Components of variance for vibratory and thermal threshold testing in normal and diabetic subjects

Gelber, David A.; Pfeifer, Michael; Broadstone, Vasti L.; Munster, E.; Peterson, Michael J.; Arezzo, Joseph C.; Shamoon, Harry; Zeidler, Adina; Clements, Rex S.; Greene, Douglas A.; Porte, Daniel; Laudadio, Charles; Bril, Vera

doi:10.1016/1056-8727(94)00042-m

Cited by 80 publications

(71 citation statements)

References 21 publications

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“…30 Our measurements of cold threshold of the finger are in agreement with a study by Gelber et al, who looked at cold temperature thresholds of the dominant finger and found no association between thermal perception thresholds and age. 23 Finally, in agreement with Lefaucheur et al, we found that there was a significant difference with both warm and cold thresholds when comparing those with ED and normal controls at the penis. 6 We evaluated the functional integrity of the penile autonomic nervous system in patients with erectile dysfunction.…”

Section: Neuropathy Of Erectile Dysfunctionsupporting

confidence: 81%

“…While QST is non-invasive, easy to perform in an office setting, reproducible and well suited for multicenter trials, it does have some limitations. 20,23,27 QST is a psychophysical test and requires the cooperation, attention and motivation of the patient. 20,27 It has been typically used for the detection of peripheral neuropathy in diabetic patients, but it captures information from the peripheral receptors which must be processed centrally and therefore requires integrity of the entire neural pathway (ie pathology anywhere along the way may affect results).…”

Section: Neuropathy Of Erectile Dysfunctionmentioning

confidence: 99%

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The neuropathy of erectile dysfunction

et al. 2002

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These studies were intended to explore the relationship between autonomic neuropathy and erectile dysfunction (ED). Sensory thresholds reflecting the integrity of both large diameter, myelinated neurons (ie pressure, touch, vibration) and small diameter axons (ie hot and cold thermal sensation) were determined on the penis and finger. Data were compared across subjects with and without ED, controlling for age, hypertension and diabetes. The correlation of specific thresholds scores and IIEF values were also examined. Seventy-three patients who visited the academic urology clinics at Montefiore hospital were evaluated. All patients were required to complete the erectile function domain of the International Index of Erectile Function (IIEF) questionnaire: 20 subjects had no complaints of ED and scored within the 'normal' range on the IIEF. Patients were subsequently tested on their index finger and glans penis for vibration (Biothesiometer), pressure (Semmes-Weinstein monofilaments), spatial perception (Tactile Circumferential Discriminator), and warm and cold thermal thresholds (Physitemp NTE-2). Sensation of the glans penis, as defined by the examined sensory thresholds, was significantly diminished in patients with ED and these differences remained significant when controlling for age, diabetes and hypertension. In contrast, thresholds on the index finger were equivalent in the ED and non-ED groups. Threshold and IIEF scores were highly correlated, consistent with an association between diminished sensation and decreasing IIEF score (worse erectile functioning). These relations also remained significant when controlling for age, diabetes and hypertension. The findings demonstrate dysfunction of large and small diameter nerve fibers in patients with ED of all etiologies. Further, the neurophysiologic measures validate the use of the IIEF as an index of ED, as objective findings of sensory neuropathy were highly correlated with worse IIEF scores. The sensory threshold methods utilized represent novel, non-invasive and relatively simple procedures, which can be used in a longitudinal fashion to assess a patient's neurological response to therapies.

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Section: Neuropathy Of Erectile Dysfunctionsupporting

confidence: 81%

Section: Neuropathy Of Erectile Dysfunctionmentioning

confidence: 99%

The neuropathy of erectile dysfunction

et al. 2002

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“…Some studies found good intraobserver reliability, but poorer inter-observer reliability [33], with coefficients of variation up to 45% [34]. Other studies found good reproducibility [35] and good validity between centres [36]; this probably relates to good standardisation and adherence to testing protocols.…”

Section: Discussionmentioning

confidence: 99%

Vibrotactile threshold measurement for detecting peripheral neuropathy: defining variability and a normal range for clinical and research use

et al. 2007

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Aims/hypothesis We aimed to define normal ranges for vibration sense as measured by vibratory perception thresholds (VPTs) using biothesiometry. Methods We performed biothesiometry in a communitydwelling sample of 901 people aged 55 to 85 years who did not have diabetes. We quantitated the variation between repeat measures using analysis of variance and BlandAltman plots. We also plotted the age-and sex-specific reference ranges. Results We found small but statistically significant differences between repeat measures using the ascending and descending method of limits. Statistically higher vibration thresholds were noted on the right arm and leg compared with the left. Significantly higher vibration thresholds were also seen in men vs women for both lower limbs. We also defined sex-specific reference intervals (normal ranges) for biothesiometry for older persons and quantitated the increase in vibration threshold with increasing age. Conclusions/interpretation For reliability, it may be sufficient to obtain the average of two ascending measures separated by at least 1 min in just the right hand or right foot, since this is usually the one with the higher threshold. Although identical reference ranges can be used for men and women for the upper limb, there are significant differences in the lower limbs. The major determinant of VPT is age: we have established age-specific norms for VPT testing for adults between 55 and 85 years of age.

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“…Nevertheless, poor standardization of measurement limits its use in clinical practice; [3][4][5] furthermore, the unique normality threshold of 25 V is criticized due to the physiologic increase in VPT with age. 6 The development of devices reducing the intra-and interoperator variability in the test execution could help research and clinical practice in the identification of new relevant reference thresholds.…”

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confidence: 99%

Vibration Perception Threshold in the Screening of Sensorimotor Distal Symmetric Polyneuropathy

Maffei¹,

Premrou²,

Roldán³

et al. 2014

J Diabetes Sci Technol

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Use of the vibration perception threshold (VPT) is a simple way of detecting large-fiber dysfunction, thus identifying individuals with diabetes at risk of ulceration. 1-2Nevertheless, poor standardization of measurement limits its use in clinical practice; 3-5 furthermore, the unique normality threshold of 25 V is criticized due to the physiologic increase in VPT with age. 6 The development of devices reducing the intra-and interoperator variability in the test execution could help research and clinical practice in the identification of new relevant reference thresholds. In this context the UltraBiotesiometer Meteda contains specific features that reduce the variability of the measurements, that is, the vibration activated only under controlled pressure, five indicator lights allowing the monitoring of the pressure, and the elasticity of vibration electrically controlled in both directions. We adopted this new technologically advanced biothesiometer to assess VPT trends in subjects without sensorimotor distal symmetric polyneuropathy and identify age-specific normality thresholds.A random sample of 150 consecutive individuals have been identified among those routinely referred to one endocrinology center in Argentina. Patients were considered eligible for the study if diabetes, neuropathy, and slipped disc were excluded. Recruitment was stratified according to three age classes: <45, 45-60, >60 years. VPT was measured using UltraBiotesiometer Meteda.Normal ranges for VPT were computed using the normal approximation. The upper limit of this range was reported along with its 95% confidence intervals. Subjects with values larger than the estimated upper limit should be considered as "nonnormal." Subgroup analyses for each age class were performed. VPT values were log-transformed before analyses because their skewed distribution. A P value < .05 was considered significant. All analyses were performed using R software.Our results document that normality threshold in the overall population is lower (20 V) than that currently suggested by guidelines (25 V) and relevant differences in VPT upper limits exist according to age classes (Table 1). The normality thresholds identified cannot provide direct indications for changing clinical practice, but the clear trend and the marked differences among the upper limits in the three age classes cannot be ignored. Further longitudinal studies adopting technologically advanced devices are needed to assess the association between age-specific normality thresholds and incidence of lower limb complications.

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Components of variance for vibratory and thermal threshold testing in normal and diabetic subjects

Cited by 80 publications

References 21 publications

The neuropathy of erectile dysfunction

The neuropathy of erectile dysfunction

Vibrotactile threshold measurement for detecting peripheral neuropathy: defining variability and a normal range for clinical and research use

Vibration Perception Threshold in the Screening of Sensorimotor Distal Symmetric Polyneuropathy

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