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.