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Interrater reliability of a manual diagnostic protocol for pancreatic functional visceral dysfunction
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Orientador(es)
Resumo(s)
A reliable manual examination has not been validated as a diagnostic tool for nociplastic visceral pain.
Aims: To establish the interrater reliability of a manual examination protocol for functional pancreatic visceral
dysfunction and the clinical criteria for a manual palpatory diagnosis based on the clinical features of the noci-
plastic visceral pain.
Methods: This double-blind cross-sectional study involved 60 participants assessed by three raters using a
manual protocol for diagnosing functional pancreatic visceral dysfunction. Five palpation-based criteria were
evaluated: (1) local pain, (2) referred pain, (3) neurovegetative symptoms, (4) hyperalgesia or allodynia, and
(5) tissue resistance/density. Interrater agreement was measured using percentage agreement and Fleiss’ kappa.
The reliability of the Verbal Numerical Rating Scale (vNRS) was assessed using the intraclass correlation coef -
cient (ICC). Repeated measures analysis of variance and Cochran’s Q test (with Bonferroni correction) were
used to analyze vNRS scores and categorical outcomes, respectively. Signi cance was set at p < 0.05.
Results: Criteria 1, 3, and 4 showed particularly high levels of agreement, with overall agreement percentages
of 93.3%, 95.6%, and 95.6%, respectively. The corresponding Fleiss’ kappa values were 0.863, 0.880, and
0.908, indicating almost perfect agreement. In contrast, Criteria 2 and 5 demonstrated substantial, but compara-
tively lower, agreement, with overall percentages of 86.7% and 87.8% and Fleiss’ kappa values of 0.679 and
0.755. The vNRS demonstrated excellent reliability across all three pancreas regions, with ICC values well
>0.90: head (ICC= 0.943, 95% con dence interval [CI]= 0.913–0.964), body (ICC= 0.950, 95% CI= 0.923–
0.968), and tail (ICC= 0.963, 95% CI= 0.944–0.977).
Conclusions: Three blinded raters reached an almost perfect pair-wise interrater agreement on the presence or
absence of functional visceral dysfunction in the topographic projection of the pancreas. This study provides pre-
liminary evidence that a manual diagnostic protocol is a reliable and potentially useful diagnostic tool in diagnos-
ing nociplastic pain in the topographic projection of the pancreas. Future research should prioritize evaluating
the validity of the nociplastic visceral pain diagnosis.
Descrição
Palavras-chave
:Nociplastic pain Pancreas reliability Visceral pain Visceral osteopathy
Contexto Educativo
Citação
Faria, Miguel; Machado, Nuno; Sousa, Marcos; Pires, Patrícia; Pires, Telma (2025). Interrater reliability of a manual diagnostic protocol for pancreatic functional visceral dysfunction. Journal of Integrative and Complementary Medicine. ISSN 2768-3605. 32:1, p. 47-54
Editora
Sage Journals