Reliability of a pressure pain threshold protocol: secondary analysis of a longitudinal trial with cluster randomization

PeerJ. 2026 Feb 25;14:e20834. doi: 10.7717/peerj.20834. eCollection 2026.

ABSTRACT

BACKGROUND: Pressure Pain Threshold (PPT) measurement is a useful method for assessing pain sensitivity when applied with a standardized protocol. However, little is known about the longitudinal stability of reliability estimates when PPT protocols are embedded in randomized controlled trials. This study aimed to estimate the relative and absolute reliability of a PPT algometry protocol in office workers across multiple time points within a six-month pragmatic randomized controlled trial.

METHODS: A secondary analysis was conducted from a cluster randomized controlled trial with office workers, where a standardized PPT protocol was applied to the neck, forearm, and lower leg. Measurements were taken bilaterally with three repetitions per site. Measurement reliability was assessed with a two-way mixed-effects intraclass correlation (ICC) model for absolute agreement (3, k), along with the Standard Error of Measurement (SEM) and Minimal Detectable Change (MDC), calculated at baseline, three, and six months, for both intervention and control groups.

RESULTS: ICC values ranged from 0.84 to 0.95, indicating good to excellent reliability across all time points and body regions. SEM ranged from 0.23 kg/cm² to 0.51 kg/cm², and MDC from 0.52 kg/cm² to 1.15 kg/cm². These values remained consistent across follow-up periods in both groups, despite expected variability due to the intervention.

CONCLUSIONS: The PPT protocol demonstrated high measurement reliability and stable properties over time for each anatomic region and both groups, supporting its use in longitudinal assessments of pain sensitivity in occupational and clinical settings.

PMID:41769391 | PMC:PMC12949580 | DOI:10.7717/peerj.20834