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Standardization of Muscle Palpation— Methodological Considerations

Kothari, Simple F. BDS*; Kothari, Mohit BDS*; Zambra, Raul F. MCS, DDS; Baad-Hansen, Lene DDS, PhD*; Svensson, Peter DDS, PhD, Dr Odont*,‡

doi: 10.1097/AJP.0b013e31828c893d
Original Articles

Objectives: To compare test-retest variability of palpation between a new palpometer and manual palpation using (1) right or left hand, (2) index or middle finger, (3) randomized or fixed sequence of force levels, (4) palpation on soft or hard surface, and (5) palpation for 2 or 10 seconds.

Methods: Twelve clinicians were instructed to target 0.5, 1.0, and 2.0 kg on a force meter using a palpometer (adjustable spring-coil with a small pin touching the examiner’s hand when the correct pressure is achieved) and manual palpation with right or left hand, index or middle finger, randomized or fixed sequence of force levels, on hard or soft surface, and for 2 or 10 seconds. During all experiments, 10 force measures were taken and variability was determined as coefficient of variation (CV) and compared with analyses of variance.

Results: In all experiments, the palpometer had lower variability compared with manual palpation (P<0.001). There were no differences between the CVs of right and left hand (P=0.122), index and middle finger (P=0.240), and soft and hard surface (P=0.240). Random sequence of force levels had higher CVs than fixed sequence with manual palpation (P=0.004), but not with palpometer (P=0.856). CVs for 2 seconds palpation were higher than 10 seconds (P=0.002).

Conclusions: The palpometer had low test-retest variability and provided a more accurate and reproducible pressure stimulus than manual palpation. The findings of this study may help to standardize palpation of human muscles required for accurate and reliable diagnosis of musculoskeletal pain conditions.

*Department of Dentistry, Section of Clinical Oral Physiology, Aarhus University

MINDLab, Center for Functionally Integrative Neuroscience, Aarhus University Hospital, Aarhus C, Denmark

Department of Oral Physiology, School of Dentistry, Universidad del Desarrollo, Concepcion, Chile

The authors declare no conflict of interest. Supported by the Section of Clinical Oral Physiology, Aarhus University, Aarhus C, Denmark.

Reprints: Simple F. Kothari, BDS, Section of Clinical Oral Physiology, School of Dentistry, Aarhus University, Vennelyst Boulevard-9, Aarhus C, Denmark (e-mail: simple.futarmal@odontologi.au.dk).

Received November 21, 2012

Accepted February 10, 2013

© 2014 by Lippincott Williams & Wilkins