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Liew, Bernard; Lee, Ho Yin; Ruegamer, David; De Nunzio, Alessandro Marco; Heneghan, Nicola R.; Falla, Deborah and Evans, David W. (2021): A novel metric of reliability in pressure pain threshold measurement. In: Scientific Reports, Vol. 11, No. 1, 6944

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The inter-session Intraclass Correlation Coefficient (ICC) is a commonly investigated and clinically important metric of reliability for pressure pain threshold (PPT) measurement. However, current investigations do not account for inter-repetition variability when calculating inter-session ICC, even though a PPT measurement taken at different sessions must also imply different repetitions. The primary aim was to evaluate and report a novel metric of reliability in PPT measurement: the inter-session-repetition ICC. One rater recorded ten repetitions of PPT measurement over the lumbar region bilaterally at two sessions in twenty healthy adults using a pressure algometer. Variance components were computed using linear mixed-models and used to construct ICCs;most notably inter-session ICC and inter-session-repetition ICC. At 70.1% of the total variance, the source of greatest variability was between subjects (sigma subj2 = 222.28 N-2), whereas the source of least variability (1.5% total variance) was between sessions (sigma sess2 = 4.83 N-2). Derived inter-session and inter-session-repetition ICCs were 0.88 (95%CI: 0.77 to 0.94) and 0.73 (95%CI: 0.53 to 0.84) respectively. Inter-session-repetition ICC provides a more conservative estimate of reliability than inter-session ICC, with the magnitude of difference being clinically meaningful. Quantifying individual sources of variability enables ICC construction to be reflective of individual testing protocols.

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