Reliability of intraoral quantitative sensory testing (QST).

(1)

Reliability

o

f intraoral

q

uantitative

sensory

testing (QST)

Pigg M¹, Baad-Hansen

L², Svensson P², List T³

¹Departme nt of Endodo ntolo g y, F acult y of O dontol og y, Mal m ö U nivers ity , Malmö, S w ed e n ²Departme nt of Clinic al Oral P h ys iol og y, Sch ool of D entistr y, Universit y of Aarhus, Aarhu s, Denmark ³Orofacial Pai n Unit, F acult y of Odont olog y, Malmö U n ivers ity , Malmö, S w eden

Introduction

Several

studies have

reported

the

occurrenc

e

of intraoral

neur

opathic

pain

conditions,

which

are often difficult

to

diagnose. Signific

ant

clinic

al

characteris

tics

of these

conditions

are somatosensory

abnormalities.

The Germa

n Research Netw

ork on Neuropathic

P

ain

(DFNS) develop

ed

a protocol

with 13 quantitative

sensory

testing (QST) measures

for detecting

somatosensory

abnor

malities

. Although

reliability

-an

important aspect of a meas

ure

-has been found to be

adequate f

or

cutaneous

QST

, m

ore information is

needed to assess

intraora

lQST reliability.

Conclusion

Inter-and intra-examiner relia

b

ilities of

most QST

measures according

to the DFNS protocol*

are

acceptable for assessing so

matosensory

function in the

orofacial

region.

* Rolke R , Mage rl W, Campbell K A , Schalber C, C aspari S , Birkle in F, T reede RD. Quan titative sensor y testing: a comprehensive pro

tocol for clinica

l trials. Eur J Pain 2006;10:77-88 .

Abstract

# 1063

Aim

T

o investigate the inte

r-and intra-e xa m iner rel iab ilit y of 13 QST measures at in tra-and e xtrao ral sites.

Met

h

ods

T w ent y-o ne h ealth y vol untee rs from Malmö U nivers ity , Malmö, S w ed e n (13 females and 8 mal es, mean ag e 40.4 y ears, ran ge 2 4-71) partici pate d. T w o in dep e ndent, bli nde d examin ers w ho w er e cali brate d in the DF NS QST protocol e xamin e d the par ticipants usi ng the entire protocol ( Ta ble 1 ; Fig u re 2 ). Each partici pa nt w as e xamin ed t w ic e on the same da y -on ce b y e ach e xa m iner (inter-e xaminer re lia bil ity). After 1-2 w e eks, one e xaminer re-e xa mined a ll partic ipants (intra-e xaminer relia bil ity ). T he measurem ents w er e made o n ( Fig u re 1 ):

1) the skin of the right che

ek

2) the tip of the tongue 3-4) bil

ateral

ly

on the gin

giva

l mu

cosa of the upper pr

emol ar region F or all param eters exc ept PH S, the in traclass correlation coefficient (ICC) w a s used to ca lculate re lia bil

ity; for PHS, Cohen’s ka

ppa w as used. Mean val ues a nd mean var iat ion w ith in eac h subject w ere c alcul ated. Table 1 . QST p rotocol according to the Ge rman Research Net w ork on Neuropa thic Pain (DFNS), an d equipment used in this stud y. The tests a re described in the o rder in w hich the y a re p erfo m ed. Figure 2. In trao ra lapplications. Table 2 . Int ra -a nd inter -exa m iner reliab ility . ICC fo r all param eters e xcept PHS, w he re C ohen’s kappa w as calculated.

Res

u

lts

Most

tests had acceptab

le to e xce lle nt inter-e xam iner (e xtra oral ly ICC= 0.5 2 -0.91, intraor all y ICC= 0.41-0.86 or kapp a 0.34) and intra-e xam iner relia bil ity (e xtra orall y ICC= 0.4 3 -0.87, intraor all y ICC= 0.53 -0.86 or kappa 0.25). Reli abi lit y for five QST measu res w a s poor (ICC= 0.12 -0.37). F

or the same test,

inter-and i ntra-observ er relia bi lities at int ra-and e xtraor al sites w ere si milar. No sig nif ica nt differenc e s bet w e en right and l eft sides w ere fou n d intraora lly . F or specific resu lts, see T ab les 2 and 3. Thermal testin g: Cold (CPT ) and he at pain t hresho ld (HPT

) had the hig

he st reproduc ib ility. PHS -a frequent findi ng int raoral ly (27%), althou gh no t on the tongu e – had lo w r epr oduci bil ity . Mechan ical tes ting: Repro duci bilit y w as h igh e

st for pressure pain thres

hol

d (PPT

)

and for mechan

ical p ai n threshol d (MPT ) and sensiti vit y (MPS). No hea lth y s ub ject had d yn am ical mech anic a l allo d yni a (DM

A), and ICC

w a s lo w for a ll me chanic al detect ion thresh old ( M DT ) measur ements, proba bl y bec a

use the thresh

olds w er e often belo w the l imit of det

ection of the instrument

s. T he relativel y smal l mean i ntraind ivid ual va riatio n (0.1 mN extra oral ly , 0.01mN on th e tip of the t ongue an d 12.4m N on the upp er premolar muc osa ) ind icates r eason abl e repr oduci bil ity . Table 3 . Mean a nd SD fo r all continuous variab le s. All value s in un its according to Ta ble 1. Figure 1. Orofac ia lm easurepoints: 1) cheek 2) tip of tongue, 3-4 ) b ilaterally on gingiva lm ucosa, upper jaw p re molar region. Extra o ra l Ti p o f tongu e Regi o 14 CDT 1.2 ± 0.6 4.2 ± 2.4 12 .3 ± 7.7 WDT 1.8 ± 0.6 2.8 ± 1.3 9.3 ± 3.0 TSL 3.3 ± 1.1 6.5 ± 2.5 19 .9 ± 7.5 CPT 18 .4 ± 8.1 16 .0 ± / 6.3 15 .3 ± 7.6 HPT 41 .5 ± 4.1 45 .3 ± 3.1 47 .9 ± 2.0 MD T 0.3 ± 0.1 0.3 ± 0.0 17 .2 ± 14.9 MPT 208 .3 ± 14 8.5 103 .1 ± 68 .4 294 .8 ± 16 1.5 MPS 1.8 ± 2. 8 1.4 ± 0.9 0.5 ± 0.5 WUR 2.8 ± 2.9 2.4 ± 1.4 2.5 ± 2.2 VDT 6.3 ± 1.1 5.1 ± 1.2 6.4 ± 1.0 PPT 280 .2 ± 85 .8 118 .0 ± 55 .0 189 .0 ± 67 .3 E -m ail: Ma ria .P igg@mah .se

The MSA The

rm otester w as used fo r tempe ratu re m easuremen ts. For CDT , WD T a nd TSL, the mean difference from baseline temper ature (32ºC e xt rao rally, 37ºC int raorally) is display ed . For CPT and HPT, pain th reshold tempe ra tures in ºC are sho w n. 1 2 3 4