title: The reliability of body pain diagrams in the quantitative measurement of pain distribution and location in patients with musculoskeletal pain: a systematic review.
abstract: OBJECTIVE
  The purpose of this study was to perform a systematic review of test-retest, intraexaminer, and interexaminer reliability of measuring pain location and distribution using the body pain diagram.
  
  
  METHODS
  We conducted a systematic review of the literature using a search conducted in Medline, CINAHL, and Nursing and Allied Health from inception to March 1, 2012. Articles were screened and selected by pairs of reviewers using predetermined inclusion criteria. Internal validity was assessed independently by 2 reviewers using a modified version of the QUADAS instrument. Articles with adequate internal validity were included in the best evidence synthesis.
  
  
  RESULTS
  We reviewed 10 studies. Of those, 6 were included in the best evidence synthesis. We found varying levels of evidence that pain location and pain distribution can be measured reliably using the body pain diagram in patients with acute and chronic low back pain with or without radiculopathy. The test-retest reliability for measuring pain distribution ranged from intraclass correlation coefficient of 0.58 to 0.94. Similarly, the test-retest reliability for measuring pain location ranged from kappa (κ) of 0.13 to 0.85. The intraexaminer and interexaminer reliability for measuring pain distribution were intraclass correlation coefficient of 0.99 and 0.99, respectively. The intraexaminer and interexaminer reliability for measuring pain location ranged from κ of 0.77 to 0.88 and 0.61 to 1.00, respectively.
  
  
  CONCLUSIONS
  We found important variations in the test-retest reliability of pain location and distribution across different test-retest scenarios and across body regions. The intraexaminer and interexaminer reliability for the measurement of pain distribution and pain location using the body pain diagram in patients with acute and chronic low back pain with or without radiculopathy are adequate.
authors.affiliation: Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Faculty of Health Sciences, University of Ontario Institute of Technology, Toronto, ON, Canada. dsoutherst@uoit.ca
authors.forename: Danielle
authors.initials: D
authors.lastname: Southerst
authors.forename: Pierre
authors.initials: P
authors.lastname: Côté
authors.forename: Maja
authors.initials: M
authors.lastname: Stupar
authors.forename: Paula
authors.initials: P
authors.lastname: Stern
authors.forename: Silvano
authors.initials: S
authors.lastname: Mior
mesh_terms: D000208:Acute Disease; D000328:Adult; D001830:Body Surface Area; D002908:Chronic Disease; D005069:Evaluation Studies as Topic; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000175:diagnosis*; D015588:Observer Variation; D010147:Pain Measurement / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
keywords: Pain; Pain Measurement; Reproducibility of Results