groups was moderate to perfect (PABAK, .46–1 and .60–1, respectively). Interexaminer
reliability was between moderate and almost perfect in the 2 groups (PABAK, .46–.92),
except for the muscles of the symptomatic group, which were below these values. With
respect to MTP classification, intraexaminer reliability was moderate to high for
most muscles, but interexaminer reliability was moderate for only 1 muscle (weighted
κ=.45), and between weak and reasonable for the rest (weighted κ=.06–.31).
Conclusions
Intraexaminer reliability is acceptable in clinical practice to identify and classify
MTPs. However, interexaminer reliability proved to be reliable only to identify MTPs,
with the symptomatic side exhibiting lower values of reliability.
Keywords
List of abbreviations:
MTP (myofascial trigger point), PA (percentage agreement), PABAK (prevalence- and bias-adjusted kappa), SIS (subacromial impact syndrome)To read this article in full you will need to make a payment
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References
- Classification, epidemiology, and natural history of myofascial pain syndrome.Curr Pain Headache Rep. 2001; 5: 412-420
- Diagnosis of myofascial pain syndrome.Phys Med Rehabil Clin N Am. 2014; 25: 341-355
- Myofascial pain and dysfunction: the trigger point manual: volume 1.2nd ed. Lippincott Williams & Wilkins, Baltimore1999
- Myofascial trigger points then and now: a historical and scientific perspective.PM R. 2015; 7: 746-761
- Topographical mapping and mechanical pain sensitivity of myofascial trigger points in the infraspinatus muscle.Eur J Pain. 2008; 12: 859-865
- High prevalence of shoulder girdle muscles with myofascial trigger points in patients with shoulder pain.BMC Musculoskelet Disord. 2011; 12: 139
- Bilateral myofascial trigger points and pressure pain thresholds in the shoulder muscles in patients with unilateral shoulder impingement syndrome.Clin J Pain. 2013; 29: 478-486
- Treatment of myofascial trigger points in patients with chronic shoulder pain: a randomized, controlled trial.BMC Med. 2011; 9: 8
- Treatment of myofascial trigger points in common shoulder disorders by physical therapy: a randomized controlled trial.BMC Musculoskelet Disord. 2007; 8: 107
- Reliability of different methodologies of infrared image analysis of myofascial trigger points in the upper trapezius muscle.Brazilian J Phys Ther. 2015; 19: 122-128
- Assessment of myofascial trigger points using ultrasound.Am J Phys Med Rehabil. 2015; 95: 72-80
- Intra-rater reliability of an experienced physiotherapist in locating myofascial trigger points in upper trapezius muscle.J Man Manip Ther. 2012; 20: 171-177
- Experienced versus inexperienced interexaminer reliability on location and classification of myofascial trigger point palpation to diagnose lateral epicondylalgia: an observational cross-sectional study.Evidence-Based Complement Altern Med. 2016; 2016: 6059719
- Test-retest reliability of myofascial trigger point detection in patients with rotator cuff tendonitis.Clin Rehabil. 2005; 19: 482-487
- Interrater reliability of palpation of myofascial trigger points in three shoulder muscles.J Man Manip Ther. 2007; 15: 203-215
- Interrater reliability in myofascial trigger point examination.Pain. 1997; 69: 65-73
- Inter-therapist reliability in locating latent myofascial trigger points using palpation.Man Ther. 1997; 2: 87-90
- Clinical precision of myofascial trigger point location in the trapezius muscle.Pain. 2001; 93: 259-266
- Standardized manual palpation of myofascial trigger points in relation to neck/shoulder pain; the influence of clinical experience on inter-examiner reproducibility.Man Ther. 2011; 16: 136-140
- The kappa statistic in reliability studies: use, interpretation, and sample size requirements.Phys Ther. 2005; 85: 257-268
- Alteration in shoulder kinematics and associated muscle activity in people with idiopathic scoliosis.Spine (Phila Pa 1976). 2010; 35: 1151-1157
- Scapular positioning and movement in unimpaired shoulders, shoulder impingement syndrome, and glenohumeral instability.Scand J Med Sci Sports. 2011; 21: 352-358
- Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report.J Bone Joint Surg Am. 1972; 54: 41-50
- Scapular kinematics and impairment features for classifying patients with subacromial impingement syndrome.Man Ther. 2010; 15: 547-551
- Painful athletic injuries of the shoulder.Clin Orthop Relat Res. 1983; : 117-124
- Reliability and diagnostic accuracy of 5 physical examination tests and combination of tests for subacromial impingement.Arch Phys Med Rehabil. 2009; 90: 1898-1903
- Guideline for diagnosis and treatment of subacromial pain syndrome.Acta Orthop. 2014; 85: 314-322
- Muscle performance during isokinetic concentric and eccentric abduction in subjects with subacromial impingement syndrome.Eur J Appl Physiol. 2010; 109: 389-395
- The relationship between clinical parameters and depression level in patients with myofascial pain syndrome.Pain Med. 2008; 9: 161-165
- The validity of the Beck Depression Inventory-Short Form as a screening and diagnostic instrument for moderate and severe depression in medical inpatients.J Affect Disord. 2005; 86: 87-91
- Muscle trigger points and pressure pain hyperalgesia in the shoulder muscles in patients with unilateral shoulder impingement: a blinded, controlled study.Exp Brain Res. 2010; 202: 915-925
Lowry R. Kappa as a measure of concordance in categorical sorting. 2001. Available at: http://vassarstats.net/kappa.html. Accessed October 5, 2016.
- The measurement of observer agreement for categorical data.Biometrics. 1977; 33: 159
- Algometry in evaluation of trigger points an referred pain.J Musculoskelet Pain. 1998; 6: 47-59
Article info
Publication history
Published online: July 24, 2017
Footnotes
José Diêgo Sales do Nascimento was supported by CAPES with a Master's scholarship.
Disclosures: none.
Identification
Copyright
© 2017 by the American Congress of Rehabilitation Medicine
