‘Numbness of the feet’ is a poor indicator for polyneuropathy in Type 2 diabetic patients

Franse, Lonneke V.; Valk, Gerlof D.; Dekker, J. H.; Heine, Robert J.; Eijk, J.T.M. van

doi:10.1046/j.1464-5491.2000.00223.x

Cited by 47 publications

(41 citation statements)

References 26 publications

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“…We rejected clinical examination, vibration perception, and warm/cold detection as reference standards: the fi rst 2 because of obvious limitations in sensitivity or specifi city, 4,17,18 and thermal sense detection because it tests small-fi ber neuropathy, whereas applying a monofi lament and light touch, such as vibration and nerve conduction, tests for large-fi ber …”

Section: Discussionmentioning

confidence: 99%

Accuracy of Monofilament Testing to Diagnose Peripheral Neuropathy: A Systematic Review

Dros¹,

Wewerinke²,

Bindels³

et al. 2009

The Annals of Family Medicine

151

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PURPOSE We wanted to summarize evidence about the diagnostic accuracy of the 5.07/10-g monofi lament test in peripheral neuropathy. METHODSWe conducted a systematic review of studies in which the accuracy of the 5.07/10-g monofi lament was evaluated to detect peripheral neuropathy of any cause using nerve conduction as reference standard. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. RESULTSWe reviewed 173 titles and abstracts of articles to identify 54 potentially eligible studies, of which 3 were fi nally selected for data synthesis. All studies were limited to patients with diabetes mellitus and showed limitations according to the QUADAS tool. Sensitivity ranged from 41% to 93% and specifi city ranged from 68% to 100%. Because of the heterogenous nature of the studies, a meta-analysis could not be accomplished.CONCLUSIONS Despite the frequent use of monofi lament testing, little can be said about the test accuracy for detecting neuropathy in feet without visible ulcers. Optimal test application and defi ning a threshold should have priority in evaluating monofi lament testing, as this test is advocated in many clinical guidelines. Accordingly, we do not recommend the sole use of monofi lament testing to diagnose peripheral neuropathy. 2009;7:555-558. doi:10.1370/afm.1016. Ann Fam Med INTRODUCTIONP eripheral neuropathy causes loss of sensation and increases the risk of ulceration of the feet. Timely identifi cation of loss of protective sensation may allow preventive intervention. Peripheral neuropathy is a complication in approximately 50% of patients with diabetes, and up to 50% of patients with peripheral neuropathy may not have symptoms. [1][2][3] Several tests are used to detect peripheral neuropathy, including vibration perception, application of warmth and cold, and nerve conduction studies, which are assumed to be the reference standard.4 Electrodiagnostic tests can be complex, expensive, and time consuming, which hampers their widespread use, especially in primary care, where for most patients peripheral neuropathy is diagnosed and treated.Monofi lament testing is an inexpensive, easy-to-use, and portable test for assessing the loss of protective sensation, and it is recommended by several practice guidelines to detect peripheral neuropathy in otherwise normal feet. 1,5,6 Monofi laments, often called Semmes-Weinstein monofi laments, are calibrated, single-fi ber nylon threads, identifi ed by values ranging from 1.65 to 6.65, that generate a reproducible buckling stress. The higher the value of the monofi lament, the stiffer and more diffi cult it is to bend. Three monofi laments commonly used to diagnose periph- M ONO FIL A MEN T T ES T ING F OR PER IPHER A L NEUROPAT HYeral neuropathy are the 4.17, 5.07 and 6.10.7-9 Forces required to bend these monofi laments are 1, 10, and 75 g, respectively. The fi lament is placed on the patient's skin (usually the feet); when there is considerable loss of sensation, the patient will not be...

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Section: Discussionmentioning

confidence: 99%

Accuracy of Monofilament Testing to Diagnose Peripheral Neuropathy: A Systematic Review

Dros¹,

Wewerinke²,

Bindels³

et al. 2009

The Annals of Family Medicine

151

View full text Add to dashboard Cite

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“…Four studies described measuring the presence of a polyneuropathy using the reference standard in a fashion that was masked to measurement of the diagnostic predictor. Two studies attained a grade of class I, 6,7 five attained a grade of class II, 3,8,9,11,13 and five attained a grade of class III. 4,5,10,12,14 Diagnostic accuracy.…”

Section: Process Formation Of Expert Panelmentioning

confidence: 98%

“…After comprehensive review of these articles, 12 articles attained a grade of class I, II, or III. [3][4][5][6][7][8][9][10][11][12][13][14] These articles serve as the major evidence basis for the case definition and are tabulated in table 3.…”

Section: Process Formation Of Expert Panelmentioning

confidence: 99%

“…Symptoms may be primarily sensory, primarily motor, or both. [4][5][6][7][10][11][12] Symptoms begin distally in the feet. Sensory symptoms are either persistent or intermittent alterations of sensation initially involving the toes or feet.…”

Section: Process Formation Of Expert Panelmentioning

confidence: 99%

“…A number of symptom questionnaires and methods for scoring symptoms have been described. [3][4][5][6][7][8][9][10][11][12][13][14] Signs. Signs of distal symmetric polyneuropathy evident upon clinical examination may include abnormalities of primary sensory modalities (pain, touch, hot, cold, vibration, and proprioception), motor system (weakness and atrophy), tendon reflexes (especially depressed or absent ankle jerks), or autonomic system.…”

Section: Process Formation Of Expert Panelmentioning

confidence: 99%

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Distal symmetric polyneuropathy: A definition for clinical research

England¹,

Gronseth²,

Franklin³

et al. 2005

Neurology

700

574

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Abstract-The objective of this report was to develop a case definition of distal symmetric polyneuropathy to standardize and facilitate clinical research and epidemiologic studies. A formalized consensus process was employed to reach agreement after a systematic review and classification of evidence from the literature. The literature indicates that symptoms alone have relatively poor diagnostic accuracy in predicting the presence of polyneuropathy; signs are better predictors of polyneuropathy than symptoms; and single abnormalities on examination are less sensitive than multiple abnormalities in predicting the presence of polyneuropathy. The combination of neuropathic symptoms, signs, and electrodiagnostic findings provides the most accurate diagnosis of distal symmetric polyneuropathy. A set of case definitions was rank ordered by likelihood of disease. The highest likelihood of polyneuropathy (useful for clinical trials) occurs with a combination of multiple symptoms, multiple signs, and abnormal electrodiagnostic studies. A modest likelihood of polyneuropathy (useful for field or epidemiologic studies) occurs with a combination of multiple symptoms and multiple signs when the results of electrodiagnostic studies are not available. A lower likelihood of polyneuropathy occurs when electrodiagnostic studies and signs are discordant. For research purposes, the best approach to defining distal symmetric polyneuropathy is a set of case definitions rank ordered by estimated likelihood of disease. The inclusion of this formalized case definition in clinical and epidemiologic research studies will ensure greater consistency of case selection.

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Current Awareness

2000

Diabetes Metab. Res. Rev.

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In order to keep subscribers up‐to‐date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of diabetes/metabolism. Each bibliography is divided into 17 sections: 1 Books, Reviews & Symposia; 2 General; 3 Genetics; 4 Epidemiology; 5 Immunology; 6 Prediction; 7 Prevention; 8 Intervention: a) General; b) Pharmacology; 9 Pathology: a) General; b) Cardiovascular; c) Neurological; d) Renal; 10 Endocrinology & Metabolism; 11 Nutrition; 12 Animal Studies; 13 Techniques. Within each section, articles are listed in alphabetical order with respect to author (10 Weeks journals ‐ Search completed at 28th June 2000)

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‘Numbness of the feet’ is a poor indicator for polyneuropathy in Type 2 diabetic patients

Abstract: Identification of neuropathic sensory symptoms is not useful as a diagnostic or even a screening tool in the assessment of diabetic neuropathy in daily practice. Therefore, the results reported in this paper mandate an annual foot examination by the general practitioner.

Cited by 47 publications

References 26 publications

Accuracy of Monofilament Testing to Diagnose Peripheral Neuropathy: A Systematic Review

Accuracy of Monofilament Testing to Diagnose Peripheral Neuropathy: A Systematic Review

Distal symmetric polyneuropathy: A definition for clinical research

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