Limitations of quantitative sensory testing when patients are biased toward a bad outcome

Dyck, Peter James; Kennedy, William R.; Kesserwani, Hassan; Melanson, Michel; Ochoa, Juan José Arana; Shy, Michael E.; Stevens, Joseph C.; Suarez, G. A.; O’Brien, Peter C.

doi:10.1212/wnl.50.5.1213

Cited by 39 publications

(25 citation statements)

References 11 publications

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“…Despite provisions made in Case IV QST testing for such an eventuality, a subject may consciously influence results of the test making QST unreliable (42;43). However, in clinical trials where participants are motivated to closely follow the testing protocol, and where such a profound conscious bias is lacking, this study indicates that QST would be a reliable test.…”

Section: Discussionmentioning

confidence: 99%

Reliability of quantitative sudomotor axon reflex testing and quantitative sensory testing in neuropathy of impaired glucose regulation

Peltier¹,

Smith²,

Russell³

et al. 2009

Muscle and Nerve

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Reproducible neurophysiological testing paradigms are critical to multi-center studies of neuropathy associated with impaired glucose regulation (IGR), yet the best methodologies and endpoints remain to be established. This study evaluates the reproducibility of neurophysiologic tests within a multi-center research setting. Twenty-three participants with neuropathy and IGR were studied. Reproducibility of QSART and QST (using the CASE IV system) were determined in a subset of patients at two sessions and calculated from intraclass correlation coefficients (ICC). QST (cold detection threshold ICC 0.80, vibration detection threshold ICC 0.75) was more reproducible than QSART (ICC foot 0.52). Performing multiple tests in one setting did not improve reproducibility of QST. QST reproducibility in IGR patients is similar to other patient groups studied. QSART reproducibility was significantly lower than QST. In this group of patients, the reproducibility of QSART was unacceptable for a secondary endpoint measure in clinical research trials.

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Section: Discussionmentioning

confidence: 99%

Reliability of quantitative sudomotor axon reflex testing and quantitative sensory testing in neuropathy of impaired glucose regulation

Peltier¹,

Smith²,

Russell³

et al. 2009

Muscle and Nerve

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“…QST has several limitations, such as its inability to discriminate between central nervous system and peripheral nervous system disease, the need for participant cooperation and attention, and the fact that it may be easily influenced by other factors. Therefore, it should not be used in isolation and needs to be interpreted in the clinical context and in conjunction with other studies 54171172173174…”

Section: Diagnostic Approachmentioning

confidence: 99%

Diagnosis and management of sensory polyneuropathy

Gwathmey

Pearson

2019

BMJ

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Sensory polyneuropathies, which are caused by dysfunction of peripheral sensory nerve fibers, are a heterogeneous group of disorders that range from the common diabetic neuropathy to the rare sensory neuronopathies. The presenting symptoms, acuity, time course, severity, and subsequent morbidity vary and depend on the type of fiber that is affected and the underlying cause. Damage to small thinly myelinated and unmyelinated nerve fibers results in neuropathic pain, whereas damage to large myelinated sensory afferents results in proprioceptive deficits and ataxia. The causes of these disorders are diverse and include metabolic, toxic, infectious, inflammatory, autoimmune, and genetic conditions. Idiopathic sensory polyneuropathies are common although they should be considered a diagnosis of exclusion. The diagnostic evaluation involves electrophysiologic testing including nerve conduction studies, histopathologic analysis of nerve tissue, serum studies, and sometimes autonomic testing and cerebrospinal fluid analysis. The treatment of these diseases depends on the underlying cause and may include immunotherapy, mitigation of risk factors, symptomatic treatment, and gene therapy, such as the recently developed RNA interference and antisense oligonucleotide therapies for transthyretin familial amyloid polyneuropathy. Many of these disorders have no directed treatment, in which case management remains symptomatic and supportive. More research is needed into the underlying pathophysiology of nerve damage in these polyneuropathies to guide advances in treatment.

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“…No matter what the instrument or procedure used, QST is only a semiobjective measure, affected by the subject's attention, motivation, and cooperation, as well as by anthropometric variables such as age, sex, body mass, and history of smoking and alcohol consumption (184,185). Expectancy and subject bias are additional factors that can exert a powerful influence on QST findings (186). Further, QST is sensitive to changes in structure or function along the entire neuroaxis from nerve to cortex; it is not a specific measure of peripheral nerve function (167).…”

Section: Diabetic Somatic Neuropathiesmentioning

confidence: 99%