Absolute and Relative Reliability of a Comprehensive Quantitative Sensory Testing Protocol in Women Treated for Breast Cancer

Abstract

Objective Quantitative sensory testing (QST) are non-invasive psychophysical assessment techniques to evaluate functioning of the somatosensory nervous system. Despite the importance of reliability for correct use of QST results in research and clinical practice, the relative and absolute intra-and inter-rater reliability of a comprehensive QST protocol to evaluate the functioning of both peripheral and central somatosensory nervous system in a breast cancer population, has not yet been investigated. Setting University Hospitals, Leuven, Belgium. Subjects Thirty women at least six months after unilateral breast cancer surgery Methods The protocol included nine static and dynamic QST methods (mechanical detection-pain thresholds, pressure pain thresholds, thermal detection-pain thresholds for heat and cold, temporal summation and conditioned pain modulation (CPM)) performed in the surgical area and more distant regions. Absolute and relative intra (60-minutes interval) and inter-rater (one-week interval) reliability was evaluated using intraclass correlation coefficients, standard error of measurement and Bland-Altman plots. Results A moderate to excellent relative intra- and inter-rater reliability was found for the evaluation of mechanical thresholds, pressure pain thresholds and temporal summation. Reliability of the CPM paradigm was considered weak. Systematic bias between raters was noticed for detection of mechanical and cold stimuli at the non-affected trunk and CPM. Conclusions Except for the evaluation of CPM, the QST protocol was found suitable for identifying differences between subjects (relative reliability) and individual follow-up after breast cancer surgery (limited systematic bias) during a one-week timeframe. Additional research is required to determine measurement properties that influence CPM test stability in order to establish a more reliable CPM test paradigm.

Biopsychosocial risk factors for pain and pain-related disability 1 year after surgery for breast cancer

“…22 Third, the inclusion of a comprehensive and reliable QST protocol to evaluate somatosensory functioning. 45 To our knowledge, this is the first study evaluating pre-and postoperative biopsychosocial risk factors for pain and pain-related disability one year after breast cancer surgery. The most consistent risk factors were symptoms related to altered central somatosensory functioning evaluated (CSI), psychological symptoms and social support.…”

Effectiveness of pain neuroscience education on somatosensory functioning after surgery for breast cancer: A double‐blinded randomized controlled trial

“…A detailed overview of the QST methods that were included to evaluate somatosensory functioning is provided in Table 1. Absolute and relative inter‐ and intra‐rater reliability of the applied protocol had been previously investigated in a population of women at least 6 months after surgery for breast cancer (Dams et al, 2022). The anatomical locations where QST was performed are illustrated in Figure 2.…”

Factors Associated with Low Inter-Session Reliability of Conditioned Pain Modulation in Older People with or Without Chronic Musculoskeletal Pain

“… 14 Additionally, the Bland–Altman analysis was performed to evaluate the absolute reliability. 12 The average and difference between the two measurement sessions in the CPM index were plotted in y and x axes, respectively, namely the Bland–Altman plots. 49 , 50 If the two sessions were in perfect agreement, the plots would be equal to the x-axis.…”

“… 11 ICC for CPM in individuals with breast cancer had weak reliability. 12 Similarly, CPM in older individuals showed low inter-session reliability with no significant ICC at −0.19 (−1.31 to 0.39). 13 Thus, several specific factors reduce the inter-session reliability of CPM efficiency.…”