I think I would be more inclined to use it with a symptomatic patient. We found that the PPT is a reliable measure, so if a symptomatic patient goes through treatments, I would probably utilize this instrument in order to track any changes.
My answer is yes. Because our research showed that norms could be established and the fact that this tool has been proven in several studies to be reliable, I would use this tool to measure pain pressure threshold in my future practice.
As far as reliability goes, an article by Kregal et al (2013) found good reliability for measuring pain pressure threshold at the patellar tendon when comparing healthy athletes to those with patellar tendinopathy. Based on what we learned in our coursework and other literature, I’ve found that the reliability of pain pressure threshold shows positive results and has proven to be an effective tool.
I’ve looked into other articles to answer your question about normative values in other areas of the body and there are some observational studies out there that are looking into this. I found one article by Keating et al (2001) that looked at establishing normative values for different spinal regions and they had promising results. The article I previously mentioned by Kregal et al (2013) also looked at establishing normative values in the patellar tendon region and they had positive results as well. Each region is likely to have its own individual normative values based on that area’s specific sensitivity to pain/pressure so it is difficult to see how our results directly compare to these other areas.
My question regards the reliability of the location of PPT, what anatomical landmarks did you use to keep the location consistent? Also, being that the same researcher completed all of the PPT, has you research team looked at any research regarding any inter-rater reliability of PPT use?
Britt – The researcher who completed PPT measurements located the central belly of the wrist extensor muscles by palpation and applied force to that area. This was repeated for each PPT trial.
In our literature review we found research that showed that PPT has high inter-rater reliability as well as test-retest reliability. In our research we chose to keep the researcher completing the PPT measurements consistent in order to keep sessions running smoothly.
I think it’s interesting that there you saw a correlation between PPT and height, weight, BMI, and grip strength. You guys discussed doing more research to better understand that correlation, but at this time, do you have any ideas or theories about why you might be seeing that correlation?
We did hypothesize that a higher BMI might have a higher pain threshold. This could be in part to a higher BMI would mean that there might be more adipose tissue. This adipose tissue could provide a “cushion” for the PPT instrumentation. Again, this is only one of the theories that we talked about amongst ourselves, so do not take this as Gospel.
Thanks for the Question Jacy!
During our initial research we looked at the comparison of different neurodynamic techniques versus static stretching and their relation to PPT and grip strength, but this is a different research study that looked at finding reliable normative values for PPT for the lateral wrist extensors due to there being no published data for this body region and therefore our initial study had a neurodynamic or a static stretch intervention, but this study is just looking at normative values. Subjects were not restricted from activity in between visits and we picked the 2-3 day time frame for a follow up due to that being the most common in the clinic.
Although your study had a subject age range of 18-29, do you feel that these noramtive values would change if the healthy population was between the ages of 30-40 or 40-50 and if so what do direction would you expect to see them go?
Thanks for the Question Natalie!
I believe that each specific area tested has a certain value in testing it. Looking at the big picture and as a future clinician I would use this PPT technique in the area that directly correlated with the patient diagnosis. For example I would use the lateral wrist extensor muscle belly testing for PPT with a diagnosis such as lateral epicondylitis. To be clear I would not use this tool to diagnose the condition, but rather as a parameter for assessing a treatments effect. As far as research for the specific area chosen for PPT, fibromyalgia notes around 18 spots in order to diagnose, but past research has looked at historically muscular tender points at varying locations around the body that can change from day to day.
Tarkenton – I was unable to attach this reply below your comment so hopefully you find this answer.
I do feel that our normative values would change if the age population were changed. In a study by Lautenbacher et al completed in 2005, they found that sensitivity to pain pressure was increased in elderly subjects compared to younger subjects. Based on the information found in this study and my personal opinion, I believe it is likely that as the population increases in age they will be able to tolerate less pain pressure leading to altered normative values.
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After doing this research, do you think that with what the research shows that you will use the PPT as clinicians?
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I think I would be more inclined to use it with a symptomatic patient. We found that the PPT is a reliable measure, so if a symptomatic patient goes through treatments, I would probably utilize this instrument in order to track any changes.
LikeLike
After doing this research, and what the results show would you use PPT as a clinician?
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My answer is yes. Because our research showed that norms could be established and the fact that this tool has been proven in several studies to be reliable, I would use this tool to measure pain pressure threshold in my future practice.
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How did your reliability and normative values for the lateral wrist extensors compare to other testing locations in the literature?
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As far as reliability goes, an article by Kregal et al (2013) found good reliability for measuring pain pressure threshold at the patellar tendon when comparing healthy athletes to those with patellar tendinopathy. Based on what we learned in our coursework and other literature, I’ve found that the reliability of pain pressure threshold shows positive results and has proven to be an effective tool.
I’ve looked into other articles to answer your question about normative values in other areas of the body and there are some observational studies out there that are looking into this. I found one article by Keating et al (2001) that looked at establishing normative values for different spinal regions and they had promising results. The article I previously mentioned by Kregal et al (2013) also looked at establishing normative values in the patellar tendon region and they had positive results as well. Each region is likely to have its own individual normative values based on that area’s specific sensitivity to pain/pressure so it is difficult to see how our results directly compare to these other areas.
Hopefully this answered your question. Thanks.
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My question regards the reliability of the location of PPT, what anatomical landmarks did you use to keep the location consistent? Also, being that the same researcher completed all of the PPT, has you research team looked at any research regarding any inter-rater reliability of PPT use?
LikeLike
Britt – The researcher who completed PPT measurements located the central belly of the wrist extensor muscles by palpation and applied force to that area. This was repeated for each PPT trial.
In our literature review we found research that showed that PPT has high inter-rater reliability as well as test-retest reliability. In our research we chose to keep the researcher completing the PPT measurements consistent in order to keep sessions running smoothly.
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When collecting data you recorded hand dominance, do you believe that this could have affected your results in any way?
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Sara – Because that portion of our collected data did not show a correlation to PPT I don’t think it had an effect on our results.
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I think it’s interesting that there you saw a correlation between PPT and height, weight, BMI, and grip strength. You guys discussed doing more research to better understand that correlation, but at this time, do you have any ideas or theories about why you might be seeing that correlation?
LikeLike
We did hypothesize that a higher BMI might have a higher pain threshold. This could be in part to a higher BMI would mean that there might be more adipose tissue. This adipose tissue could provide a “cushion” for the PPT instrumentation. Again, this is only one of the theories that we talked about amongst ourselves, so do not take this as Gospel.
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Was there any intervention applied between the two testing periods? Or were subjects restricted from any activity during this time?
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Thanks for the Question Jacy!
During our initial research we looked at the comparison of different neurodynamic techniques versus static stretching and their relation to PPT and grip strength, but this is a different research study that looked at finding reliable normative values for PPT for the lateral wrist extensors due to there being no published data for this body region and therefore our initial study had a neurodynamic or a static stretch intervention, but this study is just looking at normative values. Subjects were not restricted from activity in between visits and we picked the 2-3 day time frame for a follow up due to that being the most common in the clinic.
LikeLike
Although your study had a subject age range of 18-29, do you feel that these noramtive values would change if the healthy population was between the ages of 30-40 or 40-50 and if so what do direction would you expect to see them go?
LikeLike
Is there research that shows why certain areas are chosen to test PPT over others (i.e. lateral wrist extensor muscle belly vs. another muscle belly)?
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Thanks for the Question Natalie!
I believe that each specific area tested has a certain value in testing it. Looking at the big picture and as a future clinician I would use this PPT technique in the area that directly correlated with the patient diagnosis. For example I would use the lateral wrist extensor muscle belly testing for PPT with a diagnosis such as lateral epicondylitis. To be clear I would not use this tool to diagnose the condition, but rather as a parameter for assessing a treatments effect. As far as research for the specific area chosen for PPT, fibromyalgia notes around 18 spots in order to diagnose, but past research has looked at historically muscular tender points at varying locations around the body that can change from day to day.
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Tarkenton – I was unable to attach this reply below your comment so hopefully you find this answer.
I do feel that our normative values would change if the age population were changed. In a study by Lautenbacher et al completed in 2005, they found that sensitivity to pain pressure was increased in elderly subjects compared to younger subjects. Based on the information found in this study and my personal opinion, I believe it is likely that as the population increases in age they will be able to tolerate less pain pressure leading to altered normative values.
Thank you for your question.
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