Protocol for verifying expertise in locating fibromyalgia (FM) tender points

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OBJECTIVE: To develop a protocol for determining when an individual

is adequately trained to locate the tender points relative to

fibromyalgia in an exam.

METHODS: The error distance for each

tender point was established by polling individuals with

experience in conducting tender point exams. Bayesian

statistical methods were employed to form a protocol for

determining an individual’s proficiency in locating the tender

points. A predictive distribution was utilized to find the

probability of remaining trained at locating tender points.

Also, the probability of classifying at least 11 tender points

as tender (mild) under different “locating” criteria and

different number of points that are truly tender was computed.

RESULTS: Critical values indicating the number of tender

points needed in the qualification process for various

standards of reliability–80%, 85%, and 90%–are presented. To

be certified after 3 subjects have been examined in the 80%,

85%, and 90% criteria, one has to correctly identify 48, 50,

and 52, respectively, out of the 54 possible tender points.

CONCLUSION: We believe that at least 3 subjects should be

examined before certification is granted using any of the 3

criteria–80%, 85%, and 90%. In our example, when using the

85% criterion, the qualification process required 7 subjects

to certify an individual.

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