Quantitative Sensory Testing (QST)

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Tool Description

  • Used to quantify the neurological dysfunction associated with neuropathic pain
  • Measures thresholds for mechanical detection, vibration detection, cool and warm detection and cold and hot pain sensations. Assessment of thresholds can be used to evaluate the involvement of different nervous system functions (Nathan et al, 1986).

ICF Domain:

Body Function – Subcategory: Sensory Function

Number of Items:

6

Brief Instructions for Administration & Scoring

Administration:

  • Clinician-administered
  • Performed by administering six different threshold tests including: the mechanical detection threshold, the vibration detection threshold, the cool and warm threshold detection and the cold and hot pain threshold at eight standard test sites on the various dermatomes (Felix & Widerstrom-Noga, 2009).
  • Threshold values are recorded at either the first or last detectible level of intensity.
  • If the maximum stimulus is reached without the patient indicating sensation, the maximum value is recorded as threshold.

Equipment:

  • QST requires several pieces of equipment to ensure accurate threshold detection (vibrameter, algometer, aesthesiometer, brush, MSA thermotest, rolltemp)

Scoring:

  • For each location, the high and low threshold detection values for each of the six stimuli are recorded.
  • The high and low scores are averaged and can be compared to data from ‘un-injured’ populations.

Interpretability

MCID: not applicable in SCI
SEM: not applicable in SCI
MDC: not applicable in SCI

  • Threshold measurements for pressure and vibration can evaluate large-fiber and dorsal column function, while thresholds for thermal detection and pain can be used to assess small-fibre and spinothalamic tract function (Nathan et al, 1986).

Languages:

n/a

Training Required:

Clinicians need to be trained in the use of each piece of equipment.

Availability:

n/a

Clinical Considerations

  • Thermal pain thresholds may be particularly useful when used in combination with self-report measures of neuropathic pain for the development of pain management strategies. QST may not feasible as a general test used across clinical sites due to the necessary equipment, but may be feasible for specific clinics that focus on pain and pain management.
  • For each QST threshold, several measurements need to be taken in different dermatomes. Thresholds are to be measured both for increasing and decreasing intensity. Patient burden is extensive; testing must be in person at a clinic or hospital. QST has been used extensively to assess the functional integrity of the somatosensory system among various populations (Felix & Widerstrom-Noga, 2009). Preliminary evidence indicates high reliability among SCI participants. A significant correlation was found between average thermal pain thresholds (ATPT) and the severity of self reported pain. The scale was not developed specifically for the SCI population, although preliminary research shows it can be used within this group without any adaptations.
  • QST requires several pieces of equipment to ensure accurate threshold detection. Clinicians need to be trained in the use of each piece of equipment. Though there are instructions that are to be read to the patient prior to each test, these were not found in the original publication ((Felix & Widerstrom-Noga, 2009).

Measurement Property Summary

# of studies reporting psychometric properties: 3

Reliability:

  • Reliability of the different methods of the QST ranged from Moderate to High
  • Test-retest reliability for vibration threshold and cold pain ranged from Moderate to High
  •  (ICC=0.65-0.90).
  • Test-retest reliability for cold and warm sensation ranged from Low to High (ICC=0.23-0.81).

[Krassioukov et al. 1999, Hayes et al. 2002, Felix & Widerstrom-Noga 2009]

Validity:

  • Significant (P<.05) correlations were found between:

o   warm sensation and light touch (right L4, K=0.31)

o   cold sensation and light touch (right L4, K=0.30; left S1, K=0.28)

o   vibration and light touch (right L4, K=0.25; left L4, K=0.29)

o   cold sensation and pinprick (right L5, K=0.29)

o   vibration and pinprick (right L4, K=0.33).

[Hayes et al. 2002, Felix & Widerstrom-Noga 2009]

Responsiveness:

No values were reported for the responsiveness of the QST for the SCI population.

Floor/ceiling effect:

No values were reported for the presence of floor/ceiling effects in the QST for the SCI population.

Reviewer

Dr. Vanessa Noonan, Matthew Querée

Date Last Updated:

Mar 16, 2017

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Scoring

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Equipment Needed

QST:

Felix ER and Widerstrom-Noga EG. Reliability and validity of quantitative sensory testing in persons with spinal cord injury and neuropathic pain. JRRD. 2009;46:69-83.
http://www.ncbi.nlm.nih.gov/pubmed/19533521

Hayes KC, Wolfe DL, Hsieh JT, Potter PJ, Krassioukov A, Durham CE. Clinical and electrophysiologic correlates of quantitative sensory testing in patients with spinal cord injury. Arch Phys Med Rehabil, 2002; 83(11): 1612-1619.
http://www.ncbi.nlm.nih.gov/pubmed/12422334

Krassioukov A, Wolfe DL, Hsieh JT, Hayes KC, Durham CE. Quantitative sensory testing in patients with incomplete spinal cord injury. Arch Phys Med Rehabil, 1999; 80(10): 1258-1263.
http://www.ncbi.nlm.nih.gov/pubmed/10527084

Renwick R, Brown I. The Centre for Health Promotion's conceptual approach to quality of life: being, belonging, and becoming. In: Renwick R, Brown I, Nagler N (ed). Quality of life in health promotion and rehabilitation: Conceptual approaches, issues, and applications. Sage, Thousand Oaks, CA, 1996, p 75-86.
http://psycnet.apa.org/psycinfo/1996-97773-000

Renwick R, Nourhaghighi N, Manns P, Laliberté Rudman D. Quality of life for people with physical disabilities: a new instrument. Int J Rehab Research 2003;26:279-287.
http://www.ncbi.nlm.nih.gov/pubmed/14634362