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Examination for tenderness: learning to use 4 kg force

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By Smythe H • www.ProHealth.com • January 20, 1998


OBJECTIVE: To minimize interobserver variation in tender point
examination, a training program was developed that focused on
learning to deliver 4 kg force.
METHODS: A 3 step process was
designed to provide both measurement and feedback, serving
both didactic and research functions. There were 5 repetitions
within each step. During the first and 3rd steps, the subjects
pressed on the footplate of a dolorimeter with no immediate
feedback about the force measured. In the 2nd "training" step,
they were given immediate feedback about the force delivered,
and were taught to watch the amount and pattern of blanching
beneath and around the thumbnail.
RESULTS: Twenty-nine
observers participated in 30 studies. Initial values varied
from 1.78 to 8.92 kg (means within observers), although the
mean value was 4.05 kg (means of all observers). The training
step reduced observer variation by 65%, with reduction of mean
absolute error from 1.25 to 0.44 kg. This improvement was
sustained in the 3rd step, in which no feedback was given.
Naive participants performed as well as experts, and there
were no detectable sex differences. One observer was retested
after an interval of 8 months, and performed no better during
the the initial phase of the 2nd test than in the first. Each
training session required 3 to 5 minutes.
CONCLUSION: Specific
training efficiently reduces interobserver variations in
pressure used in tender point examinations. These skills
should be periodically refreshed to prevent drift into error.




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