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      Instrumental validity and intra/inter-rater reliability of a novel low-cost digital pressure algometer

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          Abstract

          Background

          Pain assessment is a key measure that accompanies treatments in a wide range of clinical settings. A low-cost valid and reliable pressure algometer would allow objective assessment of pressure pain to assist a variety of health professionals. However, the pressure algometer is often expensive, which limits its daily use in both clinical and research settings.

          Objectives

          This study aimed to assess the instrumental validity, and the intra- and inter-rater reliability of an inexpensive digital adapted pressure algometer.

          Methods

          A single rater applied 60 random compressions on a force platform. The pressure pain thresholds of 20 volunteers were collected twice (3 days apart) by two raters. The main outcome measurements were as follows: the maximal peak force (in kPa) and the pressure pain threshold (adapted pressure algometer vs. force platform). Cronbach’s α test was used to assess internal consistency. The standard error of measurement provided estimates of measurement error, and the measurement bias was estimated with the Bland–Altman method, with lower and upper limits of agreement.

          Results

          No differences were observed when comparing the compression results ( P = 0.51). The validity and internal intra-rater consistencies ranged from 0.84 to 0.99, and the standard error of measurement from 0.005 to 0.04 kPa. Very strong ( r = 0.73–0.74) to near-perfect ( r = 0.99) correlations were found, with a low risk of bias for all measurements. The results demonstrated the validity and intra-rater reliability of the digitally adapted pressure algometer. Inter-rater reliability results were moderate ( r = 0.55–0.60; Cronbach’s α = 0.71–0.75).

          Conclusion

          The adapted pressure algometer provide valid and reliable measurements of pressure pain threshold. The results support more widespread use of the pressure pain threshold method among clinicians.

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          Most cited references38

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          A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research.

          Intraclass correlation coefficient (ICC) is a widely used reliability index in test-retest, intrarater, and interrater reliability analyses. This article introduces the basic concept of ICC in the content of reliability analysis.
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            Progressive statistics for studies in sports medicine and exercise science.

            Statistical guidelines and expert statements are now available to assist in the analysis and reporting of studies in some biomedical disciplines. We present here a more progressive resource for sample-based studies, meta-analyses, and case studies in sports medicine and exercise science. We offer forthright advice on the following controversial or novel issues: using precision of estimation for inferences about population effects in preference to null-hypothesis testing, which is inadequate for assessing clinical or practical importance; justifying sample size via acceptable precision or confidence for clinical decisions rather than via adequate power for statistical significance; showing SD rather than SEM, to better communicate the magnitude of differences in means and nonuniformity of error; avoiding purely nonparametric analyses, which cannot provide inferences about magnitude and are unnecessary; using regression statistics in validity studies, in preference to the impractical and biased limits of agreement; making greater use of qualitative methods to enrich sample-based quantitative projects; and seeking ethics approval for public access to the depersonalized raw data of a study, to address the need for more scrutiny of research and better meta-analyses. Advice on less contentious issues includes the following: using covariates in linear models to adjust for confounders, to account for individual differences, and to identify potential mechanisms of an effect; using log transformation to deal with nonuniformity of effects and error; identifying and deleting outliers; presenting descriptive, effect, and inferential statistics in appropriate formats; and contending with bias arising from problems with sampling, assignment, blinding, measurement error, and researchers' prejudices. This article should advance the field by stimulating debate, promoting innovative approaches, and serving as a useful checklist for authors, reviewers, and editors.
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              Sex differences in pain: a brief review of clinical and experimental findings.

              Recent years have witnessed substantially increased research regarding sex differences in pain. The expansive body of literature in this area clearly suggests that men and women differ in their responses to pain, with increased pain sensitivity and risk for clinical pain commonly being observed among women. Also, differences in responsivity to pharmacological and non-pharmacological pain interventions have been observed; however, these effects are not always consistent and appear dependent on treatment type and characteristics of both the pain and the provider. Although the specific aetiological basis underlying these sex differences is unknown, it seems inevitable that multiple biological and psychosocial processes are contributing factors. For instance, emerging evidence suggests that genotype and endogenous opioid functioning play a causal role in these disparities, and considerable literature implicates sex hormones as factors influencing pain sensitivity. However, the specific modulatory effect of sex hormones on pain among men and women requires further exploration. Psychosocial processes such as pain coping and early-life exposure to stress may also explain sex differences in pain, in addition to stereotypical gender roles that may contribute to differences in pain expression. Therefore, this review will provide a brief overview of the extant literature examining sex-related differences in clinical and experimental pain, and highlights several biopsychosocial mechanisms implicated in these male-female differences. The future directions of this field of research are discussed with an emphasis aimed towards further elucidation of mechanisms which may inform future efforts to develop sex-specific treatments.
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                Author and article information

                Contributors
                Journal
                PeerJ
                PeerJ
                PeerJ
                PeerJ
                PeerJ
                PeerJ Inc. (San Diego, USA )
                2167-8359
                12 October 2020
                2020
                : 8
                : e10162
                Affiliations
                [1 ]Facultad de Ciencias de la Rehabilitación, Universidad Andrés Bello , Santiago, Santiago, Chile
                [2 ]Department of Physical Therapy, Federal University of Juiz de Fora , Governador Valadares, Minas Gerais, Brazil
                [3 ]Department of Physical Education, Federal University of Juiz de Fora , Governador Valadares, Minas Gerais, Brazil
                [4 ]Department of Physical Therapy, Universidad del Gran Rosario , Rosario, Santa Fe, Argentina
                Author information
                http://orcid.org/0000-0002-6878-8004
                http://orcid.org/0000-0003-1544-2824
                http://orcid.org/0000-0002-2417-7914
                Article
                10162
                10.7717/peerj.10162
                7560318
                33083153
                0c7b0c66-0c45-456a-8090-9185594f81bf
                © 2020 Jerez-Mayorga et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, reproduction and adaptation in any medium and for any purpose provided that it is properly attributed. For attribution, the original author(s), title, publication source (PeerJ) and either DOI or URL of the article must be cited.

                History
                : 5 March 2020
                : 21 September 2020
                Funding
                Funded by: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brasil (CAPES)
                Award ID: 001
                Funded by: Fundação de Amparo à Pesquisa de Minas Gerais (FAPEMIG)
                Award ID: APQ-02040-18
                This study was financed by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brasil (CAPES)—Finance Code 001, and by Fundação de Amparo à Pesquisa de Minas Gerais (FAPEMIG)—Finance Code APQ-02040-18. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Anesthesiology and Pain Management
                Drugs and Devices
                Evidence Based Medicine
                Kinesiology

                pain assessment,validity,reliability,pressure algometry,pressure pain threshold,inexpensive

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