The Semmes Weinstein monofilament examination as a screening tool for diabetic peripheral neuropathy

Feng, Yuzhe; Schlösser, Felix J.V.; Sumpio, Bauer E.

doi:10.1016/j.jvs.2009.05.017

Cited by 297 publications

(233 citation statements)

References 40 publications

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“…This corroborates our systematic review results: DPN and PVD clinical collection methods seem relatively unimportant (4,15). Although several authors have described the foot pulse palpation to have low sensitivity (16,17), the SWM application procedure does not have consensus (18,19) and the tuning fork has low reliability (19); several studies have shown that these simple methods can be implemented for both community (2,8,15,19,20) and high risk (3, 4) setting diabetic foot screening, independently of the variables collection method.…”

Section: Discussionsupporting

confidence: 86%

Validation and comparison of currently available stratification systems for patients with diabetes by risk of foot ulcer development

Monteiro‐Soares

Carneiro

Sampaio

et al. 2012

European Journal of Endocrinology

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Aims/hypothesis: There are five systems to stratify the risk for the development of a diabetic foot ulcer (DFU). This study aimed to prospectively validate all of them in the same cohort of participants to allow their direct comparison. Methods: A retrospective cohort study was conducted on all patients with diabetes but without an active DFU attending our podiatry section (nZ364) from January 2008 to December 2010. Participants' characteristics and all variables composing the stratification systems were assessed at baseline. Follow-up was performed for 1 year or until DFU occurred. Results: Participants had a mean age of 64 years; 99.7% had type 2 diabetes and 48.6% were male. Median follow-up was 12 months (1-12) during which 33 subjects (9.1%) developed a DFU. Age, diabetes duration, foot deformity, peripheral vascular disease, diabetic peripheral neuropathy, previous DFU, and previous lower extremity amputation were associated with DFU occurrence. All systems presented greater DFU occurrence frequency as the risk group was higher (c 2 , P!0.001) and showed good diagnostic accuracy values, especially negative predictive value (R95%) and area under the receiver operating curve (R0.73). The lowest performance concerned positive predictive value (%29.5%). Conclusions/interpretation: All the currently available stratification systems show high accuracy to detect which patients will develop a DFU with no significant differences among them. Therefore, for diabetic foot screening and resource allocation, it would be desirable to have a single unified system, combining the available systems, prospectively validated in a multicenter context and testing the inclusion of novel predictive variables' pertinence.

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Section: Discussionsupporting

confidence: 86%

Validation and comparison of currently available stratification systems for patients with diabetes by risk of foot ulcer development

Monteiro‐Soares

Carneiro

Sampaio

et al. 2012

European Journal of Endocrinology

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“…[32] One of the five results is a summary of the Semmes-Weinstein monofilament examination, which is by itself a sensitive gage of feet neuropathy, even though more involved. [40] In any test the reflex is found to be either absent, reduced or present, which scores 1, 0.5 or 0, respectively. To obtain the score the points are added up.…”

Section: Diabetic Peripheral Neuropathymentioning

confidence: 98%

“…[41,42] DPN is a serious condition which can cause ulceration of feet that, if cannot be treated, might require amputation of affected lower limb extremities. [40] Testing for DPN is theoretically meaningful as the high BP is generally considered a co-factor of T2DM. It creates a favourable environment for glucose to attach to cell receptors.…”

Section: Diabetic Peripheral Neuropathymentioning

confidence: 99%

Data-analytically derived flexible HbA1c thresholds for type 2 diabetes mellitus diagnostic

Stranieri

Yatsko

Jelinek

et al. 2015

AIR

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Glycated haemoglobin (HbA1c) is now more commonly used as an alternative test to the fasting plasma glucose and oral glucose tolerance tests for the identification of Type 2 Diabetes Mellitus (T2DM) because it is easily obtained using the point-of-care technology and represents long-term blood sugar levels. According to WHO guidelines, HbA1c values of 6.5% or above are required for a diagnosis of T2DM. However outcomes of a large number of trials with HbA1c have been inconsistent across the clinical spectrum and further research is required to determine the efficacy of HbA1c testing in identification of T2DM. Medical records from a diabetes screening program in Australia illustrate that many patients could be classified as diabetics if other clinical indicators are included, even though the HbA1c result does not exceed 6.5%. This suggests that a cutoff for the general population of 6.5% may be too simple and miss individuals at risk or with already overt, undiagnosed diabetes. In this study, data mining algorithms have been applied to identify markers that can be used with HbA1c. The results indicate that T2DM is best classified by HbA1c at 6.2% -a cutoff level lower than the currently recommended one, which can be even less, having assumed the threshold flexibility, if additionally to HbA1c being high the rule is conditioned on oxidative stress or inflammation being present, atherogenicity or adiposity being high, or hypertension being diagnosed, etc.

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“…Light touch sensation was assessed with use of the 5.07 SWM [20], which is generally accepted as an effective, inexpensive, portable, painless, easy to administer, and reliable screening method for assessing touch-pressure sensation in a valid fashion. In fact, the SWM was shown to be more sensitive than the vibration perception threshold in measuring peripheral sensation [21,22]. The tester asked blindfolded participants to indicate by stating the word-now when and where on their foot they sensed the pressure of the monofilament.…”

Section: Outcome Measurementsmentioning

confidence: 99%

Monochromatic Infrared Photo Energy in Diabetic Peripheral Neuropathy

Ammar

2012

ISRN Rehabilitation

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Diabetes is a very common cause of peripheral neuropathy, and there is no optimal intervention universally accepted by clinicians. Monochromatic infrared photo energy is a relatively new modality used in the United States for reducing pain and increasing circulation. This study investigated the effects of monochromatic infrared photo energy on reducing pain, improving sensation, and increasing balance in patients with diabetic peripheral neuropathy. Thirty-five patients with diabetic peripheral neuropathy completed the program and were randomly assigned into two groups. Group 1 (experimental, n = 18) received monochromatic infrared photo energy, therapeutic exercises, and balance training. Group 2 (control, n = 17) received therapeutic exercises and balance training. Both groups received three treatment sessions per week for 4 weeks. Outcome included pain intensity measured on a visual analogue scale, sensation measured with the Semmes-Weinstein monofilament 5.07, and balance measured with the Berg score, before and after the 12 therapy sessions (1 month after the start of the intervention). Analysis of covariance tests revealed statistically significant improvements, specifically, P = .01, .014, and .0001, for pain, sensation, and balance, respectively, in the experimental group. Within the limitations of this study, monochromatic infrared photo energy may play a role in treating diabetic peripheral neuropathy by reducing pain, improving sensation, and increasing balance.

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The Semmes Weinstein monofilament examination as a screening tool for diabetic peripheral neuropathy

Cited by 297 publications

References 40 publications

Validation and comparison of currently available stratification systems for patients with diabetes by risk of foot ulcer development

Validation and comparison of currently available stratification systems for patients with diabetes by risk of foot ulcer development

Data-analytically derived flexible HbA1c thresholds for type 2 diabetes mellitus diagnostic

Monochromatic Infrared Photo Energy in Diabetic Peripheral Neuropathy

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