Comparison of the accuracy of monofilament testing at various points of feet in peripheral diabetic neuropathy screening

Abstract

BackgroundDiabetic Peripheral Neuropathy is one of the most prevalent complications of diabetes mellitus. The development and progression of such complications are responsible for much of the morbidity and mortality. The purpose of this study was to evaluate the effectiveness of Semmes–Weinstein monofilament ten gram in 3, 4, eight and ten points in the screening of diabetic peripheral neuropathy in patients with diabetes mellitus.MethodsIn a descriptive correlational design, 150 patients with diabetes mellitus were selected using convenience sampling. All patients were evaluated for sensory neuropathy using ten gram Semmes-Weinstein Monofilaments and questionnaire on neuropathy symptoms. In the next phase, nerve conduction velocity was examined. The most common subjective symptoms were paresthesia of both feet, pain in feet, burning sensation in the extremities and numbness in the extremities.ResultsThe results showed that the sensitivity of Monofilament in three and four points were 35.9 to 53.8 present and 38.5 to 51.3 percent respectively. Specificity of Monofilament the same points, were 73.9 to 84.7 and 73 to 87.4 percent respectively. Monofilament sensitivity at eight and ten points were 38.5 to 61.5 and 64.1 to 30.8 percent respectively. Also, specificity of the same points were 77.5 to 95.5 and 64 to 89.2 percent respectively. It was revealed that the difference sensitivity and specificity of Monofilament in three and four points with sensitivity and specificity in eight and ten point is not statistically significant.ConclusionsThis study showed that Semmes-Weinstein monofilament can easily use as a simple and inexpensive device for screening. Since increasing the number of points it was not significantly difference. Therefore, we suggest that screening for diabetic peripheral neuropathy, especially in large populations to avoid wasting time on Monofilament application, areas like three or four points eight and ten points could be used.

Prevalence of neuropathy in type 2 diabetic patients and its association with other diabetes complications: The Verona Diabetic Foot Screening Program

“…This tool has probably become the most widely promoted method for diagnosing neuropathy (Singh, Armstrong, & Lipsky, 2000), whose use needs some technical attentions (Armstrong, n.d.) and a critical evaluation of patients' answers (Slater, Koren, Ramot, Buchs, & Rapoport, 2014). It is not clear which number of anatomic sites should be tested from one to ten, but the performance of the test did not seem different in three or four points versus eight and ten points (Baraz, Zarea, Shahbazian, & Latifi, 2014). Testing 10 sites evaluates all dermatomes of the foot and may improve the sensitivity and specificity compared with testing a single site (Singh et al, 2000).…”

Elevated peripheral blood levels of CXCL10 are associated with the presence of diabetic polyneuropathy in subjects with type 2 diabetes

“…In their work, the diagnostic threshold was defined as the inability to perceive at least four sites out of the ten evaluated. Nevertheless, Baraz et al [29] reported that in terms of sensitivity and specificity, there were no significant differences between the monofilament testing in three to four points and the monofilament testing in ten points. In the present study, we carried out the DPN classification using the monofilament test in three points, and its results were also consistent with the NDS and NSS scales.…”

Prevalence of peripheral neuropathy and its impact on activities of daily living in people with type 2 diabetes mellitus

“…Furthermore, touch sensation of the hands and feet was measured using the 10 g Semmes‐Weinstein Monofilament (SWM) test at the tips of the index and ring fingers of both hands and four areas of the foot (plantar surface of the distal hallux and the first, third, and fifth metatarsal heads) using the Touch‐Test Sensory Evaluator 5 Piece Hand Kit (Baraz, Zarea, Shahbazian, & Latifi, ). Interviewing was performed to obtain self‐reports of the impact of pain on ADL using the patient neurotoxicity questionnaire (PNQ) and a visual analog scale (VAS) (0‐100) in the Myanmar languages.…”