Assessing tactile acuity in rheumatology and musculoskeletal medicine-how reliable are two-point discrimination tests at the neck, hand, back and foot?

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. Conclusion. 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.