The Tuning Fork Revisited

Liniger, C.; Albeanu, A.; Bloise, Donatella; Assal, Jean‐Philippe

doi:10.1111/j.1464-5491.1990.tb01319.x

Cited by 104 publications

(67 citation statements)

References 19 publications

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“…According to the neuropathy disability and symptom score used for diagnosis of peripheral neuropathy [4] in 1994/1995 peripheral neuropathy was found in 24 % of IDDM and 38 % of NIDDM patients. The prevalence of impaired vibration perception (age-related score according to Liniger et al [31] at the first metatarsal bone) remained unchanged (Table 4).…”

Section: Assessment Of Quality Of Carementioning

confidence: 97%

The JEVIN trial: A population-based survey on the quality of diabetes care in Germany: 1994/1995 compared to 1989/1990

Schiel¹,

Müller²,

Sprott³

et al. 1997

Diabetologia

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SummarySince 1990 in most Eastern European countries health care systems have been decentralized or are undergoing the processes of decentralization. Increasingly, diabetic patients are no longer treated by diabetologists but by non-specialized physicians. During the same period structured treatment and teaching programmes have been introduced and health care is increasingly influenced by the St. Vincent declaration. To show the effect of these changes on the quality of diabetes care 90 % (n = 244) of all insulin-treated diabetic patients aged 16 to 60 years and living in the city of Jena (100247 inhabitants) were studied in 1994/1995. The results were compared with the baseline examination of 1989/1990 (n = 190). HbAac (HbAlc/mean normal) in IDDM patients under specialized care was similar in 1994/1995 (1.54+0.27, n=47) to 1989/1990 (1.52+0.31, n = 131, p = 0.0018), but higher under non-specialized care (1.71 + 0.38, n = 80,p = 0.0087). In the total group of NIDDM patients there was no significant change in HbAlc (1994HbAlc ( /1995HbAlc ( :1.75 + 0.4, n = 117, vs 1989HbAlc ( /1990:1.78 + 0.4, n = 59,p = 0.67), but with a tendency to higher HbAlc under non-specialized (1.81+0.4, n =79) compared to specialized care (1.66 + 0.39, n = 38, p = 0.06). Incidence of severe hypoglycaemia (IDDM 0.13; NIDDM 0.04), ketoacidosis (0.02; 0.01) and the prevalence of nephropathy (21%; 35 %) and neurogathy (24 %; 38 %) remained unchanged in comparison to 1989/1990, whereas there was an increase in the prevalence of diabetic retinopathy. Specialized care is mandatory for patients with IDDM. [Diabetologia (1997[Diabetologia ( ) 40: 1350[Diabetologia ( -1357 Keywords IDDM, NIDDM, population-based trial, HbAlc, care quality.Insulin-dependent (IDDM) and non-insulin-dependent (NIDDM) diabetes mellitus confer a high risk of developing diabetic late complications with the result of excess mortality and morbidity [1][2][3][4][5]. Up to the present, optimal quality of care and regular screening have been the most important factors for preventing late complications [6][7][8][9][10]. Most of the data available concerning quality management of diabetes have been derived from selected populations [11,12].

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Section: Assessment Of Quality Of Carementioning

confidence: 97%

The JEVIN trial: A population-based survey on the quality of diabetes care in Germany: 1994/1995 compared to 1989/1990

Schiel¹,

Müller²,

Sprott³

et al. 1997

Diabetologia

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“…There is growing evidence supporting the use of the graduated 128-Hz tuning fork in routine clinical screening and assessments. The graduated tuning fork relies on a vibration extinction threshold estimated as the interaction between two virtual triangles that move exponentially on a scale from 0 to 8 [37], with a score of <4/8 indicative of high risk [38].…”

Section: Measuring Vptmentioning

confidence: 99%

Vibration perception threshold—a valuable assessment of neural dysfunction in people with diabetes

Garrow¹,

Boulton²

2006

Diabetes Metabolism Res

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Diabetic peripheral neuropathy (DPN) has been identified as a key element in the causal pathway to foot ulceration and other lower-extremity complications, impaired quality of life and increased mortality. Early detection is essential to optimise effective risk management, including adequate foot care, patient education, and future pharmacological therapy. However, data suggest that screening has been mostly sub-optimal, and many physicians remain unfamiliar with non-invasive screening tests. There is evidence in the literature to suggest that vibration perception threshold (VPT) measures can be used to easily and accurately identify at-risk diabetic patients, including those with early neuropathic deficits. These measures have been used in population-based studies and are associated with an increased risk of severe and expensive outcomes, such as ulcers and amputations. Incorporating VPT testing into clinical practice has the potential to significantly improve the outcomes in patients with DPN, thereby substantially reducing the socio-economic burden of this common and challenging disease.

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“…At this time, the vibration was determined on the 9-point grading scale (0/8-8/8) of the tuning fork. The patient was considered to have neuropathy if the vibration perception thresholds were inferior or equal to 4/8 [13] .…”

Section: Methodsmentioning

confidence: 99%

The At-Risk Foot Concerns Not Only Patients with Diabetes Mellitus

Pataky

Herrmann²,

Regat

et al. 2008

Gerontology

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Background: The prevalence of the at-risk foot in patients with diabetes is high and is increasing with age. The screening of the at-risk foot should be performed in all geriatric patients and on a regular basis. Objective: To estimate the prevalence of at-risk foot in a geriatric population of patients and to identify associated principal risk factors in patients with diabetes, nondiabetic patients with neurological disorders and subjects without any known cause of sensory loss at the lower limb. Methods: A longitudinal prospective study has been conducted in a university long-term care facility with mostly geriatric patients.Four hundred and twenty-six consecutive hospital admissions were recruited between October 2005 and September 2006.Lower limb neuropathy (LLN) was evaluated by the vibration perception threshold using a 128-Hz Rydel-Seiffer® tuning fork. Peripheral vascular disease (PVD) was evaluated by the Doppler technique. Patients with LLN and/or PVD were considered to have at-risk foot. Results: Of the 426 participants (median age 80 years, range 26–97), 110 (25.8%) had LLN, 82 (19.2%) had PVD and 92 (21.6%) had both LLN and PVD. Diagnosed diabetes mellitus was present in 96 (22.5%) patients and different neurological disorders having impact on foot sensitivity in 100 (23.5%) patients. The prevalence of the at-risk foot was similar in patients with diabetes (68.7%), in nondiabetic patients with chronic neurological medical conditions (66.0%), or in those without any evidence of diabetes or neurological disease (66.1%). Age was shown to be a predictive factor for the presence of LLN (OR 1.02, 95% CI 1.01–1.04, p = 0.002). Conclusion: The prevalence of the at-risk foot in geriatric patients is high, independently of the presence of diabetes. The results suggest that both nondiabetic patients and patients with chronic neurological disorders should be screened for the presence of LLN and PVD as diabetic patients. This screening should be mandatory both in institutions and at home by the general practitioner(s).

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The Tuning Fork Revisited

Cited by 104 publications

References 19 publications

The JEVIN trial: A population-based survey on the quality of diabetes care in Germany: 1994/1995 compared to 1989/1990

The JEVIN trial: A population-based survey on the quality of diabetes care in Germany: 1994/1995 compared to 1989/1990

Vibration perception threshold—a valuable assessment of neural dysfunction in people with diabetes

The At-Risk Foot Concerns Not Only Patients with Diabetes Mellitus

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