David R. Gutknecht, MD
What is the accuracy of various aspects of the clinical examination for diagnosing large-fiber peripheral neuropathy (LFPN) in patients with diabetes?
Included studies assessed the accuracy or precision of bedside screening for peripheral neuropathy in patients with diabetes, described the study patients and physical examination maneuvers, reported operating characteristics or sufficient data to construct 2 × 2 tables, and compared the screening tests to a reference standard. Outcomes were test sensitivity and specificity and likelihood ratios.
MEDLINE (to Nov 2009) and EMBASE/Excerpta Medica (to wk 50, 2009) were searched for English-language studies. 9 studies met the inclusion criteria; 2 were considered to be high-quality. All studies used nerve conduction testing as the reference standard.
Prevalence of LFPN in the included studies ranged from 23% to 79%. The operating characteristics of selected symptoms, physical examination findings, and combinations of findings are shown in the Table.
Vibration testing with a 128-Hz tuning fork and pressure sensation testing with the Semmes-Weinstein 5.07 monofilament are most accurate for diagnosing large-fiber peripheral neuropathy in patients with diabetes.
Accuracy of various tests for diagnosis of large-fiber peripheral neuropathy in patients with diabetes*
*Diagnostic terms defined in Glossary.
†For +LR, insensate on ≥ 5 of 8 attempts; for −LR, insensate on ≤ 1 of 8 attempts.
‡For +LR, vibration persists > 20 s; for −LR, vibration persists ≤ 10 s.
§Knee and ankle reflexes, muscle trophism of lower limbs, muscle strength in lower limbs, ability to walk on heels, and inspection of foot.
||Pain sensation, vibration perception, pressure sensation, ankle reflexes, and thermal sensitivity.
¶Vibration perception threshold, temperature perception, pin prick, and Achilles reflex.
**Appearance of feet, ulceration, ankle reflexes, and vibration perception.
David R. Gutknecht. Review: Vibration testing and monofilament testing are most accurate for diagnosing large-fiber peripheral neuropathy in diabetes. Ann Intern Med. 2010;153:JC4–10. doi: 10.7326/0003-4819-153-8-201010190-02010
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Published: Ann Intern Med. 2010;153(8):JC4-10.
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism, Neurology.
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