# Reliability of a pressure pain threshold protocol: secondary analysis of a longitudinal trial with cluster randomization

## TL;DR

This study shows that measuring pressure pain thresholds is reliable and consistent over six months in office workers, making it useful for tracking pain sensitivity in research and clinical settings.

## Contribution

The study provides novel evidence on the longitudinal reliability of a PPT protocol in a real-world randomized trial with multiple time points.

## Key findings

- ICC values ranged from 0.84 to 0.95, indicating good to excellent reliability across all time points and body regions.
- SEM and MDC values remained consistent over six months, showing stable measurement properties.
- Reliability was maintained in both intervention and control groups despite expected variability.

## Abstract

Pressure Pain Threshold (PPT) measurement is a useful method for assessing pain sensitivity when applied with a standardized protocol. However, little is known about the longitudinal stability of reliability estimates when PPT protocols are embedded in randomized controlled trials. This study aimed to estimate the relative and absolute reliability of a PPT algometry protocol in office workers across multiple time points within a six-month pragmatic randomized controlled trial.

A secondary analysis was conducted from a cluster randomized controlled trial with office workers, where a standardized PPT protocol was applied to the neck, forearm, and lower leg. Measurements were taken bilaterally with three repetitions per site. Measurement reliability was assessed with a two-way mixed-effects intraclass correlation (ICC) model for absolute agreement (3, k), along with the Standard Error of Measurement (SEM) and Minimal Detectable Change (MDC), calculated at baseline, three, and six months, for both intervention and control groups.

ICC values ranged from 0.84 to 0.95, indicating good to excellent reliability across all time points and body regions. SEM ranged from 0.23 kg/cm2 to 0.51 kg/cm2, and MDC from 0.52 kg/cm2 to 1.15 kg/cm2. These values remained consistent across follow-up periods in both groups, despite expected variability due to the intervention.

The PPT protocol demonstrated high measurement reliability and stable properties over time for each anatomic region and both groups, supporting its use in longitudinal assessments of pain sensitivity in occupational and clinical settings.