Interrater Agreement of Manual Palpation for Identification of Myofascial Trigger Points: A Systematic Review and Meta-Analysis
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Alasdair T L Rathbone1, Liza Grosman-Rimon, Dinesh A Kumbhare
1*Schulich School of Medicine and Dentistry, University of Western Ontario, London †Toronto Rehabilitation Institute, Musculoskeletal Rehabilitation Program, University Health Network (UHN) ‡Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada.
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.
Insights
Manual palpation for identifying myofascial trigger points (MTrPs) shows unreliable agreement between clinicians. Future research should explore integrating this technique with more dependable diagnostic methods for better accuracy.
Area of Science:
- Musculoskeletal pain research
- Diagnostic accuracy studies
- Rehabilitation science
Background:
- Myofascial trigger points (MTrPs) are a common source of musculoskeletal pain.
- Manual palpation is a primary method for MTrP identification.
- The reliability of manual palpation for MTrPs requires objective assessment.
Purpose of the Study:
- To statistically estimate the agreement of manual palpation in identifying MTrPs.
- To explore factors influencing the reliability of manual palpation for MTrPs.
Main Methods:
- Systematic literature search of MEDLINE and Embase (2007-present) plus prior reviews.
- Inclusion of studies reporting Cohen κ or data for its calculation.
- Exclusion of studies lacking variability data or examining palpation through body cavities.
Main Results:
- Interrater agreement for manual palpation of MTrPs yielded a κ estimate of 0.452.
- Localized tenderness (κ=0.676) and pain recognition (κ=0.575) demonstrated higher reliability.
- Insufficient studies (n=1) precluded meta-analysis for intrarater agreement.
Conclusions:
- Manual palpation for MTrP identification exhibits low reliability.
- Future research should focus on combining manual palpation with more reliable diagnostic approaches.
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