Interrater Reliability of a Manual Diagnostic Protocol for Pancreatic Functional Visceral Dysfunction

BACKGROUND: 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 nociplastic visceral pain. METHODS: < 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 comparatively 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% confidence 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 preliminary evidence that a manual diagnostic protocol is a reliable and potentially useful diagnostic tool in diagnosing nociplastic pain in the topographic projection of the pancreas. Future research should prioritize evaluating the validity of the nociplastic visceral pain diagnosis.