Vibration Perception Threshold in the Screening of Sensorimotor Distal Symmetric Polyneuropathy

Abstract

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.

Vibration threshold in non-diabetic subjects

“…We found that with increasing age the vibration perception decreases at all points of measurement. Age-dependency of vibration perception has been first reported by Pearson et al PLOS ONE [20] and has been confirmed by several other studies [2,[4][5][6][7][21][22][23][24]. However, it is not clear what causes this reduction of vibration perception [2].…”

“…Different VPT values for a biothesiometer have been described [5,7] and it appeared that in individuals without sensory disturbances VPT are not only influenced by age [5] but also by height [7]. Bloom et al already mentioned that next to a strong correlation with age, height appeared to be of influence on VPT assessed at the feet [5].…”

“…Bloom et al already mentioned that next to a strong correlation with age, height appeared to be of influence on VPT assessed at the feet [ 5 ]. Maffei et al provided normal values depending on age and height but did not specify the location of the measurement [ 7 ]. As therapeutic approaches for large myelinted nerve fiber deficits are proceeding [ 6 ], specific normal values to follow up patients are crucial.…”

Changes in the vibration sensitivity and pressure pain thresholds in patients with burning mouth syndrome

“…These results correlate with the findings of a recent study that reported a reduction in the vibration thresholds of the distal part of the feet in patients with BMS [ 13 , 16 ]. When analyzed collectively, these findings indicate a hypofunction of large fibers (Aß), as is also present in other neuropathies [ 34 , 35 ].…”

Identifying Peripheral Neuropathy in Fall Patients with the Heat-Washout Method

“…This discrepancy may reflect the concern that the biothesiometer, the monofilament, and the tuning fork are potentially challenged by variation in the clinical examination comprising testing technique, for instance disagreements about exact pressure applied and testing anatomic site selection, furthermore, varying interpretation of the findings, for instance, if loss of the vibrotactile perception may be a normal physical finding in the very old subjects or indicates peripheral neuropathy 27,41 . Moreover, cognitively impaired patients may have difficulties understand and respond verbally to the test, and thus indicating if the perception of the monofilament, the biothesiometer, or the tuning fork is perceived.…”