![]() While there have been several small studies investigating inter- and/or intra-rater reliability of monofilament and vibration perception testing results of these studies are variable, and generalisability of these findings limited by inconsistency of testing methods. Reliability refers to the level of consistency of measurement results between different clinicians (inter-rater) and the same clinican on multiple occasions (intra-rater). However there are limited data available comparing the reliability of different testing methods. Similarly, methods for testing protective sensation testing using monofilament examination can vary clinically in terms of location and number of sites tested. Several techniques are available for testing vibration perception, including use of a neurothesiometer or similar instrument, as well as graduated and non-graduated tuning forks. Diminished vibration perception and ability to detect 10 g monofilament have demonstrated predictive capacity for future foot ulceration, and are widely used both clinically and in research. Current international guidelines recommend testing of protective sensation using monofilament, as well as additional tests such as vibration perception, reflexes, pain perception and asking about neurological symptoms. Methods for conducting clinical chairside neurological tests to establish the presence and monitor the progression of DPN are varied, and assess different nerve fibre types. ![]() Therefore, early and accurate diagnosis of DPN is paramount to mitigating the risk of associated foot complications. Additionally education and routine foot care in those with DPN have been shown to reduce risk of associated foot complications. For example, intensive glycaemic control has demonstrated a reduction of neuropathy incidence of between 25% and 57%. Prophylactic care in people with diabetes has been shown to prevent or delay development of DPN. DPN is associated with lower limb complications such as foot deformity, increased plantar pressures, ulceration and infection and, is implicated in 50–75% of all non-traumatic lower limb amputations. Up to 50% of persons with diabetes are affected by diabetic peripheral neuropathy (DPN), which causes widespread sensory loss, primarily affecting the feet and legs. Years of clinical experience only marginally affected test reliability overall and due to subjective nature of the tests we suggest that testing should be performed regularly and repetitively.ĭiabetes is a significant health problem and was recently estimated to affect approximately 451 million people worldwide. Use of a graduated tuning fork was slightly more reliable than other methods of tuning fork application however all had substantial reliability. Four- and 10-site 10 g monofilament testing have similarly acceptable levels of reliability and the neurothesiometer is the most reliable method of assessing vibration perception function. We support the current recommendations of using more than one test to screen and monitor progression of DPN. The 10-site monofilament (К: 0.44–0.77) outperformed the 4-site test (К: 0.34–0.67) and the dampened tuning fork method (К: 0.41–0.49) showed lower intra-rater reliability compared to both conventional (К: 0.52–0.57) and graduated methods (К: 0.50–0.57). All tests demonstrated acceptable inter-rater reliability ranging from moderate (10-site monofilament, К: 0.54, CI: 0.38–0.70, p = 0.02) to substantial (graduated tuning fork, К: 0.68, CI: 0.41–0.95, p < 0.01). Twenty-four participants (63% male, 100% type 2, 4% with DPN) underwent tuning fork testing and returned for retest. Resultsįifty participants (66% male, 100% type 2, 32% with DPN) underwent monofilament and neurothesiometer testing with 44 returning for the retest. The intra- (Cohen’s К) and inter-rater (Cohen’s or Fleiss’ К) reliability of each test was determined. ![]() In a separate cohort, the reliability of a graduated tuning fork as well as two methods of conventional tuning fork (on/off method and dampening method) was undertaken by a new graduate podiatrist and podiatrist with one-year’s clinical experience. Three podiatrists with varying clinical experience tested four- and 10-site, 10 g monofilament and vibration perception threshold (VPT). The aim of this study was to determine the inter- and intra-rater reliability of methods used to test vibration perception and protective sensation in a community-based population of adults with type 2 diabetes. However, there is limited research investigating the reliability of these tests in people with diabetes. Testing of protective sensation and vibration perception are two of the most commonly used non-invasive methods of screening for diabetes-related peripheral neuropathy (DPN).
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |