International Journal of Biometeorology

, Volume 56, Issue 5, pp 811–821 | Cite as

Reliability of the method of levels for determining cutaneous temperature sensitivity

Original Paper


Determination of the thermal thresholds is used clinically for evaluation of peripheral nervous system function. The aim of this study was to evaluate reliability of the method of levels performed with a new, low cost device for determining cutaneous temperature sensitivity. Nineteen male subjects were included in the study. Thermal thresholds were tested on the right side at the volar surface of mid-forearm, lateral surface of mid-upper arm and front area of mid-thigh. Thermal testing was carried out by the method of levels with an initial temperature step of 2°C. Variability of thermal thresholds was expressed by means of the ratio between the second and the first testing, coefficient of variation (CV), coefficient of repeatability (CR), intraclass correlation coefficient (ICC), mean difference between sessions (S1-S2diff), standard error of measurement (SEM) and minimally detectable change (MDC). There were no statistically significant changes between sessions for warm or cold thresholds, or between warm and cold thresholds. Within-subject CVs were acceptable. The CR estimates for warm thresholds ranged from 0.74°C to 1.06°C and from 0.67°C to 1.07°C for cold thresholds. The ICC values for intra-rater reliability ranged from 0.41 to 0.72 for warm thresholds and from 0.67 to 0.84 for cold thresholds. S1-S2diff ranged from −0.15°C to 0.07°C for warm thresholds, and from −0.08°C to 0.07°C for cold thresholds. SEM ranged from 0.26°C to 0.38°C for warm thresholds, and from 0.23°C to 0.38°C for cold thresholds. Estimated MDC values were between 0.60°C and 0.88°C for warm thresholds, and 0.53°C and 0.88°C for cold thresholds. The method of levels for determining cutaneous temperature sensitivity has acceptable reliability.


Thermotactile quantitative sensory testing Healthy subjects Reliability 


  1. Arezzo JC, Schaumburg HH, Laudadio C (1986) Thermal sensitivity tester: device for quantitative assessment of thermal sense in diabetic neuropathy. Diabetes 35:590–592CrossRefGoogle Scholar
  2. Armstrong FM, Bradbury JE, Ellis SH, Owens DR, Rosen I, et al. (1991) A study of peripheral diabetic neuropathy. The application of age related reference values. Diabet Med 8 Symposium: S94-9Google Scholar
  3. Beaton DE, Boers M, Wells GA (2002) Many faces of the minimal clinically important difference (MCID): a literature review and directions for future research. Curr Opin Rheumatol 14(2):109–114CrossRefGoogle Scholar
  4. Becser N, Sand T, Zwart J-A (1998) Reliability of cephalic thermal thresholds in healthy subjects. Cephalgia 18:574–582CrossRefGoogle Scholar
  5. Bird SJ, Brown MJ, Spino C, Watling S, Floyt HL (2006) Value of repeated measures of nerve conduction and quantitative sensory testing in diabetic neuropathy trial. Muscle Nerve 34:214–224CrossRefGoogle Scholar
  6. Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1(8476):307–310CrossRefGoogle Scholar
  7. Chong PS, Cros DP (2004) American Association Of Electrodiagnostic Medicine Review: Quantitative sensory testing equipment and reproducibility studies. Available at: Accessed on December 21, 2010
  8. Claus D, Hilz MJ, Neuendoerfer B (1990) Thermal discrimination thresholds: a comparison of different methods. Acta Neurol Scand 81:533–540CrossRefGoogle Scholar
  9. Dyck PJ, Kratz KM, Lehman KA, Karnes JL, Melton LJ et al (1991) The Rochester diabetic neuropathy study: design criteria for types of neuropathy, selection bias, and repeatability of neuropathic tests. Neurology 41:799–807CrossRefGoogle Scholar
  10. Gelber DA, Pfeifer MA, Broadstone VL, Munster EW, Peterson M et al (1995) Components of variance for vibratory and thermal threshold testing in normal and diabetic subjects. J Diabetes Complications 9:170–176CrossRefGoogle Scholar
  11. Guyton AC, Hall JE (2000) Textbook of medical physiology. W.B. Saunders Company, LondonGoogle Scholar
  12. Hagander LG, Midani HA, Kuskowski MA, Parry GJ (2000) Quantitative sensory testing: effect of site and skin temperature on thermal thresholds. Clin Neurophysiol 111(1):17–22CrossRefGoogle Scholar
  13. Hensel H, Andres KH, von Düring M (1974) Structure and function of cold receptors. Pflugers Arch 352:1–10CrossRefGoogle Scholar
  14. Hopkins WG (2000) Measures of reliability in sports medicine and science. Sports Med 30(1):1–15CrossRefGoogle Scholar
  15. Hsieh YW, Wang CH, Wu SC, Chen PC, Sheu CF et al (2007) Establishing the minimal clinically important difference of the Barthel Index in stroke patients. Neurorehabil Neural Repair 21(3):233–238CrossRefGoogle Scholar
  16. Huck SW, Cormier WH (1996) Reading statistics and research, 2nd edn. Harper Collins, New YorkGoogle Scholar
  17. Kojo I, Pertovaara A (1987) The effects of stimulus area and adaptation temperature on warm and heat pain thresholds in man. Int J Neurosci 32(3–4):875–880CrossRefGoogle Scholar
  18. Meier PM, Berde CB, DiCanzio J, Zurakowski D, Sethna NF (2001) Quantitative assessment of cutaneous thermal and vibration sensation and thermal pain detection thresholds in healthy children and adolescents. Muscle Nerve 24:1339–1345CrossRefGoogle Scholar
  19. Merchut MP, Toleikis C (1990) Aging and quantitative sensory thresholds. Electromyogr Clin Neurophysiol 30:293–297Google Scholar
  20. Moravcová E, Bednařík J, Svobodník A, Dušek L (2005) Reproducibility of thermal threshold assessment in small-fibre neuropathy patients. Scripta Medica (Brno) 78(3):177–184Google Scholar
  21. Roebroeck ME, Harlaar J, Lankhorst GJ (1993) The application of generalizability theory to reliability assessment: an illustration using isometric force measurement. Phys Ther 73:386–401Google Scholar
  22. Stratford PW, Finch E, Solomon P et al (1996) Using the Roland-Morris questionnaire to make decisions about individual patients. Physiother Can 48:107–110Google Scholar
  23. Strigo IA, Carli F, Bushnell MC (2000) Effect of ambient temperature on human pain and temperature perception. Anesthesiology 92:699–707CrossRefGoogle Scholar
  24. Valensi P, Attali J-R, Gagant S (1993) Reproducibility of parameters for assessment of diabetic neuropathy. French Group for Research of Diabetic Neuropathy. Diabet Med 10:933–939CrossRefGoogle Scholar
  25. Yarnitsky D (1997) Quantitative sensory testing. Muscle Nerve 20(2):198–204CrossRefGoogle Scholar
  26. Yarnitsky D, Ochoa JL (1991) Warm and cold specific somatosensory systems. Psychophysical thresholds, reaction times and peripheral conduction velocities. Brain 114:1819–1826CrossRefGoogle Scholar
  27. Yarnitsky D, Sprecher E (1994) Thermal testing: normative data and repeatability for various test algorithms. J Neurol Sci 125:39–45CrossRefGoogle Scholar
  28. Zwart J-A, Sand T (2002) Repeatability of dermatomal warm and cold sensory thresholds in patients with sciatica. Eur Spine J 11:441–446CrossRefGoogle Scholar

Copyright information

© ISB 2011

Authors and Affiliations

  1. 1.Faculty of Health StudiesUniversity of LjubljanaLjubljanaSlovenia
  2. 2.Department of Automation, Biocybernetics and RoboticsJosef Stefan InstituteLjubljanaSlovenia

Personalised recommendations