Inter-rater Reliability of Pressure Pain Threshold Between Experienced and Novice Examiners: A Case Study of 2 Educational Approaches

Abstract

Background and Purpose. Pressure Pain Threshold (PPT) is used to objectively assess pain in clinical settings and is a recommended part of physical therapist education. An individual who is experienced in administering PPT will frequently train a student on the technique; however, optimal educational approaches for this instruction have not yet been identified. Therefore, the purpose of this case report is to describe 2 educational approaches (unstructured lecture and structured feedback with clinical relevance) in training 2 separate cohorts of Doctor of Physical Therapy students in PPT. The primary outcome of interest was the inter-rater reliability of PPT between an experienced and novice examiner. Case Description. Cohort 1 (n = 37) received a traditional lecture approach consisting of watching a prerecorded video online, an in-person lecture with demonstration of the technique, and time to practice. Cohort 2 (n = 34) received the prerecorded video online and lecture with demonstration; however, key additions included a clinical relevance discussion along with structured peer-to-peer and instructor-to-student feedback using a competency-based checklist. PPT was assessed by each student (novice examiner) and one instructor (experienced examiner). Inter-rater reliability of PPT between a novice and experienced examiner was evaluated. Outcomes. Inter-rater reliability improved from poor/moderate (intraclass correlation coefficient low back = 0.46 [0.16–0.68], quadriceps = 0.54 [0.26–0.73]) to good (low back = 0.84 [0.67–0.92], quadriceps = 0.90 [0.79–0.95]) after the addition of structured feedback. Discussion. Structured feedback from peers and instructors may be useful when learning PPT and improving inter-rater reliability, which has implications for training students within a laboratory or classroom. However, this case study would need to be replicated in an experimental design to examine the effects of varying types of feedback on learning outcomes.