Inter- and Intra-Rater Reliability of Soft Tissue Palpation Scoring in the Equine Thoracic Epaxial Region.
Authors: Merrifield-Jones Megan, Tabor Gillian, Williams Jane
Journal: Journal of equine veterinary science
Summary
Back pain assessment in horses relies heavily on manual palpation, yet the subjective nature of this approach raises questions about consistency between practitioners and repeatability of findings over time. Merrifield-Jones and colleagues evaluated three assessment methods—traditional pressure algometry, a FlexiForce Sensor, and manual palpation scoring—by measuring mechanical nociception thresholds in the thoracic epaxial region across multiple raters and repeated tests. Manual palpation performed exceptionally well for inter-rater reliability (ICC 90.0%), with no significant differences between three separate physiotherapists' assessments (P = .64), whilst the pressure algometer showed poor inter-rater agreement (P = .002) and concerning intra-rater inconsistency, with horses demonstrating increased sensitivity to repeated testing (P = .014). The FlexiForce Sensor demonstrated excellent intra-rater reliability (ICC 94.7%) but proved impractical for clinical use, leaving manual palpation as the most viable tool for practitioners. For equine professionals assessing back pain, this research validates the use of standardised categorical scoring systems during manual palpation, suggesting that inconsistency between clinicians may reflect genuine differences in palpation technique rather than inherent unreliability of the method itself—a finding that underscores the importance of consistent, evidence-based assessment protocols.
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Practical Takeaways
- •Manual palpation by trained physiotherapists using standardized categorical scoring is a reliable and practical alternative to mechanical devices for assessing equine thoracic back pain
- •Pressure algometers show inconsistent results between operators and sessions—avoid relying on these devices alone for objective assessment of equine back pain
- •FlexiForce sensors are highly repeatable within a single operator but require standardization before clinical use; invest in proper training protocols if adopting this technology
Key Findings
- •Manual palpation by ACPAT Chartered Physiotherapists demonstrated excellent inter-rater reliability (ICC 90.0%, P = 0.64) using a categorical scoring system
- •Pressure algometer showed poor inter-rater reliability with significant differences between experimenters (P = 0.002) and lack of intra-rater consistency (P = 0.014)
- •FlexiForce Sensor demonstrated excellent intra-rater reliability (ICC 94.7%, P = 0.347) but significant inter-rater differences (P = 0.025) and was difficult to use clinically
- •Horses showed increasing sensitivity to repeated pressure algometer measures, suggesting device-related artifact rather than true tissue response changes