title: Assessing tactile acuity in rheumatology and musculoskeletal medicine--how reliable are two-point discrimination tests at the neck, hand, back and foot?
abstract: OBJECTIVE
  Chronic pain from rheumatic and musculoskeletal conditions is associated with cortical changes and altered tactile acuity. Tactile acuity is considered a clinical signature of primary somatosensory representation. The two-point discrimination (TPD) threshold is increasingly used both clinically and in research. Remarkably, the reliability and precision of the measure at commonly used sites has not been determined. This study aimed to determine the utility, intra- and inter-rater reliability, bias and variability of TPD threshold assessment at the neck, back, hand and foot using mechanical callipers.
  
  
  METHODS
  Intra- and inter-rater reliability of TPD was assessed at the back, neck, hand and foot of 28 healthy young adults by 28 clinicians. Each clinician received training in the assessment of TPD using mechanical callipers and following a standardized protocol. Intraclass correlation coefficients (ICCs) and Bland-Altman plots were used to assess reliability, bias and variability.
  
  
  RESULTS
  Intra-rater assessments in all four regions and inter-rater assessments at the neck and foot were reliable (ICC range 0.79-0.86), but large variability was seen in all assessments. Inter-rater assessment of the back (ICC = 0.66) and hand (ICC = 0.62) was deemed unreliable. Negligible systematic bias suggested learning did not affect reliability.
  
  
  CONCLUSIONS
  Individual clinicians are able to reliably assess TPD threshold at the neck, back, hand and foot using mechanical callipers. Measures obtained by different clinicians were only reliable for the neck and foot. Large variability was observed in all assessments, which suggests clinicians should be cautious when interpreting changes in tactile acuity in individual patients.
authors.affiliation: Sansom Institute for Health Research, University of South Australia, Adelaide, Australia.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Catley
authors.forename: Abby
authors.initials: A
authors.lastname: Tabor
authors.forename: Benedict M
authors.initials: BM
authors.lastname: Wand
authors.forename: G Lorimer
authors.initials: GL
authors.lastname: Moseley
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005528:Foot; D006225:Hand; D006801:Humans; D008297:Male; D009140:Musculoskeletal Diseases / Q000175:diagnosis* / Q000503:physiopathology*; D009333:Neck; D015588:Observer Variation; D046709:Pattern Recognition, Physiological; D011597:Psychomotor Performance; D012016:Reference Values; D015203:Reproducibility of Results; D012216:Rheumatic Diseases / Q000175:diagnosis* / Q000503:physiopathology*; D012219:Rheumatology / Q000379:methods; D055698:Touch Perception / Q000502:physiology*
keywords: cortical reorganisation; reliability; repeatability; tactile acuity; two-point discrimination