A systematic review of the psychometric properties of pressure pain detection threshold in evaluating mechanical pain threshold in people with hand or wrist injuries

• Published in: Journal of hand therapy 2023-10, Vol.36 (4), p.845-859
• Main Authors: Straatman, Lauren N., Lukacs, Michael J., Carlesso, Lisa, Grewal, Ruby, Lalone, Emily A., Walton, David M.
• Format: Article
• Language: English
• Subjects: Bias; Carpal tunnel syndrome; Complex regional pain syndrome; Correlation coefficient; Correlation coefficients; Error analysis; Evaluation; Fractures; Grey literature; Hand; Hand or wrist Injuries; Heterogeneity; Humans; Injuries; Kappa coefficient; Osteoarthritis; Overuse injuries; Pain; Pain Threshold; PPDT; Pressure pain detection threshold; Psychometric properties; Psychometrics; Quantitative psychology; Reliability; Reproducibility of Results; Responsiveness; Review; Standard error; Systematic review; Upper Extremity; Validity; Wrist; Wrist Injuries - complications; Wrist Injuries - diagnosis
• ISSN: 0894-1130; 1545-004X
• DOI: 10.1016/j.jht.2023.06.008

The aim of this study was to conduct a systematic review of the psychometric properties of Pressure Pain Detection Threshold (PPDT) measures in people with hand or wrist injuries. MEDLINE, Embase, and CINAHL databases were searched to identify eligible studies evaluating psychometric properties of PPDT in samples composed of at least 50% of people with hand or wrist injury. The Consensus-based Standards for the Measurement of Health Instruments' risk of bias checklist was used to critically appraise the included studies, and qualitative synthesis was performed by pooling the results of all studies that presented the same measurement property using Grading of Recommendations, Assessment, Development, and Evaluation. From 415 studies, 11 relevant studies were identified. Of the 11 studies, four hand or wrist injuries were represented; carpal tunnel syndrome, distal radius fractures, osteoarthritis, and complex regional pain syndrome. Intra-rater reliability was considered sufficient (intraclass correlation coefficient 0.64-0.94), with small reported standard error of the mean values (5.3-39.2 kPa). Results of validity and responsiveness could not be synthesized due to heterogeneity. Risk of bias for reliability and measurement error was assessed as very good or adequate, whereas validity and responsiveness were doubtful or inadequate. Overall quality of evidence was low or very low for all measurement properties. Inconsistent results and low quality evidence provide little confidence in the overall measurement properties of PPDT in a hand or wrist injury population. No criterion standard for pain further highlights complexities around pain measurement such that the results obtained from PPDT measures in clinical practice cannot be compared to a gold standard measure. •Pain represents a challenge to measure as it is a highly subjective, latent construct that cannot be directly observed.•Pressure pain detection threshold (PPDT) is one such tool used by health care professionals and researchers to obtain measures of mechanical pain sensitivity in deep somatic structures.•Our results demonstrated moderate to high intra-rater reliability of PPDT.•Moderate correlations between PPDT, NPRS, and BCTQ indicate that an increased sensitivity to pain is associated with worse functional scores.•Lack of a priori hypotheses highlight complexities around pain measurement and the lack of criterion measures of pain.