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Research ArticleSystematic Reviews

Accuracy of Monofilament Testing to Diagnose Peripheral Neuropathy: A Systematic Review

Jacquelien Dros, Astrid Wewerinke, Patrick J. Bindels and Henk C. van Weert
The Annals of Family Medicine November 2009, 7 (6) 555-558; DOI: https://doi.org/10.1370/afm.1016
Jacquelien Dros
MD
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Astrid Wewerinke
MD
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Patrick J. Bindels
MD, PhD
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Henk C. van Weert
MD, PhD
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    Figure 1.

    Flowchart of the study selection process.

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    Table 1.

    Characteristics of the Included Studies, With Nerve Conduction Study as Reference Standard

    CharacteristicLee, 200314a,bPerkins, 200115a,cShin, 200019d
    CI=confidence interval; QUADAS = Quality Assessment of Diagnostic Accuracy Studies, LR = likelihood ratio; MT = metatarsal, NR = not reported.
    a QUADAS limitation: selection criteria not clearly described.
    b QUADAS limitation: test results possibly not interpreted without knowledge of the other test results.
    c QUADAS limitation: withdrawals from study not clearly explained.
    d QUADAS limitation: execution of index test and reference standard not described in sufficient detail.
    Participants n (% women)37 (46)478 (34)126 (54)
    Age, mean, y595458
    PopulationUnselected type 2 diabetic outpatients in Pusan, Koreaa. 426 Unselected diabetic patients attending secondary and tertiary diabetic clinics, and recruited through advertisements
 b. 52 Nondiabetic reference subjects in Toronto General Hospital/University Health Network, CanadaConsecutive diabetic patients referred to a secondary foot clinic in Seoul, Korea
    Methods of monofilament testing
        Sites, No. and Location10, Dorsal between base digit 1–2; ventral digit 1,3,5; MT heads 1,3,5; medial and lateral midfoot; heel1, HalluxNR
        Threshold≥ 5 of 10 incorrect (1 foot)a. ≥ 5 of 8 incorrect (both feet)
 b. ≥ 2 of 8 incorrect (both feet)NR
    Sensitivity (95% CI)93.1 (0.77–0.99)a. 40.9 (0.36–0.46)
 b. 77.0 (0.72–0.81)56.7 (0.44–0.69)
    Specificity (95% CI)100.0 (0.63–1.00)a. 96.2 (0.90–0.99)
 b. 68.3 (0.58–0.77)94.9 (0.86–0.99)
    LR+ (95% CI)16.5 (1.1–245.0)a. 10.6 (4.0–28.0)
 b. 2.4 (1.8–3.2)11.2 (4.0–34.0)
    LR– (95% CI)0.07 (0.02–0.26)a. 0.61 (0.56–0.67)
 b. 0.34 (0.27–0.42)0.46 (0.35–0.60)

Additional Files

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  • Supplemental Appendixes

    Supplemental Appendix 1. Search Strategy; Supplemental Appendix 2. QUADAS

    Files in this Data Supplement:

    • Supplemental data: Appendix 1-2 - PDF file, 3 pages, 132 KB
  • The Article in Brief

    Accuracy of Monofilament Testing to Diagnose Peripheral Neuropathy: A Systematic Review

    Jacquelien Dros , and colleagues

    Background This systematic review evaluates monofilament testing for diagnosis of peripheral neuropathy of the feet, a condition that causes numbness or a complete loss of sensation.

    What This Study Found Despite frequent recommendations for use of the test, researchers conclude that existing data are limited in their ability to draw conclusions about its accuracy because of a lack of diagnostic studies with adequate methods.

    Implications

    • The authors recommend against the sole use of microfilament testing to diagnose peripheral neuropathy.
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The Annals of Family Medicine: 7 (6)
The Annals of Family Medicine: 7 (6)
Vol. 7, Issue 6
1 Nov 2009
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Accuracy of Monofilament Testing to Diagnose Peripheral Neuropathy: A Systematic Review
Jacquelien Dros, Astrid Wewerinke, Patrick J. Bindels, Henk C. van Weert
The Annals of Family Medicine Nov 2009, 7 (6) 555-558; DOI: 10.1370/afm.1016

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Accuracy of Monofilament Testing to Diagnose Peripheral Neuropathy: A Systematic Review
Jacquelien Dros, Astrid Wewerinke, Patrick J. Bindels, Henk C. van Weert
The Annals of Family Medicine Nov 2009, 7 (6) 555-558; DOI: 10.1370/afm.1016
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  • Association between pre-diabetes and microvascular and macrovascular disease in newly diagnosed type 2 diabetes
  • Peripheral Neuropathy Defined by Monofilament Insensitivity and Diabetes Status: NHANES 1999-2004
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