Protocol for verifying expertise in locating fibromyalgia tender points.

Publication Type
Journal Article
Year of Publication
McIntosh, M J; Hewett, J E; Buckelew, S P; Conway, R R; Rossy, L A
Arthritis Care Res
Date Published
1998 Jun
Bayes Theorem; Bias; Certification; Clinical Competence; Fibromyalgia; Humans; Observer Variation; Physical Examination; Reproducibility of Results

OBJECTIVE: To develop a protocol for determining when an individual is adequately trained to locate the tender points relative to fibromyalgia in an exam.

METHODS: The error distance for each tender point was established by polling individuals with experience in conducting tender point exams. Bayesian statistical methods were employed to form a protocol for determining an individual's proficiency in locating the tender points. A predictive distribution was utilized to find the probability of remaining trained at locating tender points. Also, the probability of classifying at least 11 tender points as tender (mild) under different "locating" criteria and different number of points that are truly tender was computed.

RESULTS: Critical values indicating the number of tender points needed in the qualification process for various standards of reliability--80%, 85%, and 90%--are presented. To be certified after 3 subjects have been examined in the 80%, 85%, and 90% criteria, one has to correctly identify 48, 50, and 52, respectively, out of the 54 possible tender points.

CONCLUSION: We believe that at least 3 subjects should be examined before certification is granted using any of the 3 criteria--80%, 85%, and 90%. In our example, when using the 85% criterion, the qualification process required 7 subjects to certify an individual.