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Davidson MJ1, Nielson PMF1, Taberner AJ1, Kruger JA1
1University of Auckland, Auckland Bioengineering Institute, Auckland, New Zealand
Background: Physiotherapists commonly use digital palpation to assess muscle tone (also termed tension, tightness, or subjective stiffness). However, these assessments are subjective, and little is known about the reproducibility of these measures either between or within practitioners. Despite this, it is standard practice globally to use palpation to assess muscle tone, and base clinical treatment on these assessments.
Purpose: The aim of this study was to assess physiotherapists' ability to discriminate a 7-point scale for the assessment of muscle tone, against a novel device that can objectively measure force, displacement, and calculate stiffness.
Methods: Physiotherapists who palpate muscles (minimum of 30 minutes per week) and identified as 'musculoskeletal' or 'pelvic floor' where invited to participate. The ability to discriminate a 7-point arbitrary scale (a modified version of a scale published by Reissing (2005)), against a purpose built 'palpation instrument' was assessed. The instrument, developed by the Auckland Bioengineering Institute, can accurately measure the force applied to displace a moveable probe a certain distance. The end of the probe was covered with silicone to resemble soft tissue coverage of muscle. Three randomized trials of the 7-point scale were completed. Participants were further divided into groups based on the length of their clinical experience. Repeated measures ANOVA's were conducted to examine interactions.
Results: A total of 84 physiotherapists (n = 42 musculoskeletal, n = 42 pelvic floor) were recruited. Years of clinical experience ranged from 3 months to 50 years, with participants predominately female (81%).
There were significant one-way interactions in the categories of the 7-point scale for stiffness; force level applied; and displacement of probe (p 0.001). There were significant two-way interactions between force applied and type of physiotherapist (p 0.001) and years of experience (p = 0.013), and between displacement of the probe and type of physiotherapist (p 0.001).
There were no significant two-way interactions for stiffness between scale level selected and type of physiotherapist (p = 0.272), or years of experience (p = 0.268), nor between displacement of the probe and years of experience (p = 0.059). There were no statistically significant three-way interactions between scale level selected, type of physiotherapist, and years of experience for stiffness (p = 0.828); force applied (p = 0.481); or displacement of the probe (p = 0.565).
Conclusion(s): Physiotherapists can discriminate a 7-point palpation scale assessing muscle 'tone' against an objective measuring device. Years of clinical experience and type of physiotherapist appear not to influence the use of this scale for assessing 'tone', however they do appear to influence the amount of force applied, and the distance the probe is moved. Further testing of the scale is ongoing to see if improvements in consistency can be obtained.
Implications: The eventual aim of the study is to produce an instrument that can assist in palpation training of physiotherapists.
Keywords: Muscle tone, palpation, assessment
Funding acknowledgements: Funding for this study has been provided by: Auckland Bioengineering Institute; Physiotherapy New Zealand; and Maurice and Phyllis Paykel Trust.
Purpose: The aim of this study was to assess physiotherapists' ability to discriminate a 7-point scale for the assessment of muscle tone, against a novel device that can objectively measure force, displacement, and calculate stiffness.
Methods: Physiotherapists who palpate muscles (minimum of 30 minutes per week) and identified as 'musculoskeletal' or 'pelvic floor' where invited to participate. The ability to discriminate a 7-point arbitrary scale (a modified version of a scale published by Reissing (2005)), against a purpose built 'palpation instrument' was assessed. The instrument, developed by the Auckland Bioengineering Institute, can accurately measure the force applied to displace a moveable probe a certain distance. The end of the probe was covered with silicone to resemble soft tissue coverage of muscle. Three randomized trials of the 7-point scale were completed. Participants were further divided into groups based on the length of their clinical experience. Repeated measures ANOVA's were conducted to examine interactions.
Results: A total of 84 physiotherapists (n = 42 musculoskeletal, n = 42 pelvic floor) were recruited. Years of clinical experience ranged from 3 months to 50 years, with participants predominately female (81%).
There were significant one-way interactions in the categories of the 7-point scale for stiffness; force level applied; and displacement of probe (p 0.001). There were significant two-way interactions between force applied and type of physiotherapist (p 0.001) and years of experience (p = 0.013), and between displacement of the probe and type of physiotherapist (p 0.001).
There were no significant two-way interactions for stiffness between scale level selected and type of physiotherapist (p = 0.272), or years of experience (p = 0.268), nor between displacement of the probe and years of experience (p = 0.059). There were no statistically significant three-way interactions between scale level selected, type of physiotherapist, and years of experience for stiffness (p = 0.828); force applied (p = 0.481); or displacement of the probe (p = 0.565).
Conclusion(s): Physiotherapists can discriminate a 7-point palpation scale assessing muscle 'tone' against an objective measuring device. Years of clinical experience and type of physiotherapist appear not to influence the use of this scale for assessing 'tone', however they do appear to influence the amount of force applied, and the distance the probe is moved. Further testing of the scale is ongoing to see if improvements in consistency can be obtained.
Implications: The eventual aim of the study is to produce an instrument that can assist in palpation training of physiotherapists.
Keywords: Muscle tone, palpation, assessment
Funding acknowledgements: Funding for this study has been provided by: Auckland Bioengineering Institute; Physiotherapy New Zealand; and Maurice and Phyllis Paykel Trust.
Topic: Women's & men's pelvic health; Musculoskeletal
Ethics approval required: Yes
Institution: University of Auckland
Ethics committee: University of Auckland Human Participants Ethics Committee
Ethics number: 20490
All authors, affiliations and abstracts have been published as submitted.
