A reliability study of a novel visual ischemic palpation scale in an experimental setting

Michele Margelli, Andrea Segat, Maddalena Raule, Caterina Giacchetti, Gustavo Zanoli, Leonardo Pellicciari

Research output: Contribution to journalArticlepeer-review


Background: Manual palpation is an important part of the clinical examination and generally it has low reliability. The aim of this study was to assess the reliability of a novel method for discriminating 3 different levels of palpation force. Methods: This reliability study included 96 healthy physiotherapists and physiotherapy students, who have been taught a new palpation graduated procedure called Visual Ischemic Palpatory Scale (VIPS), aimed to classify the applied pressure based on the finger's ischemia. Force was recorded by a force measurement system putting sensor over a rigid surface. To study the characteristic of VIPS the analysis of variance (ANOVA), Spearman rank correlation coefficient, Intraclass Correlation Coefficient (ICC), Standard Error of Measurements (SEM), and Minimal Detectable Change (MDC) were calculated. Results: Three distinct degrees were found with distinct forces expression: 1st degree 76.04 g (95% CI 65.86–86.22), 2nd degree 307.87 g (95% CI 263.29–352.44) and 3rd degree 1319.48 g (CI 1204.73–1434.23). Male participants significantly recorded a greater force than females. Good to excellent reliability across degrees were found (0.89 [95% CI: 0.82–0.97]), and final agreement found that more than 65.6% of sample recorded a force in the cut-offs identified. SEM values became bigger as the recorded force increased and MDC were equal to 48.94 g, 188.73 g, and 379.24 g for 1st, 2nd, and 3rd degree, respectively. Conclusions: VIPS would appear to have three distinct degrees, sex dependent, with specific force expression for each degree and a good to excellent intra-rater reliability, but a poor agreement between raters.

Original languageEnglish
Article number102384
JournalMusculoskeletal Science and Practice
Publication statusPublished - Aug 2021


  • Pain assessment
  • Palpation
  • Physical therapy
  • Rehabilitation
  • Reliability

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation


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