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Huisman D, Mansfield M, Cummins TM, Moss-Morris R, McMahon SB, Bannister K. Gastrointestinal pain: A systematic review of temporal summation of pain paradigms and outcomes. Eur J Pain 2024. [PMID: 38817207 DOI: 10.1002/ejp.2283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 03/31/2024] [Accepted: 05/06/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND AND OBJECTIVE Since targeted treatment for gastrointestinal pain is elusive, identifying the mechanistic underpinning of this pain type is important. Facilitation of spinal neuronal responses underpins certain pain types, and the psychophysical temporal summation of pain (TSP) paradigm provides a proxy measure of spinal facilitatory processes. Our aim was to systematically review whether facilitated TSP is a feature of gastrointestinal pain in patients with, or pain-free people experiencing experimentally induced, gastrointestinal pain. DATABASES AND DATA TREATMENT EMBASE, MEDLINE, PsychInfo, CINAHL, and Web of Science were systematically searched, from inception to July 2023, for human studies reporting TSP paradigm outcomes in the context of gastrointestinal pain. The Appraisal tool for Cross-Sectional studies was used for quality assessment and applied independently by two researchers. RESULTS Fifteen papers consisting of cross-sectional (n = 6), case-control (n = 8), and retrospective cohort (n = 1) studies, were included. Thirteen studies investigated TSP in people with gastrointestinal pain with (n = 5) or without (n = 8) defined pathology. Two studies evoked TSP by repetitive gut stimulation in people undergoing abdominal medical procedures. Preliminary evidence showed that facilitated TSP correlated with the presence of functional gastrointestinal pain in women, and those with a history of trauma. No effect was observed in people with inflammatory bowel disease, although it was often unclear if they experienced pain. CONCLUSIONS It is not possible to conclude whether facilitated TSP is a feature of gastrointestinal pain. We recommend that subgroup findings are corroborated and that TSP paradigms are standardized in order that direct comparisons between studies may be made. SIGNIFICANCE STATEMENT Evidence indicated that pain facilitatory processes, as evidenced by a facilitated TSP outcome, contribute to functional gastrointestinal pain in women and those with a history of trauma. However, heterogeneity of study populations and paradigms precluded statistical synthesis and findings would need be corroborated. Studies exploring facilitatory processes in people with inflammatory bowel diseases did not report significant results, but pain is not a given in these conditions and, conversely, may be driven by peripheral inflammation during active disease. This should be taken in consideration in future explorations. REGISTRATION REVIEW PROSPERO CRD42022341845.
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Affiliation(s)
- Danielle Huisman
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Michael Mansfield
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
- Centre of Precision Rehabilitation for Spinal Pain, University of Birmingham, Birmingham, UK
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Tatum M Cummins
- Neurorestoration Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rona Moss-Morris
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Stephen B McMahon
- Neurorestoration Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kirsty Bannister
- Central Modulation of Pain, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Da Cruz Junior ATV, Vasconcelos BHB, Barroso TGCP, Souza GS, Monteiro LCP, Xavier MB, Callegari B. Plantar pressure distribution and altered postural control in multibacillary leprosy patients. BMC Infect Dis 2024; 24:130. [PMID: 38267905 PMCID: PMC10809460 DOI: 10.1186/s12879-023-08749-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 10/25/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Leprosy is a chronic infectious disease caused by Mycobacterium leprae, predominantly affecting the peripheral nerves, resulting in sensory and motor deficits in the feet. Foot ulcers and imbalances are frequent manifestations in leprosy, often correlating with diminished sensitivity. While clinical scales and monofilament esthesiometers are conventionally utilized to evaluate foot sensitivity and balance in these patients, their discriminatory power is limited and their effectiveness is greatly dependent on the examiner's proficiency. In contrast, baropodometry and posturography offer a more comprehensive evaluation, aiming to preempt potential damage events. This study aimed was to assess the correlation between baropodometry and force plate measurements in leprosy patients and control participants, to improve the prevention and treatment of foot ulcers and complications associated with leprosy. METHODOLOGY This cross-sectional study was conducted during 2022 and enrolled 39 participants (22 patients with multibacillary leprosy and 17 non-leprosy controls). Demographic data were collected, and a monofilament esthesiometer was used to assess sensory deficits. In addition, physical examinations and balance and plantar pressure tests were conducted. The Student's t-test was used to compare mean and maximum plantar pressures between groups. For most COP variables, a Mann-Whitney Wilcoxon test was used, except for AP amplitude which was analyzed with the Student's t-test due to its normal distribution. The relationship between foot pressure and balance control was assessed using Spearman's correlation, focusing on areas with significant pressure differences between groups. PRINCIPAL FINDINGS Leprosy patients showed increased pressure in forefoot areas (T1, M1, T2-T5, and M2) and decreased pressure in hindfoot regions (MH and LH) compared to controls. These patients also displayed higher AP and ML amplitudes, suggesting poorer COP control. Correlation analyses between the two groups revealed that foot plantar pressures significantly impact balance control. Specifically, increased T1 region pressures correlated with greater sway in balance tasks, while decreased MH region pressures were linked to reduced COP control. CONCLUSIONS/SIGNIFICANCE The findings suggest a joint disturbance of plantar pressure distribution and static balance control in leprosy patients. These alterations may increase the risk of tissue injuries, including calluses and deformities, as well as falls.
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Affiliation(s)
- Alex Tadeu Viana Da Cruz Junior
- Laboratory of Human Motricity Studies, Health Science Institute, Federal University of Para, Belém, Brazil
- Nucleous of Tropical Medicine, Federal University of Para, Belém, Brazil
| | | | | | - Givago Silva Souza
- Nucleous of Tropical Medicine, Federal University of Para, Belém, Brazil
- Biological Science Institute, Federal University of Para, Belém, Brazil
| | | | - Marília Brasil Xavier
- Nucleous of Tropical Medicine, Federal University of Para, Belém, Brazil
- Biological and Health Sciences Center, State University of Pará (UEPA), Belém, Pará, Brazil
| | - Bianca Callegari
- Laboratory of Human Motricity Studies, Health Science Institute, Federal University of Para, Belém, Brazil.
- Nucleous of Tropical Medicine, Federal University of Para, Belém, Brazil.
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Virgin LN. On the mechanics of monofilaments used in touch sensory perception. Med Eng Phys 2024; 123:104083. [PMID: 38365337 DOI: 10.1016/j.medengphy.2023.104083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/30/2023] [Accepted: 12/10/2023] [Indexed: 02/18/2024]
Abstract
The buckling of a slender monofilament is a standard clinical method used to assess touch sensory perception, with specific applications to somatosensory impairment in patients after a stroke, detecting carpal tunnel syndrome, and as a prognosis tool for diabetic peripheral neuropathy. The basis of this approach is the Semmes-Weinstein monofilament, which comprises a calibrated set of thin, polycarbonate rods with different diameters. Application of a monofilament onto the surface of the skin with increasing pressure causes the rod to buckle. That is, at a specific force of pushing down on the far end, the monofilament suddenly bows out sidewards - the buckling load. The ability of a patient to detect increasingly finer monofilament buckling (pressure threshold) is then used to assess sensory deterioration. This paper addresses the underlying mechanics of the buckling process. Despite the accuracy and repeatability problems that have been reported in the literature, and the necessarily subjective aspects of sensory physiology, the mathematical modeling of the monofilament buckling is unambiguous and provides some fundamental insight into the parameters that underlie this approach.
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Affiliation(s)
- Lawrence N Virgin
- Department of Mechanical Engineering, Duke University, Durham, NC 27708, USA.
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Senthilkumar S, Dasarathan R, Pazhani P, Gaur A, Sakthivadivel V. Comparing the Ipswich Touch Test (IpTT) and 10gm-SMWF (10-gm Semmes-Weinstein mono-filament) in Indian population subset with type 2 diabetes mellitus to detect diabetes neuropathy. Ir J Med Sci 2023; 192:2793-2799. [PMID: 37140765 DOI: 10.1007/s11845-023-03376-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/12/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Diabetic neuropathy diagnosis involves invasive procedures like nerve biopsy and nerve conduction studies which are seldom available at rural health centers. The Ipswich Touch Test (IpTT) is one test that can be performed by the caregiver and it's simple to perform. AIM This study was aimed to compare the validity of the IpTT and 10gm-SMWF (10-gm Semmes-Weinstein mono-filament) test with the vibration perception threshold (VPT) using biothesiometer. METHODS Two hundred patients with type 2 diabetes, between the age of 30 and 50 years, were included in the study. The neuropathy assessment was performed by biothesiometer, 10gm-SMWF test, and IpTT. Taking VPT(> 25 V) as the gold standard; the sensitivity and specificity of IpTT and 10gm-SMWF are calculated and compared to each other. RESULTS On comparing with the VPT, the 10gm-SMWF test had a sensitivity of 94.7% and specificity of 85.7%, and the IpTT had a sensitivity of 91.9% and specificity of 85.7%. 10gm-SMWF test (Kappa value 0.733) had better agreement with VPT than IpTT (Kappa value 0.675). On Spearman's correlation, the 10gm-SMWF test and the IpTT had r values of 0.738 and 0.686 respectively (P = 0.000). CONCLUSION 10gm-SMWFis a better test to diagnose neuropathy than the IpTT; but in the absence of 10gm-SMWFs, the IpTT is an ideal alternative. IpTT can be performed in a bedside or chairside setting in the absence of a professional health care provider who can screen patients for neuropathy and alert the physician of an impending complication where amputation can be avoided.
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Affiliation(s)
| | - Ramesh Dasarathan
- Department of General Medicine, Governement Omandurar Medical College, Chennai, India
| | | | - Archana Gaur
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Varatharajan Sakthivadivel
- Department of General Medicine, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, 508126, India.
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Dunker Ø, Uglem M, Bu Kvaløy M, Løseth S, Hjelland IE, Allen SM, Dehli Vigeland M, Kleggetveit IP, Sand T, Nilsen KB. Diagnostic accuracy of the 5.07 monofilament test for diabetes polyneuropathy: influence of age, sex, neuropathic pain and neuropathy severity. BMJ Open Diabetes Res Care 2023; 11:e003545. [PMID: 37989346 PMCID: PMC10660161 DOI: 10.1136/bmjdrc-2023-003545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/13/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION There is a need for simple and cheap diagnostic tools for diabetic polyneuropathy (DPN). We aimed to assess the diagnostic accuracy of the 5.07/10 g monofilament test in patients referred to polyneuropathy assessments, as well as to examine how disease severity, age, sex and neuropathic pain (NP) impact diagnostic accuracy. RESEARCH DESIGN AND METHODS Five Norwegian university hospitals recruited patients with diabetes aged 18-70 referred to neurological outpatient clinics for polyneuropathy assessments. The 5.07/10 g Semmes-Weinstein monofilament examination (SWME) was validated against the Toronto consensus for diagnosing diabetic neuropathies; the results were stratified by age, sex and NP. Disease severity was graded by a combined nerve conduction study (NCS) Z-score, and logistic regression was applied to assess whether disease severity was a predictor of diagnostic accuracy. RESULTS In total, 506 patients were included in the study. Global sensitivity was 0.60 (95% CI 0.55, 0.66), specificity 0.82 (95% CI 0.75, 0.87), positive and negative predictive values were 0.86 (95% CI 0.81, 0.90) and 0.52 (95% CI 0.46, 0.58), respectively, positive and negative likelihood ratios were 3.28 (95% CI 2.37, 4.53) and 0.49 (95% CI 0.42, 0.57), respectively. The SWME was less sensitive in females (0.43), had lower specificity in patients with NP (0.56), and performed worse in patients ≥50 years. NCS-based disease severity did not affect diagnostic accuracy (OR 1.15, 95% CI 0.95, 1.40). CONCLUSIONS This multicenter study demonstrates poor diagnostic performance for the 5.07/10 g SWME in patients with diabetes referred to polyneuropathy assessments; it is particularly unsuited for female patients and those with NP. The diagnostic accuracy of the SWME was not influenced by NCS-based disease severity, demonstrating that it does not perform better in patients with later stages of DPN. We do not recommend the use of the 5.07/10 g monofilament in the evaluation of patients with diabetes referred to polyneuropathy assessments.
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Affiliation(s)
- Øystein Dunker
- Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Neurology and Clinical Neurophysiology, Oslo University Hospital, Oslo, Norway
| | - Martin Uglem
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology Faculty of Medicine and Health Sciences, Trondheim, Norway
- Department of Neurology and Clinical Neurophysiology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Marie Bu Kvaløy
- Department of Neurology, Section of Clinical Neurophysiology, Stavanger University Hospital, Stavanger, Norway
| | - Sissel Løseth
- Department of Neurology and Clinical Neurophysiology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, The Artic University of Norway, Tromsø, Norway
| | - Ina Elen Hjelland
- Department of Clinical Neurophysiology, Haukeland University Hospital, Bergen, Norway
| | - Sara Maria Allen
- Department of Neurology and Clinical Neurophysiology, Oslo University Hospital, Oslo, Norway
| | | | - Inge Petter Kleggetveit
- Department of Neurology and Clinical Neurophysiology, Oslo University Hospital, Oslo, Norway
| | - Trond Sand
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology Faculty of Medicine and Health Sciences, Trondheim, Norway
- Department of Neurology and Clinical Neurophysiology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Kristian Bernhard Nilsen
- Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
- Department of Neurology and Clinical Neurophysiology, Oslo University Hospital, Oslo, Norway
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Hebert A, MacDermid J, Harris J, Packham T. How should we define and assess painful sensitivity in the hand? An international e-Delphi study. J Hand Ther 2023:S0894-1130(23)00116-3. [PMID: 37777441 DOI: 10.1016/j.jht.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 06/24/2023] [Accepted: 08/15/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Painful sensitivity in the hand is commonly seen with neuropathic pain, interfering with daily activities including rehabilitation. However, there are currently several terms used to describe the problem and a lack of guidance on what assessments should be used. PURPOSE To gather expert opinion a) identifying current and common terminology used in hand therapy, b) developing a consensus definition of hypersensitivity, and c) developing consensus guidance on how to best assess allodynia. STUDY DESIGN International e-Delphi survey study. METHODS We conducted an e-Delphi consensus study drawing on international experts in hand rehabilitation. We planned up to four rounds of consensus-seeking, defining consensus as 75% or more of participants agreeing with a definition or recommendation. Experts were identified from 21 countries, with the nomination of other experts encouraged for 'snowball sampling'. The first round included clinical vignettes describing 'painful sensitivity of the hand' and asked participants to describe how they would assess each case. Definitions for hypersensitivity, tactile hyperesthesia, and allodynia were also requested. RESULTS We invited 68 participants: 44 more were added through nominations. Sixty-three agreed to participate and were sent the round one survey; 54 participants from 19 countries completed this survey and were invited to participate in all subsequent rounds. No two definitions of hypersensitivity were the same, while 87% of the definitions for allodynia and 78% for tactile hyperesthesia were concordant with a published taxonomy. Over 700 assessment items were proposed in round one: ultimately 38 items representing eight distinct constructs reached a consensus for assessing allodynia. CONCLUSIONS Therapists definitions were consistent with an existing taxonomy for allodynia. Although hypersensitivity conceptualizations varied regarding the qualities of stimulus and response, a working definition was reached. Recommended assessments were relatively consistent internationally, holistic, and reflected a potential link between allodynia and central sensitization.
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Affiliation(s)
- Andrea Hebert
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, c/o Institute for Applied Health Sciences, Hamilton, Ontario, Canada
| | - Joy MacDermid
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, c/o Institute for Applied Health Sciences, Hamilton, Ontario, Canada; School of Physiotherapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Jocelyn Harris
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, c/o Institute for Applied Health Sciences, Hamilton, Ontario, Canada
| | - Tara Packham
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, c/o Institute for Applied Health Sciences, Hamilton, Ontario, Canada.
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Taneja AK, Chhabra A. Neuropathy Score Reporting and Data System (NS-RADS): A Practical Review of MRI-Based Peripheral Neuropathy Assessment. Semin Ultrasound CT MR 2023; 44:386-397. [PMID: 37437974 DOI: 10.1053/j.sult.2023.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
The Neuropathy Score Reporting and Data System (NS-RADS) is a newly developed MR imaging-based classification that standardizes reporting and multidisciplinary communication for MR imaging diagnosis and follow-up of peripheral neuropathies. NS-RADS classification has shown to be accurate and reliable across different centers, readers' experience levels, and degrees of peripheral neuropathies, which include nerve injury, entrapment, neoplasm, diffuse neuropathy, post-interventional status, and temporal changes in muscle denervation. This article brings a practical review of NS-RADS classification, representative MR cases, and a step-by-step tutorial on how to approach this staging system. Readers can gain knowledge and apply it in their practice, aiming to standardize the communications between specialties and improve patient management.
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Affiliation(s)
- Atul K Taneja
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX; Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
| | - Avneesh Chhabra
- Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX; Johns Hopkins University, Baltimore, MD; Walton Center of Neuroscience, Liverpool, UK; University of Dallas, Richardson, TX; Johns Hopkins University, Maryland, MD; Walton Centre for Neuroscience, Liverpool, UK.
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Turkman A, Thanaraaj V, Soleimani-Nouri P, Harb E, Thakkar M. Outcomes of Sciatic Nerve Injury Repairs: A Systematic Review. EPLASTY 2023; 23:e42. [PMID: 37664809 PMCID: PMC10472424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Background The objective of this study was to investigate the surgical repair techniques and the outcomes of sciatic nerve injuries in traumatic wounds. Methods A literature search was conducted using the following keywords:sciatic, nerve, repair, technique, conduit, graft, reconstruction, outcome, rehabilitation, recovery, function, surgery, and NOT anesthesia. Results In total, 715 studies were retrieved. After abstract review, 13 articles fit the criteria. A total of 2627 repairs were carried out, including nerve grafts (n = 953), suture (n = 482), and neurolysis (n = 1192). Six studies reported good motor outcome, and good sensory outcome was reported across 2 studies. The thigh region accounted for 81.5% of lesions. Sciatic, peroneal, and tibial nerves were all equally affected. Gunshot wounds were the most common mechanism of injury (22.6%). Conclusions The cumulative evidence demonstrates sciatic nerve injury repair has poor motor and sensory outcomes. This study shows there is a lack of standardized outcome measures, making comparisons very difficult. Graft lengths of <4 cm within the intermediate region yielded more successful outcomes. Further higher quality studies of nerve transfers in the lower limbs are needed to determine the optimal repair to restore sciatic nerve function.
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Affiliation(s)
- Ahmed Turkman
- Imperial College London, Faculty of Medicine, London, United Kingdom
| | | | | | - Elissa Harb
- Imperial College London, Faculty of Medicine, London, United Kingdom
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Castellano VK, Commander J, Burch T, Burch H, Remy J, Harman B, Zabala ME. Plantar threshold sensitivity assessment using an automated tool-Clinical assessment comparison between a control population without type 2 diabetes mellitus, and populations with type 2 diabetes mellitus, with and without neuropathy symptoms. PLoS One 2023; 18:e0286559. [PMID: 37418442 PMCID: PMC10328367 DOI: 10.1371/journal.pone.0286559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 05/02/2023] [Indexed: 07/09/2023] Open
Abstract
Diabetic peripheral neuropathy is often classified as a loss of sensation in the extremities, particularly in elderly populations. The most common diagnosis technique is with the use of the hand-applied Semmes-Weinstein monofilament. This study's first aim was to quantify and compare sensation on the plantar surface in healthy and type 2 diabetes mellitus populations with the standard Semmes-Weinstein hand-applied methodology and a tool that automates this approach. The second was to evaluate correlations between sensation and the subjects' medical characteristics. Sensation was quantified by both tools, at thirteen locations per foot, in three populations: Group 1-control subjects without type 2 diabetes, Group 2-subjects with type 2 diabetes and with neuropathy symptoms, and Group 3-subjects with type 2 diabetes without neuropathy symptoms. The percentage of locations sensitive to the hand-applied monofilament, yet insensitive to the automated tool was calculated. Linear regression analyses between sensation and the subject's age, body mass index, ankle brachial index, and hyperglycemia metrics were performed per group. ANOVAs determined differences between populations. Approximately 22.5% of locations assessed were sensitive to the hand-applied monofilament, yet insensitive to the automated tool. Age and sensation were only significantly correlated in Group 1 (R2 = 0.3422, P = 0.004). Sensation was not significantly correlated with the other medical characteristics per group. Differences in sensation between the groups were not significant (P = 0.063). Caution is recommended when using hand-applied monofilaments. Group 1's sensation was correlated to age. The other medical characteristics failed to corelate with sensation, despite group.
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Affiliation(s)
- Vitale Kyle Castellano
- Department of Mechanical Engineering, Samuel Ginn College of Engineering, Auburn University, Auburn, Alabama, United States of America
| | - Jon Commander
- Internal Medicine Associates, Opelika, Alabama, United States of America
- Edward via College of Osteopathic Medicine, Auburn, Alabama, United States of America
| | - Thomas Burch
- Department of Mechanical Engineering, Samuel Ginn College of Engineering, Auburn University, Auburn, Alabama, United States of America
| | - Hayden Burch
- Department of Mechanical Engineering, Samuel Ginn College of Engineering, Auburn University, Auburn, Alabama, United States of America
| | - Jessica Remy
- Edward via College of Osteopathic Medicine, Auburn, Alabama, United States of America
| | - Benjamin Harman
- Edward via College of Osteopathic Medicine, Auburn, Alabama, United States of America
| | - Michael E. Zabala
- Department of Mechanical Engineering, Samuel Ginn College of Engineering, Auburn University, Auburn, Alabama, United States of America
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Chauhan AS, Varre MS, Izuora K, Trabia MB, Dufek JS. Prediction of Diabetes Mellitus Progression Using Supervised Machine Learning. SENSORS (BASEL, SWITZERLAND) 2023; 23:4658. [PMID: 37430572 DOI: 10.3390/s23104658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 07/12/2023]
Abstract
Diabetic peripheral neuropathy (DN) is a serious complication of diabetes mellitus (DM) that can lead to foot ulceration and eventual amputation if not treated properly. Therefore, detecting DN early is important. This study presents an approach for diagnosing various stages of the progression of DM in lower extremities using machine learning to classify individuals with prediabetes (PD; n = 19), diabetes without (D; n = 62), and diabetes with peripheral neuropathy (DN; n = 29) based on dynamic pressure distribution collected using pressure-measuring insoles. Dynamic plantar pressure measurements were recorded bilaterally (60 Hz) for several steps during the support phase of walking while participants walked at self-selected speeds over a straight path. Pressure data were grouped and divided into three plantar regions: rearfoot, midfoot, and forefoot. For each region, peak plantar pressure, peak pressure gradient, and pressure-time integral were calculated. A variety of supervised machine learning algorithms were used to assess the performance of models trained using different combinations of pressure and non-pressure features to predict diagnoses. The effects of choosing various subsets of these features on the model's accuracy were also considered. The best performing models produced accuracies between 94-100%, showing the proposed approach can be used to augment current diagnostic methods.
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Affiliation(s)
- Apoorva S Chauhan
- Department of Mechanical Engineering, University of Nevada, Las Vegas, NV 89154, USA
| | - Mathew S Varre
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA
| | - Kenneth Izuora
- Department of Internal Medicine, University of Nevada, Las Vegas, NV 89154, USA
| | - Mohamed B Trabia
- Department of Mechanical Engineering, University of Nevada, Las Vegas, NV 89154, USA
| | - Janet S Dufek
- Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, NV 89154, USA
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Khoo YH, Abdullah JM, Idris Z, Ghani ARI, Halim SA. Dorsal Column Bedside Examination Test: Tips for the Neurosurgical Resident. Malays J Med Sci 2023; 30:172-179. [PMID: 37102052 PMCID: PMC10125238 DOI: 10.21315/mjms2023.30.2.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 07/10/2022] [Indexed: 04/28/2023] Open
Abstract
The dorsal column medial lemniscus (DCML) system is a sensory pathway of the central nervous system; it carries sensations of soft touch, vibration, proprioception, two-point discrimination, and pressure from the skin and joints. The clinical signs of the DCML pathway lesions include loss of soft touch, vibratory sense, proprioception, discrimination sense, and a positive Rhomberg test. Diseases that affect this pathway are usually degenerative, for example, spinal cord degeneration due to vitamin B12 deficiency; it can also be affected by trauma or infarction of the posterior spinal artery causing posterior cord syndrome. This video manuscript provides a step-by-step examination technique of the dorsal column examination, specially catered for Malaysian medical students and trainees. A series of videos show the techniques for soft touch sensation examination, examination of the vibratory sense, examination of the joint position sense, examination of two-point discrimination and the Rhomberg test. We hope that students can adhere to these techniques and apply them in their daily neurological assessments.
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Affiliation(s)
- Yee Hwa Khoo
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Neurosciences, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Neurosurgery, Queen Elizabeth Hospital, Sabah, Malaysia
| | - Jafri Malin Abdullah
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Neurosciences, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
- Brain and Behaviour Cluster, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Zamzuri Idris
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Neurosciences, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
- Brain and Behaviour Cluster, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Abdul Rahman Izaini Ghani
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Neurosciences, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
- Brain and Behaviour Cluster, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Sanihah Abdul Halim
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Brain and Behaviour Cluster, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Unit of Neurology, Department of Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
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12
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Nkonge KM, Nkonge DK, Nkonge TN. Screening for diabetic peripheral neuropathy in resource-limited settings. Diabetol Metab Syndr 2023; 15:55. [PMID: 36945043 PMCID: PMC10031885 DOI: 10.1186/s13098-023-01032-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 03/15/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Diabetic neuropathy is the most common microvascular complication of diabetes mellitus and a major risk factor for diabetes-related lower-extremity complications. Diffuse neuropathy is the most frequently encountered pattern of neurological dysfunction and presents clinically as distal symmetrical sensorimotor polyneuropathy. Due to the increasing public health significance of diabetes mellitus and its complications, screening for diabetic peripheral neuropathy is essential. Consequently, a review of the principles that guide screening practices, especially in resource-limited clinical settings, is urgently needed. MAIN BODY Numerous evidence-based assessments are used to detect diabetic peripheral neuropathy. In accordance with current guideline recommendations from the American Diabetes Association, International Diabetes Federation, International Working Group on the Diabetic Foot, and National Institute for Health and Care Excellence, a screening algorithm for diabetic peripheral neuropathy based on multiphasic clinical assessment, stratification according to risk of developing diabetic foot syndrome, individualized treatment, and scheduled follow-up is suggested for use in resource-limited settings. CONCLUSIONS Screening for diabetic peripheral neuropathy in resource-limited settings requires a practical and comprehensive approach in order to promptly identify affected individuals. The principles of screening for diabetic peripheral neuropathy are: multiphasic approach, risk stratification, individualized treatment, and scheduled follow-up. Regular screening for diabetes-related foot disease using simple clinical assessments may improve patient outcomes.
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13
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Zurong Y, Yuandong L, Xiankui T, Fuhao M, Tang L, Junkun Z. Morphological and Mechanical Properties of Lower-Limb Muscles in Type 2 Diabetes: New Potential Imaging Indicators for Monitoring the Progress of DPN. Diabetes 2022; 71:2751-2763. [PMID: 36125913 DOI: 10.2337/db22-0009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 09/14/2022] [Indexed: 01/11/2023]
Abstract
The aim of this study was to explore changes in morphological and mechanical properties of lower-limb skeletal muscles in patients with diabetes with and without diabetic peripheral neuropathy (DPN) and seek to find a potential image indicator for monitoring the progress of DPN in patients with type 2 diabetes mellitus (T2DM). A total of 203 patients with T2DM, with and without DPN, were included in this study. Ultrasonography and ultrasound shear wave imaging (USWI) of the abductor hallux (AbH), tibialis anterior (TA), and peroneal longus (PER) muscles were performed for each subject, and the shear wave velocity (SWV) and cross-sectional area (CSA) of each AbH, TA, and PER were measured. The clinical factors influencing AbH_CSA and AbH_SWV were analyzed, and the risk factors for DPN complications were investigated. AbH_CSA and AbH_SWV in the T2DM group with DPN decreased significantly (P < 0.05), but no significant differences were found in the SWV and CSA of the TA and PER between the two groups. Toronto Clinical Scoring System (CSS) score and glycosylated hemoglobin (HbA1c) were independent predictors of AbH_CSA and AbH_SWV. As AbH_SWV and AbH_CSA decreased, Toronto CSS score and HbA1c increased and incidence of DPN increased significantly. In conclusion, the AbH muscle of T2DM patients with DPN became smaller and softer, while its morphological and mechanical properties were associated with the clinical indicators related to the progression of DPN. Thus, they could be potential imaging indicators for monitoring the progress of DPN in T2DM patients.
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Affiliation(s)
- Yang Zurong
- Department of Ultrasound Diagnosis, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Li Yuandong
- College of Mechanical and Vehicle Engineering, Hunan University, Changsha, Hunan, China
| | - Tan Xiankui
- Department of Ultrasound Diagnosis, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Mo Fuhao
- College of Mechanical and Vehicle Engineering, Hunan University, Changsha, Hunan, China
| | - Liu Tang
- Department of Orthopaedics, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zhan Junkun
- Department of Geriatric, Institute of Aging and Geriatrics, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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14
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Schneider D. Deriving Value: Live Visits in the Context of a Changing World. Clin Diabetes 2022; 41:137-139. [PMID: 37092150 PMCID: PMC10115752 DOI: 10.2337/cd22-0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Doron Schneider
- Population Health Services, Tandigm Health, Conshohocken, PA
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15
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International Delphi Recommendations for Pediatric Lower Limb Neurological Test Protocols for Muscle Strength, Reflexes, and Tactile Sensitivity. Pediatr Phys Ther 2022; 34:497-506. [PMID: 35943387 DOI: 10.1097/pep.0000000000000946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To gain consensus from physical therapists on pediatric lower limb neurological tests of muscle strength, tactile sensitivity, and reflexes. METHODS A Delphi technique was used for 2 sequential questionnaire rounds to gain consensus from a panel of pediatric physical therapists (n = 28). Physical therapists rated their agreement to items from statements on pediatric lower limb neurological tests, their protocols, and interpretation using a 6-point Likert scale. RESULTS Ninety percent of items gained consensus: 80% on pediatric lower limb neurological tests, 88% on test protocols, and 92% on test interpretation. Fifty-one percent of items had high agreement and high importance. CONCLUSION There is variability in pediatric neurological tests used, their protocols, and interpretation. Identification of items with high agreement and importance is the first step to develop a standardized lower limb neurological assessment for pediatric clients of varying ages and diagnoses.
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16
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Dube S, Hulke SM, Wakode SL, Khadanga S, Thakare AE, Bharshankar RN, Pakhare A. Effectiveness of Semmes Weinstein 10 gm monofilament in diabetic peripheral neuropathy taking nerve conduction and autonomic function study as reference tests. J Family Med Prim Care 2022; 11:6204-6208. [PMID: 36618173 PMCID: PMC9810846 DOI: 10.4103/jfmpc.jfmpc_195_22] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/27/2022] [Accepted: 05/19/2022] [Indexed: 11/11/2022] Open
Abstract
Context Diabetic peripheral neuropathy (DPN) if detected early can reduce the burden on the health system and prevent the development of diabetic foot ulcers and amputation. Aim To study the effectiveness of Semmes Weinstein 10 gm monofilament in detecting DPN taking nerve conduction studies (NCS) and autonomic function testing (AFT) as reference tests. Settings and Design Observational and comparative cross-sectional study conducted in the Physiology department AIIMS, Bhopal in collaboration with the Medicine department of the institute. Methods and Material A total of 72 diagnosed type-2 diabetes mellitus patients were examined using Semmes Weinstein 10 gm monofilament, DPN was confirmed using NCS (Nihon Kohden Neuropack XI machine) and autonomic neuropathy was confirmed using AFT (Ewing's battery and Power lab) with heart rate variability (HRV). Diagnostic value of Semmes Weinstein 10 gm monofilament taking NCS and AFT as reference test was calculated. Statistical Analysis Used Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) were calculated using the standard formula. Results Sensitivity, specificity, PPV, and NPV using monofilament are 69.23%, 20%, 69.23% and 20% respectively taking NCS as reference test and 70.59%, 0, 92.30%, and 0 respectively taking AFT as reference test. Conclusions Semmes Weinstein 10 gm monofilament is not the ideal screening test for the diagnosis of DPN. Sole clinical use of monofilament should be discouraged.
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Affiliation(s)
- Suchitra Dube
- Physiology Department, AIIMS, Bhopal, Madhya Pradesh, India
| | - Sandip M. Hulke
- Physiology Department, AIIMS, Bhopal, Madhya Pradesh, India,Address for correspondence: Dr. Sandip M. Hulke, Associate Professor, Department of Physiology, AIIMS, Bhopal - 462 026, Madhya Pradesh, India. E-mail:
| | | | - Sagar Khadanga
- Medicine Department, AIIMS, Bhopal, Madhya Pradesh, India
| | | | | | - Abhijit Pakhare
- Community Medicine Department, AIIMS, Bhopal, Madhya Pradesh, India
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17
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Neuropathy Score Reporting and Data System (NS-RADS): MRI Reporting Guideline of Peripheral Neuropathy Explained and Reviewed. Skeletal Radiol 2022; 51:1909-1922. [PMID: 35478047 DOI: 10.1007/s00256-022-04061-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 02/02/2023]
Abstract
A standardized guideline and scoring system should be used for the MR imaging diagnosis of peripheral neuropathy. The MR imaging-based Neuropathy Score Reporting and Data System (NS-RADS) is a newly devised classification system (in press in AJR) that can be used to communicate both type and severity of peripheral neuropathy in the light of clinical history and examination findings. The spectrum of neuropathic conditions and peripheral nerve disorders covered in this system includes nerve injury, entrapment, neoplasm, diffuse neuropathy, and post-interventional states. This classification system also describes the temporal MR imaging appearances of regional muscle denervation changes. This review article is based on the multicenter validation study pre-published in American journal of Roentgenology and discusses technical considerations of optimal MR imaging for peripheral nerve evaluation and discusses the NS-RADS classification and its severity scales with illustration of conditions that fall under each classification. The readers can gain knowledge of the NS-RADS classification system and learn to apply it in their practices for improved inter-disciplinary communications and timely patient management.
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18
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Secrist E, Wally MK, Yu Z, Castro M, Seymour RB, Hsu JR. Depression Screening and Behavioral Health Integration in Musculoskeletal Trauma Care. J Orthop Trauma 2022; 36:e362-e368. [PMID: 35981227 DOI: 10.1097/bot.0000000000002361] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To report our experiences in implementing a behavioral health integration pathway, including a validated depression screening and referral to care. DESIGN Retrospective case series. SETTING Single surgeon's musculoskeletal trauma outpatient practice during calendar year 2019. PATIENTS All patients presenting to the practice during 2019 were included (n = 573). INTERVENTION We piloted the usage of Patient Health Questionnaire (PHQ)-2 and PHQ-9 screening. An evidence-based, real-time treatment protocol embedded in the electronic health record was triggered when a patient screened positive for depression including an automated behavioral health integration pathway. MAIN OUTCOME MEASUREMENTS The percentage of patients screened, the results of the PHQ screening, and the number of patients referred and enrolled in behavioral health programs were collected. RESULTS Of the 573 patients, 476 (83%) received the PHQ-2 screening, 80 (14%) had a current screening on file (within 1 year), and 17 (3.0%) were not screened. One hundred seventy-two patients (36%) had a PHQ-2 score of 2 or greater and completed the PHQ-9; of them, 60 (35% of patients screened with full PHQ-9, 13% of patients screened) screened positive for symptoms of moderate depression (PHQ-9 score ≥10), and 19 (4.0%) reported passive suicidal ideation (PHQ-9 item 9). Fifty of these patients were referred to behavioral health through the pathway, and 8 patients enrolled in the program. Ten patients were not referred because of a technical error that was quickly resolved. Patients reporting suicidal ideation were managed with psychiatric crisis resources including immediate virtual consult in the examination room. CONCLUSIONS This case series demonstrates the feasibility of screening patients for depressive symptoms and making necessary referrals to behavioral health in outpatient musculoskeletal trauma care. We identified 50 patients with depression and appropriately triaged them for further care in our community.
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Affiliation(s)
- Eric Secrist
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC; and
| | - Meghan K Wally
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC; and
| | - Ziqing Yu
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC; and
| | - Manuel Castro
- Department of Psychiatry, Atrium Health, Charlotte, NC
| | - Rachel B Seymour
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC; and
| | - Joseph R Hsu
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC; and
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Tronstad C, Pabst O, Amini M, Kleggetveit IP, Elvebakk O, Martinsen OG, Jenssen TG, Hisdal J, Berg TJ, Qvigstad E. Development of a prototype toe sensor for detection of diabetic peripheral small fiber neuropathy. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:99-104. [PMID: 36086669 DOI: 10.1109/embc48229.2022.9871101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Diabetic peripheral neuropathy (DPN) affects a large proportion of people with diabetes, and early detection is essential to prevent further progression. Widespread clinical testing relies on simplicity and cost-effectiveness of examination. Early signs of DPN may be detected by assessing the sudomotor nerves, and sudomotor activity can be measured by bioimpedance. We present a prototype toe probe for DPN detection including sensors for measuring skin AC conductance, skin temperature and humidity. The prototype was tested on five participants with DPN and five healthy age-matched controls in a pilot study. Sudomotor sensor responses to a simple deep breathing test were very weak or absent in the DPN group, with all controls having larger responses than the DPN group. Evaporation was lower for the DPN group, and skin temperature was higher on average. For the same foot, the results for sudomotor responses were in agreement with sensory neurography amplitudes from the sural nerve whereas the monofilament test gave normal results for two of the DPN participants. If sufficient detection accuracy is confirmed in larger studies, the method may provide a simple and cost-effective tool to support clinical examination. Clinical Relevance- We present the early realization and testing of a simple device to support early detection of diabetic peripheral neuropathy.
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20
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Saeidnia H, Esmaeili R, Babamiri M, Pourtaghi F, Hassanipour S, Pourtaghi G. Effect of the level of manual performance disability caused by exposure to vibration among sailors working on sailing speed vessels. BMC Musculoskelet Disord 2022; 23:515. [PMID: 35637474 PMCID: PMC9150357 DOI: 10.1186/s12891-022-05448-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND hand-arm vibration is one of the typical annoying physical factors. Hand-arm vibration syndrome (HAVS) is a disorder caused by vibrating working tools which vibrate hands beyond the threshold. Long-term HAVS may result in damage to blood vessels, chronic numbness in the fingers, bone injury, and muscular weakness. People are exposed to high-rate noise vibration in a variety of situations, including vessel employment and operating in tiny boats. Moreover, the extant study was conducted to examine manual function disability levels caused by Sailing Speed Vessels (SSV) vibration. METHODS The extant study was quasi-experimental research in which, 52 male sailors in SSVs were chosen as the experimental group, and 27 office personnel were selected as the control group. The demographic factors questionnaire, DASH questionnaire, grip and pinch strength tests, the neurosensory exam, and the skill-dexterity test were all employed in this study. SPSS23 software was used to analyze the data. RESULTS The findings suggested that the experimental group experienced greater vibration disorder symptoms than the control group. Because the experimental group had a higher score, the individuals experienced poorer circumstances in terms of arm, shoulder, and hand impairment as compared to the control group. The mean grip strength of hands and fingers in two hands of the experimental group was lower than the control group (P < 0.05). There was a statistically significant relationship among grip strengths of both experimental and control groups (P < 0.05). There was a reduction in skill and dexterity of both dominant and non-dominant hands of members in the experimental group. According to the statistical tests, there was no significant association between dominant (P = 0.001) skills and non-dominant (P = 0.010) hands in experimental and control groups. There was not also any significant relationship between skill and dexterity of both hands (P = 0.001) and the dominant hand tweezer test (P = 0.001) in two experimental and control groups. There was a statistically significant association between experimental and control groups in terms of assembly skill and dexterity (P = 0.482). CONCLUSION Individuals who are at risk of vibration experience less physical and sensory function. DASH score, grip strength, skill, and dexterity could predict the reduction in physical function disability.
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Affiliation(s)
- Hamid Saeidnia
- Marine Medicine Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Reza Esmaeili
- Marine Medicine Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Babamiri
- Department of Ergonomics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Farideh Pourtaghi
- Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soheil Hassanipour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Gholamhossein Pourtaghi
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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21
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O'Brien T, Karem J. Combined Utility of the Semmes-Weinstein Monofilament and the Timed Vibration Test in the Prediction of Diabetic Foot Ulcers. J Am Podiatr Med Assoc 2022; 112:20-174. [PMID: 36458996 DOI: 10.7547/20-174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Neurologic screening tests are often used to identify and stratify patients at risk for diabetic foot complications such as infections, ulcers, and amputations. Two of the most commonly cited methods are the 5.07 Semmes-Weinstein monofilament (SWM) for loss of protective sensation and vibratory sensation testing. The aim of this study was to determine whether combined SWM and the timed vibration test (TVT) more effectively predicts diabetic foot ulcer (DFU) development compared with each test alone. METHODS An electronic medical record database search was performed restricted to podiatric medical clinic patients with diabetes and DFU ICD-10 diagnosis codes. Of 200 patients who met the criteria, 24 developed DFUs. A statistical analysis was performed comparing the SWM and TVT at various cutoff times and the combined SWM/TVT in their ability to predict DFUs. RESULTS Statistical analysis revealed that the TVT cutoff time of less than 4 sec was superior to the other times for prediction of DFUs. The combined SWM/TVT results at less than 4 sec were superior to each test individually: sensitivity, 87.5%; specificity, 84.7%; positive predictive value, 43.8%; and receiver operating characteristics area under the curve, 0.86. CONCLUSIONS The SWM combined with TVT was shown to be superior compared with either test alone in discriminating DFU risk. In addition, the TVT cutoff time of less than 4 sec proved to have greater diagnostic yield than other times, including 0 sec. This unexpected finding might impact providers relying on the absence of vibration sensation via tuning fork testing as an optimal marker of DFU risk.
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Affiliation(s)
- Todd O'Brien
- *University of Maine, Graduate School of Biomedical Sciences and Engineering, Orono, ME.,†Penobscot Community Health Center, Bangor, ME
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22
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Rattanakrong N, Promma N, Saraboon C, Waongenngarm P. Physical impairments, sensory disturbance, and functional ability in a cancer patient with and without chemotherapy-induced peripheral neuropathy symptoms. Support Care Cancer 2022; 30:5055-5062. [PMID: 35217909 DOI: 10.1007/s00520-022-06927-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 02/19/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The present study examined the objective and patient-reported measures of physical impairments, sensory disturbance, and functional ability between cancer patients with and without chemotherapy-induced peripheral neuropathy (CIPN) symptoms. METHODS Forty-one cancer survivors exposed to neurotoxic chemotherapies were conveniently recruited and completed a single cross-sectional assessment of patient-reported outcomes (VAS for pain intensity and ABC scale) and objective assessments (SWM test, TUG test, 5xSTS test, Romberg test with eyes open and eyes closed, 6MWT, and FAB scale). RESULTS Cancer patients who had undergone chemotherapy with CIPN symptoms did significantly worse in the SWM test, TUG test, 5xSTS test, Romberg test with eyes closed, 6MWT, FAB scale, and ABC scale (p < 0.05) when compared with cancer survivors without CIPN symptoms. CONCLUSION Cancer survivors with CIPN symptoms have lower physical performance, sensory perception, and functional ability, which may increase the risk of falling and disability. These findings further emphasize the need for effective rehabilitation and interventions to treat CIPN symptoms and related physical impairment and functional deficits.
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Affiliation(s)
- Nida Rattanakrong
- Department of Rehabilitation Medicine, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Noppawan Promma
- Department of Rehabilitation Medicine, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Chanatsupang Saraboon
- Department of Rehabilitation Medicine, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Pooriput Waongenngarm
- Faculty of Health Science Technology, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand.
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Intensive Daily Symptom and Function Monitoring Is Feasible and Acceptable to Women Undergoing First-Line Chemotherapy for Gynecologic Cancer. Cancer Nurs 2022; 45:369-377. [PMID: 35025773 DOI: 10.1097/ncc.0000000000001042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Women receiving chemotherapy for gynecologic cancer (GC) experience severe symptoms with associated functional changes. Understanding day-to-day symptom and function variation within and across chemotherapy treatment cycles could inform improved symptom management, but such studies are rare and may be infeasible in clinical care. OBJECTIVE The aim of this study was to evaluate feasibility and acceptability of daily symptom monitoring combined with objective and self-reported functional assessments every 21 days during active chemotherapy for GC. METHODS Thirty women enrolled in a prospective observational study during first-line chemotherapy completed a daily symptom and falls diary during their entire chemotherapy treatment period. Patient-reported outcomes and objective symptom and function testing were assessed before each chemotherapy appointment. Study outcomes included accrual and attrition rates, completion of study assessments, and qualitative perceptions of study participation. RESULTS Participants were 92% White, 60% had high school or higher education, 68% were married/partnered, and 62% had stage III or IV cancer at diagnosis. The study had an 83% accrual rate, 6.6% early withdrawal rate, and 17% total attrition rate. Missing assessments for prechemotherapy patient-reported outcomes and objective assessments ranged from 27% to 35% and 35% to 47% respectively, with a general decrease across cycles. Daily diary completion rate was 83% overall. Participants rated study participation positively. CONCLUSIONS Intensive daily symptom and function monitoring was feasible and acceptable to GC patients and may provide a sense of symptom controllability. IMPLICATIONS FOR PRACTICE Daily symptom and function monitoring in research studies may provide patients with information to support symptom discussions with the clinical team. Future work should develop proactive symptom management interventions using personalized symptom trajectories.
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24
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Tronstad C, Amini M, Olesen E, Qvigstad E, Pabst O, Martinsen T, Abie SM, Martinsen ØG, Hisdal J, Jenssen TG, Kalvøy H. Diabetic Foot Assessment using Skin Impedance in a Custom Made Sensor-sock. JOURNAL OF ELECTRICAL BIOIMPEDANCE 2022; 13:136-142. [PMID: 36694878 PMCID: PMC9837869 DOI: 10.2478/joeb-2022-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Indexed: 06/17/2023]
Abstract
Diabetic peripheral neuropathy (DPN) may lead to several changes in the skin, and some of these may influence the skin impedance spectrum. In the present study we have developed a prototype solution for skin impedance spectroscopy at selected skin sites (big toe pulp, heel and toe ball) that was tested in a pilot study on five patients with DPN and five healthy controls. At the big toe, most of the controls had markedly lower impedance than the DPN group, especially in the range of 1-100 kHz. The separation between the groups seems to be weaker at the heel and weakest at the toeball. The results may indicate that monitoring of the skin impedance spectrum may be a method for detection of skin changes associated with DPN, encouraging further studies with the big toe sensor in particular.
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Affiliation(s)
- Christian Tronstad
- Department of Clinical and Biomedical Engineering, Oslo University Hospital, Oslo, Norway
| | - Maryam Amini
- Department of Clinical and Biomedical Engineering, Oslo University Hospital, Oslo, Norway
| | - Eline Olesen
- Department of Physics, University of Oslo, Oslo, Norway
| | - Elisabeth Qvigstad
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Oliver Pabst
- Department of Physics, University of Oslo, Oslo, Norway
| | - Tormod Martinsen
- Department of Clinical and Biomedical Engineering, Oslo University Hospital, Oslo, Norway
| | - Sisay M. Abie
- Faculty of Ecology and Natural Resource Management, Norwegian University of Life Sciences, Oslo Ås, Norway
| | - Ørjan G. Martinsen
- Department of Clinical and Biomedical Engineering, Oslo University Hospital, Oslo, Norway
- Department of Physics, University of Oslo, Oslo, Norway
| | - Jonny Hisdal
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway
| | - Trond G. Jenssen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Håvard Kalvøy
- Department of Clinical and Biomedical Engineering, Oslo University Hospital, Oslo, Norway
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25
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Lyon MM. Diabetic Ulcer Prevention. PHYSICIAN ASSISTANT CLINICS 2022. [DOI: 10.1016/j.cpha.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Lin YJ, Kao TW, Chen WL. Relationship between peripheral neuropathy and cognitive performance in the elderly population. Medicine (Baltimore) 2021; 100:e26071. [PMID: 34011128 PMCID: PMC8137106 DOI: 10.1097/md.0000000000026071] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 04/07/2021] [Accepted: 04/27/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT There are only a few studies that have shown an association of peripheral neuropathy with cognitive impairment in elderly individuals. Therefore, we investigated the relationship between cognitive performance and peripheral neuropathy.From the database of the National Health and Nutrition Examination Survey (NHANES, 1999-2002), each participant completed a household interview, physical performance test, questionnaire regarding personal health, and Digit Symbol Substitution Test (DSST) to evaluate cognitive performance. The severity of peripheral neuropathy was assessed based on the number of insensate areas in both feet during monofilament examination. We used the multivariate linear regression to analyze the association of the DSST findings with insensate areas of the worse foot.There were 828 participants in our study from NHANES 1999 to 2002; their mean age was 69.96 ± 7.38 years, and 51.3% were male. The β coefficients of the number of insensate areas associated with the DSST findings were all negative values, and the absolute value increased as the number of insensate areas increased. After adjustment for pertinent variables, the correlations remained significantly negative (all P for trend <.001). In addition, subgroup analysis showed no gender differences in the negative association, but this association was not significant in obese participants (P > .05).Our study provides evidence that the severity of peripheral neuropathy is significantly negatively correlated with cognitive performance.
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Affiliation(s)
| | - Tung-Wei Kao
- Division of Family Medicine
- Division of Geriatric Medicine, School of Medicine, National Defense Medical Center
- Health Management Center, Department of Family and Community Medicine, Tri-Service General Hospital, Taipei
| | - Wei-Liang Chen
- Division of Family Medicine
- Division of Geriatric Medicine, School of Medicine, National Defense Medical Center
- Health Management Center, Department of Family and Community Medicine, Tri-Service General Hospital, Taipei
- Department of Biochemistry, National Defense Medical Center, Taiwan, Republic of China
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César Ernesto LC, Néstor MZ, Raúl IS, Francisco Javier PV, Tania S MU, Francisco BH, Alejandro CM, Marcela JZ, Almeda-Valdes P. Comparison of Clinical Tests for Peripheral Diabetic Neuropathy in a Type 1 Diabetes Cohort. Endocr Pract 2021; 27:567-570. [PMID: 33798738 DOI: 10.1016/j.eprac.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/21/2021] [Accepted: 03/23/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the performance and agreement of 5 modalities for testing sensory neuropathy against a neurothesiometer among Hispanic patients with type 1 diabetes (T1D) in an outpatient setting. METHODS A cross-sectional study was conducted at a tertiary reference center in Mexico City. Sensitivity, specificity, predictive values, and likelihood ratios were calculated using a VibraTip device, 128 Hz tuning fork, and the Semmes-Weinstein 5.07/10 g monofilament test, Ipswich touch test (IpTT), and pinprick test (PPT). The VPT obtained using a neurothesiometer was used as the standard. Agreement between tests was calculated using kappa coefficients. RESULTS Our study included 78 patients (156 examinations), of whom 56.4% were females. The mean age was 38.2 ± 13.0 years, and the mean body mass index was 24.6 ± 4.8 kg/m2. The best sensitivity was found for IpTT and VibraTip (89.7% and 79.3%, respectively), while the PPT and IpTT had the highest positive predictive values (94.4% and 92.9%, respectively). The highest kappa coefficients were obtained for the IpTT vs neurothesiometer (kappa coefficient [κ] = 0.893, P < .001), followed by VibraTip vs neurothesiometer (κ = 0.782, P < .001). The VibraTip vs IpTT also had a substantial agreement (κ= 0.713, P < .001). CONCLUSION Our findings demonstrated that the IpTT had the best diagnostic performance and agreement compared with the standard in this cohort of Hispanic patients with T1D. The IpTT is a useful, simple test for diabetic neuropathy screening. These findings support its inclusion in future guidelines for diabetic foot examination.
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Affiliation(s)
- Lam-Chung César Ernesto
- Department of Endocrinology and Metabolism. Instituto Nacional de Ciencias, Médicas y Nutrición Salvador Zubirán
| | - Martínez Zavala Néstor
- Department of Endocrinology and Metabolism. Instituto Nacional de Ciencias, Médicas y Nutrición Salvador Zubirán
| | - Ibarra-Salce Raúl
- Department of Endocrinology and Metabolism. Instituto Nacional de Ciencias, Médicas y Nutrición Salvador Zubirán
| | | | - Mena Ureta Tania S
- Department of Endocrinology and Metabolism. Instituto Nacional de Ciencias, Médicas y Nutrición Salvador Zubirán
| | - Berumen Hermosillo Francisco
- Department of Endocrinology and Metabolism. Instituto Nacional de Ciencias, Médicas y Nutrición Salvador Zubirán
| | - Campos Muñoz Alejandro
- Department of Endocrinology and Metabolism. Instituto Nacional de Ciencias, Médicas y Nutrición Salvador Zubirán
| | - Janka Zires Marcela
- Department of Endocrinology and Metabolism. Instituto Nacional de Ciencias, Médicas y Nutrición Salvador Zubirán
| | - Paloma Almeda-Valdes
- Department of Endocrinology and Metabolism. Instituto Nacional de Ciencias, Médicas y Nutrición Salvador Zubirán.
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Baxi H, Habib A, Hussain MS, Hussain S, Dubey K. Prevalence of peripheral neuropathy and associated pain in patients with diabetes mellitus: Evidence from a cross-sectional study. J Diabetes Metab Disord 2021; 19:1011-1017. [PMID: 33520819 DOI: 10.1007/s40200-020-00597-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/27/2020] [Indexed: 12/11/2022]
Abstract
Background Diabetic peripheral neuropathy (DPN) is the most common and troublesome complication of diabetes mellitus. It affects almost half the population with diabetes and worsens quality of life of the patient. This study was aimed to determine the prevalence of peripheral neuropathy and associated pain in patients with diabetes mellitus. Methods This was a cross-sectional study conducted over a period of six months. Patient's ≥ 18 years with confirmed diagnosis of diabetes mellitus were included in the study. Patients with hypothyroidism, medical illness such as cancer, liver or renal disease, cervical or lumbar spondylosis, pregnant patients with diabetes and patients receiving any treatment that might influence nerve function (e.g., cytotoxic or antiepileptic agents) were excluded from the study. DPN was diagnosed using 10 g monofilament test. The S-LANSS questionnaire was used to assess the associated painful symptoms. Association was calculated using chi-square test. A p- value of ≤0.05 was considered statistically significant. All the statistical analysis was performed using SPSS v22. Result The overall prevalence of DPN was found to be 28.85% from which 88% patients were found to have painful symptoms. A significant association of DPN was observed with the duration of diabetes (p = 0.004), poor glycaemic control (p = 0.03) and other diabetic complications such as nephropathy (p = 0.002). No association of neuropathy was found with retinopathy and hypertension. Duration of diabetes (>15 years), and HbA1c (>9%) was found to be positively associated the painful DPN. Conclusion The current study found a high prevalence of DPN and it was found to be significantly associated with duration of diabetes, poor glycaemic control and nephropathy.
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Affiliation(s)
- Harveen Baxi
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062 India
| | - Anwar Habib
- Department of Medicine, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, 110062 India
| | - Md Sarfaraj Hussain
- Department of Pharmacognosy & Phytochemistry, R. V Northland Institute of Pharmacy, Dadri, Uttar Pradesh India
| | - Salman Hussain
- Departmen of Pharmaceutical Medicine, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062 India
| | - Kiran Dubey
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062 India
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Carmichael J, Fadavi H, Ishibashi F, Shore AC, Tavakoli M. Advances in Screening, Early Diagnosis and Accurate Staging of Diabetic Neuropathy. Front Endocrinol (Lausanne) 2021; 12:671257. [PMID: 34122344 PMCID: PMC8188984 DOI: 10.3389/fendo.2021.671257] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/17/2021] [Indexed: 12/14/2022] Open
Abstract
The incidence of both type 1 and type 2 diabetes is increasing worldwide. Diabetic peripheral neuropathy (DPN) is among the most distressing and costly of all the chronic complications of diabetes and is a cause of significant disability and poor quality of life. This incurs a significant burden on health care costs and society, especially as these young people enter their peak working and earning capacity at the time when diabetes-related complications most often first occur. DPN is often asymptomatic during the early stages; however, once symptoms and overt deficits have developed, it cannot be reversed. Therefore, early diagnosis and timely intervention are essential to prevent the development and progression of diabetic neuropathy. The diagnosis of DPN, the determination of the global prevalence, and incidence rates of DPN remain challenging. The opinions vary about the effectiveness of the expansion of screenings to enable early diagnosis and treatment initiation before disease onset and progression. Although research has evolved over the years, DPN still represents an enormous burden for clinicians and health systems worldwide due to its difficult diagnosis, high costs related to treatment, and the multidisciplinary approach required for effective management. Therefore, there is an unmet need for reliable surrogate biomarkers to monitor the onset and progression of early neuropathic changes in DPN and facilitate drug discovery. In this review paper, the aim was to assess the currently available tests for DPN's sensitivity and performance.
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Affiliation(s)
- Josie Carmichael
- Diabetes and Vascular Research Centre, National Institute for Health Research, Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, United Kingdom
| | - Hassan Fadavi
- Peripheral Neuropathy Group, Imperial College, London, United Kingdom
| | - Fukashi Ishibashi
- Internal Medicine, Ishibashi Medical and Diabetes Centre, Hiroshima, Japan
| | - Angela C Shore
- Diabetes and Vascular Research Centre, National Institute for Health Research, Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, United Kingdom
| | - Mitra Tavakoli
- Diabetes and Vascular Research Centre, National Institute for Health Research, Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, United Kingdom
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Di Stasio G, Montanelli M. A Narrative Review on the Tests Used in Biomechanical Functional Assessment of the Foot and Leg: Diagnostic Tests of Deformities and Compensations. J Am Podiatr Med Assoc 2020; 110:447062. [PMID: 33151303 DOI: 10.7547/19-040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND To date, scientific literature has not as yet come up with any review showing the diagnostic tests used for functional assessment of the foot and leg. METHODS A literature review was conducted of electronic databases (MEDLINE, PEDro, DOAJ, BioMed Central, PLOS, and Centre for Reviews and Dissemination at the University of York) up to December 8, 2018. The biomechanical tests, which have adequate supportive literature, were divided into qualitative tests that provide a dichotomy/trichotomy-type answer to clinical diagnostic questions; semiquantitative tests that provide numerical data to clinical diagnostic questions; and quantitative tests that record continuous numerical data (in analogue or digital form). RESULTS These tests produce a useful functional evaluation model of the foot and leg for different purposes: evaluation of lower limb deficits or abnormalities in healthy patients and in athletes (in sports or other physical activities); assessment of tissue stress syndromes caused by pathomechanics; evaluation of lower limb deficits or abnormalities in rheumatic disease and diabetic foot patients; and to determine the appropriate functional or semifunctional foot orthotic therapy and therapeutic path used in gait rehabilitation. CONCLUSIONS Many of these tests have adequate diagnostic reliability and reproducibility and therefore can be considered diagnostic. Few of these are validated, and some have initiated the validation process by determining their sensitivity and specificity. The widespread use of these tools in clinical practice (diagnosis of function) lacks scientific evidence and in-depth analysis of their limitations.
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31
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Ylitalo KR, Strotmeyer ES, Pettee Gabriel K, Lange-Maia BS, Avis NE, Karvonen-Gutierrez CA. Peripheral Nerve Impairment and Recurrent Falls Among Women: Results From the Study of Women's Health Across the Nation. J Gerontol A Biol Sci Med Sci 2020; 75:2020-2027. [PMID: 31549141 DOI: 10.1093/gerona/glz211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Falls and related injuries are important public health concerns yet underappreciated in early aging. This study examined the association of peripheral nerve impairment (PNI) with fall outcomes in early old aged women (60-72 years). METHODS Women (n = 1,725; mean age 65.1 ± 2.7 years) from the longitudinal cohort Study of Women's Health Across the Nation completed a PNI questionnaire on presence, frequency, and severity of symptoms, and 10- and 1.4-g monofilament testing in 2016-2017. PNI was defined as four or more self-reported symptoms or monofilament insensitivity. Recurrent falls (two or more) and recurrent fall injuries (two or more falls with one or more injuries) in the previous 12 months were assessed via questionnaire. Poisson regression was used to generate risk ratios (RRs) and corresponding 95% confidence intervals (CIs) for the fall outcomes, adjusting for covariates. RESULTS Approximately 12.3% of participants reported two ore more falls, 7.6% reported recurrent falls with injury, and 15.8% reported four or more PNI symptoms. Women with recurrent falls were more likely to report four or more PNI symptoms compared to women without recurrent falls (32.1% vs 13.5%; p < .001). One quarter (25.6%) of participants had four or more PNI symptoms or monofilament insensitivity; after adjusting for covariates, women with either symptoms or insensitivity were more likely to report recurrent falls compared to women with neither (RR = 1.64; 95% CI: 1.24, 2.17). CONCLUSIONS These findings suggest that PNI may identify those at high risk for falls, particularly among women during early late life. Neuropathy screening instruments such as symptom questionnaires or monofilament testing are easy to implement and may have utility for fall risk assessment.
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Affiliation(s)
- Kelly R Ylitalo
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, Texas
| | - Elsa S Strotmeyer
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Kelley Pettee Gabriel
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health - Austin Campus, Texas.,Department of Women's Health, Dell Medical School, Chicago, Illinois.,Department of Kinesiology and Health Education, The University of Texas at Austin, Chicago, Illinois
| | - Brittney S Lange-Maia
- Department of Preventive Medicine, Center for Community Health Equity, Rush University Medical Center, Chicago, Illinois
| | - Nancy E Avis
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
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32
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Howarth D. Preventing foot complications in people with diabetes mellitus. Nurs Stand 2020; 34:69-74. [PMID: 31468824 DOI: 10.7748/ns.2019.e11432] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2019] [Indexed: 12/19/2022]
Abstract
'Diabetic foot' is a term used to describe a group of syndromes in which neuropathy and/or ischaemia lead to tissue breakdown and reduced resistance to infection in a patient with diabetes mellitus. Foot ulceration is a serious and potentially limb-threatening complication of diabetes that can lead to pain, tissue necrosis and amputation, and may significantly affect an individual's well-being and mobility. Foot complications also have wider economic implications for healthcare services. Therefore, it is important to reduce the risk of foot complications through regular foot assessments and providing patient education and appropriate referral to specialist services. This article discusses foot complications in people with diabetes, outlining the causes, signs and symptoms, and associated risk factors. It also outlines the assessment and prevention measures that patients and healthcare practitioners can take to reduce the risk of foot complications.
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Hu A, Koh B, Teo MR. A review of the current evidence on the sensitivity and specificity of the Ipswich touch test for the screening of loss of protective sensation in patients with diabetes mellitus. Diabetol Int 2020; 12:145-150. [PMID: 33786269 DOI: 10.1007/s13340-020-00451-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/25/2020] [Indexed: 10/24/2022]
Abstract
Aims To evaluate the sensitivity and specificity of the Ipswich touch test for the screening of loss of protective sensation in patients with diabetes mellitus based on the current literature. Methods Three electronic databases were searched for eligible studies that investigated the sensitivity and specificity of the Ipswich touch test. Methodological quality was assessed using the QUADAS-2 tool. Results Five studies that reported the sensitivity and specificity of the Ipswich touch test were included. When compared to the 10 g monofilament, the sensitivity ranges from 51 to 83.3% and the specificity ranges from 96.4 to 98%. When compared to the vibration perception test ≥25 V, Ipswich touch test sensitivity ranges from 76 to 100% and specificity ranges from 90 to 96.6%. Conclusions The Ipswich touch test has a high specificity in screening for loss of protective sensation in the feet of patients with diabetes mellitus. It is a useful test to be included in diabetic foot screenings, especially when other sensory tools are not available. However, more rigorous studies need to be conducted as there is currently only a limited pool of research evidence to substantiate it as a screening tool for loss of protective sensation in the diabetic foot.
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Affiliation(s)
- Arnold Hu
- Podiatry Department, Ng Teng Fong General Hospital, National University Health System, 1 Jurong East Street 21, Singapore, 609606 Singapore
| | - Beatrice Koh
- Podiatry Department, Ng Teng Fong General Hospital, National University Health System, 1 Jurong East Street 21, Singapore, 609606 Singapore
| | - Melissa-Raye Teo
- Podiatry Department, Ng Teng Fong General Hospital, National University Health System, 1 Jurong East Street 21, Singapore, 609606 Singapore
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Peterson M, Pingel R, Rolandsson O, Dahlin LB. Vibrotactile perception on the sole of the foot in an older group of people with normal glucose tolerance and type 2 diabetes. SAGE Open Med 2020; 8:2050312120931640. [PMID: 32587694 PMCID: PMC7294473 DOI: 10.1177/2050312120931640] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 05/13/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To evaluate vibrotactile sense in an older group of people with normal glucose tolerance and type 2 diabetes relative to other sensory tests. METHODS Vibration perception thresholds on the sole of the foot (Multifrequency vibrametry and Biothesiometer) were compared to the results from evaluation of touch (monofilament), electrophysiology (sural nerve) and thermal sensation (Thermotest®). RESULTS Vibration perception and temperature thresholds, as well as sural nerve function, differed between normal glucose tolerance and type 2 diabetes. Measuring vibration perception thresholds at lower frequencies with multifrequency vibrametry versus biothesiometer provided correlations similar to sural nerve amplitude. Temperature thresholds correlated with vibration perception thresholds and sural nerve function. Monofilaments revealed pathology in only a few participants with type 2 diabetes. CONCLUSIONS In an older group of people, vibration perception thresholds show a correlation similar to sural nerve amplitude on tactile and non-tactile surfaces. Measuring a vibration perception threshold on a tactile surface in type 2 diabetes provides no clear advantage over measuring it on the medial malleolus. In older type 2 diabetes subjects, both large and small diameter nerve fibers are affected.
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Affiliation(s)
- Magnus Peterson
- Department of Public Health and Caring Sciences, Section of Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
- Academic Primary Healthcare Centre, Stockholm, Sweden
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Ronnie Pingel
- Department of Statistics, Uppsala University, Uppsala, Sweden
| | - Olov Rolandsson
- Department of Public Health and Clinical Medicine, Section of Family Medicine, Umeå University, Umeå, Sweden
| | - Lars B Dahlin
- Department of Translational Medicine—Hand Surgery, Lund University and Skåne University Hospital, Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
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35
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Rodríguez-Sánchez B, Peña-Longobardo LM, Sinclair AJ. Cost-effectiveness analysis of the Neuropad device as a screening tool for early diabetic peripheral neuropathy. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:335-349. [PMID: 31720872 DOI: 10.1007/s10198-019-01134-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 10/30/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To carry out a cost-effectiveness analysis of the use of Neuropad as a screening test for diabetic neuropathy together with the standard care tool, the 10-g monofilament, in people with diabetes. RESEARCH DESIGN AND METHODS A cost-effectiveness analysis using a Markov model was developed to assess the impact on costs and outcomes of using Neuropad as a test for diabetic neuropathy (1) as a complement to the standard test, the 10-g monofilament (Neuropad + monofilament vs. monofilament); and (2) as a substitute for the monofilament (Neuropad vs. monofilament); from the healthcare provider perspective. The time horizon was 3 years. Data on costs and health gains were extracted from the literature. The incremental cost-utility ratio was calculated. Deterministic and probabilistic sensitivity analyses were also performed. RESULTS Compared with standard care, Neuropad, in combination with the 10-g monofilament tool, is the dominant strategy as it leads to higher health gains and lower costs. In practice, compared with using the monofilament alone, performing both tests would lead to a savings of £1049.26 per patient and 0.044 QALY gain. Results were found to be consistent across the sensitivity analyses. CONCLUSIONS Using both screening tools (Neuropad + monofilament) is a cost-effective strategy and the dominant alternative, when compared against using the 10-g monofilament alone. The results would be of special relevance in the early detection of diabetic peripheral neuropathy and to ensure the efficient allocation of resources and, thus, the sustainability of healthcare systems.
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Affiliation(s)
- B Rodríguez-Sánchez
- Faculty of Law and Social Sciences, University of Castilla-La Mancha, Calle San Pedro Mártir 7, 45002, Toledo, Spain.
| | - L M Peña-Longobardo
- Faculty of Law and Social Sciences, University of Castilla-La Mancha, Calle San Pedro Mártir 7, 45002, Toledo, Spain
| | - A J Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, University of Aston, Birmingham, UK
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Javed S, Hayat T, Menon L, Alam U, Malik RA. Diabetic peripheral neuropathy in people with type 2 diabetes: too little too late. Diabet Med 2020; 37:573-579. [PMID: 31797434 DOI: 10.1111/dme.14194] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2019] [Indexed: 12/12/2022]
Abstract
Diabetic peripheral neuropathy in people with type 2 diabetes is poorly managed because of its insidious onset, delayed diagnosis and more complex aetiology resulting from the contribution of not only hyperglycaemia, but also ageing, hyperlipidaemia, hypertension and obesity. Because there is no US Food and Drug Adminstration-approved disease-modifying therapy for diabetic peripheral neuropathy, the key to ameliorating it in type 2 diabetes has to be through earlier diagnosis and timely multi-factorial risk factor reduction. The management of painful diabetic peripheral neuropathy also requires a detailed appraisal of the choice of therapy, taking into account efficacy, patient wishes, comorbidities, side effect profile and potential for abuse.
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Affiliation(s)
- S Javed
- Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, UK
| | - T Hayat
- Primary Health Care Corporation, Doha, Qatar
| | - L Menon
- Department of Medicine, Weill-Cornell Medicine-Qatar, Doha, Qatar
| | - U Alam
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - R A Malik
- Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, UK
- Department of Medicine, Weill-Cornell Medicine-Qatar, Doha, Qatar
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Palladino R, Tabak AG, Khunti K, Valabhji J, Majeed A, Millett C, Vamos EP. Association between pre-diabetes and microvascular and macrovascular disease in newly diagnosed type 2 diabetes. BMJ Open Diabetes Res Care 2020; 8:8/1/e001061. [PMID: 32332069 PMCID: PMC7202749 DOI: 10.1136/bmjdrc-2019-001061] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/22/2020] [Accepted: 03/28/2020] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE The associated risk of vascular disease following diagnosis of type 2 diabetes in people previously identified as having pre-diabetes in real-world settings is unknown. We examined the presence of microvascular and macrovascular disease in individuals with newly diagnosed type 2 diabetes by glycemic status within 3 years before diagnosis. RESEARCH DESIGN AND METHODS We identified 159 736 individuals with newly diagnosed type 2 diabetes from the UK Clinical Practice Research Datalink database in England between 2004 and 2017. We used logistic regression models to compare presence of microvascular (retinopathy and nephropathy) and macrovascular (acute coronary syndrome, cerebrovascular and peripheral arterial disease) disease at the time of type 2 diabetes diagnosis by prior glycemic status. RESULTS Half of the study population (49.9%) had at least one vascular disease, over one-third (37.4%) had microvascular disease, and almost a quarter (23.5%) had a diagnosed macrovascular disease at the time of type 2 diabetes diagnosis.Compared with individuals with glycemic values within the normal range, those detected with pre-diabetes before the diagnosis had 76% and 14% increased odds of retinopathy and nephropathy (retinopathy: adjusted OR (AOR) 1.76, 95% CI 1.69 to 1.85; nephropathy: AOR 1.14, 95% CI 1.10 to 1.19), and 7% higher odds of the diagnosis of acute coronary syndrome (OR 1.07, 95% CI 1.03 to 1.12) in fully adjusted models at time of diabetes diagnosis. CONCLUSIONS Microvascular and macrovascular diseases are detected in 37%-24% of people with newly diagnosed type 2 diabetes. Pre-diabetes before diagnosis of type 2 diabetes is associated with increased odds of microvascular disease and acute coronary syndrome. Detection of pre-diabetes might represent an opportunity for reducing the burden of microvascular and macrovascular disease through heightened attention to screening for vascular complications.
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Affiliation(s)
- Raffaele Palladino
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
- Department of Public Health, University "Federico II" of Naples, Naples, Italy
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Adam G Tabak
- Department of Epidemiology and Public Health, University College London, London, UK
- 1st Department of Medicine, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | - Jonathan Valabhji
- Imperial College Healthcare NHS Trust, London, UK
- NHS England, Skipton House, London, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Eszter P Vamos
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
- Department of Primary Care and Public Health, Imperial College London, London, UK
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Identification of potential plantar ulceration among diabetes patients using plantar soft tissue stiffness. J Mech Behav Biomed Mater 2020; 103:103567. [PMID: 32090958 DOI: 10.1016/j.jmbbm.2019.103567] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 11/09/2019] [Accepted: 11/29/2019] [Indexed: 11/24/2022]
Abstract
This study investigates the relationship between plantar tissue stiffness and selected parameters, including age, diabetes mellitus (DM) duration, body mass index (BMI), and HbA1c level. 70 diabetes patients with no foot problems were recruited. The plantar soft tissue at the 2nd sub-metatarsal head (MTH) pad was examined using the novel indentation system developed. The stiffness constant, K, was used to describe the tissue stiffness. The four factors (age, DM duration, BMI, and HbA1c level) were plotted against the plantar tissue stiffness. The scatter plots revealed that a higher plantar tissue stiffness was usually associated with (1) BMI>25 kgm-2, (2) HbA1c score >10% (86 mmol/mol), and (3) DM duration >10 years. The three risk criteria were further evaluated using the binary classification test. The predictions were reported to be fairly accurate and reliable in detecting stiffened tissues. The study has successfully identified the strong association of BMI, HbA1c, and DM duration with the plantar tissue properties. Special attention should be given to the high risk group with BMI>25 kgm-2, HbA1c score >10% (86 mmol/mol), and DM duration >10 years. The high diagnostic odds ratio attained suggests its potential usefulness in helping clinicians to diagnose diabetic foot more efficiently.
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Lanting SM, Spink MJ, Tehan PE, Vickers S, Casey SL, Chuter VH. Non-invasive assessment of vibration perception and protective sensation in people with diabetes mellitus: inter- and intra-rater reliability. J Foot Ankle Res 2020; 13:3. [PMID: 31988664 PMCID: PMC6966840 DOI: 10.1186/s13047-020-0371-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/13/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Testing of protective sensation and vibration perception are two of the most commonly used non-invasive methods of screening for diabetes-related peripheral neuropathy (DPN). However, there is limited research investigating the reliability of these tests in people with diabetes. The aim of this study was to determine the inter- and intra-rater reliability of methods used to test vibration perception and protective sensation in a community-based population of adults with type 2 diabetes. METHODS Three podiatrists with varying clinical experience tested four- and 10-site, 10 g monofilament and vibration perception threshold (VPT). In a separate cohort, the reliability of a graduated tuning fork as well as two methods of conventional tuning fork (on/off method and dampening method) was undertaken by a new graduate podiatrist and podiatrist with one-year's clinical experience. The intra- (Cohen's К) and inter-rater (Cohen's or Fleiss' К) reliability of each test was determined. RESULTS Fifty participants (66% male, 100% type 2, 32% with DPN) underwent monofilament and neurothesiometer testing with 44 returning for the retest. Twenty-four participants (63% male, 100% type 2, 4% with DPN) underwent tuning fork testing and returned for retest. All tests demonstrated acceptable inter-rater reliability ranging from moderate (10-site monofilament, К: 0.54, CI: 0.38-0.70, p = 0.02) to substantial (graduated tuning fork, К: 0.68, CI: 0.41-0.95, p < 0.01). The 10-site monofilament (К: 0.44-0.77) outperformed the 4-site test (К: 0.34-0.67) and the dampened tuning fork method (К: 0.41-0.49) showed lower intra-rater reliability compared to both conventional (К: 0.52-0.57) and graduated methods (К: 0.50-0.57). CONCLUSION We support the current recommendations of using more than one test to screen and monitor progression of DPN. Four- and 10-site 10 g monofilament testing have similarly acceptable levels of reliability and the neurothesiometer is the most reliable method of assessing vibration perception function. Use of a graduated tuning fork was slightly more reliable than other methods of tuning fork application however all had substantial reliability. Years of clinical experience only marginally affected test reliability overall and due to subjective nature of the tests we suggest that testing should be performed regularly and repetitively.
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Affiliation(s)
| | | | - Peta Ellen Tehan
- School of Health Sciences, University of Newcastle, Newcastle, Australia
- Priority Research Centre for Gender, Health and Ageing, University of Newcastle, Newcastle, Australia
| | - Stephanie Vickers
- School of Health Sciences, University of Newcastle, Newcastle, Australia
| | - Sarah Louise Casey
- School of Health Sciences, University of Newcastle, Newcastle, Australia
| | - Vivienne Helaine Chuter
- School of Health Sciences, University of Newcastle, Newcastle, Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Newcastle, Australia
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Henderson AD, Johnson AW, Rasmussen LG, Peine WP, Symons SH, Scoresby KA, Ridge ST, Bruening DA. Early-Stage Diabetic Neuropathy Reduces Foot Strength and Intrinsic but Not Extrinsic Foot Muscle Size. J Diabetes Res 2020; 2020:9536362. [PMID: 32258170 PMCID: PMC7091556 DOI: 10.1155/2020/9536362] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/14/2020] [Accepted: 02/25/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Tracking progression of diabetic peripheral polyneuropathy (DPN) is usually focused on sensory nerves and subjective testing methods. Recent studies have suggested that distal muscle atrophy may precede sensation loss. Methods to objectively measure distal muscle size and strength are needed to help understand how neuropathy affects muscle function. PURPOSE To evaluate individual intrinsic and extrinsic foot muscle sizes and functional foot strength in participants with DPN. METHODS Thirty individuals participated in this cross-sectional study (15 DPN and 15 matched controls). Sizes of 10 separate muscles of the lower leg and foot were measured using ultrasound imaging. Functional foot strength was also quantified using custom great toe and lateral toe flexion tests along with a doming test. Muscle size and strength metrics were compared between groups using ANOVAs and paired t-tests (α = 0.05). Correlations between strength and relevant muscle sizes were also evaluated. RESULTS The sizes of all four intrinsic foot muscles were smaller in individuals with DPN (p ≤ 0.03), while only one (toe extensor) of the six extrinsic muscles was smaller (p ≤ 0.03), while only one (toe extensor) of the six extrinsic muscles was smaller (p ≤ 0.03), while only one (toe extensor) of the six extrinsic muscles was smaller (p ≤ 0.03), while only one (toe extensor) of the six extrinsic muscles was smaller (r ≤ 0.80) with several corresponding intrinsic muscle sizes. The doming strength test did not show any difference between groups and was moderately correlated with one muscle size (r ≤ 0.80) with several corresponding intrinsic muscle sizes. The doming strength test did not show any difference between groups and was moderately correlated with one muscle size (. CONCLUSION Diabetic peripheral polyneuropathy affects intrinsic muscles before extrinsics. Ultrasound imaging of individual muscles and functional toe flexion tests can be used clinically to monitor DPN progression and foot function. Participants need to be trained in the doming test before a relationship can be established between this test and DPN foot function. Future studies should include muscle quality measurements to better understand characteristics of affected muscles.
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Affiliation(s)
| | - A. Wayne Johnson
- Exercise Sciences Department, Brigham Young University, Provo, UT, USA
| | | | - Weston P. Peine
- Exercise Sciences Department, Brigham Young University, Provo, UT, USA
| | - Sydney H. Symons
- Exercise Sciences Department, Brigham Young University, Provo, UT, USA
| | - Kade A. Scoresby
- Exercise Sciences Department, Brigham Young University, Provo, UT, USA
| | - Sarah T. Ridge
- Exercise Sciences Department, Brigham Young University, Provo, UT, USA
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Evaluation of Long-term Outcomes of Facial Sensation following Cranial Vault Reconstruction for Craniosynostosis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2135. [PMID: 31044113 PMCID: PMC6467630 DOI: 10.1097/gox.0000000000002135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 12/12/2018] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Cranial vault reshaping to correct craniosynostosis in infants may injure terminal branches of the trigeminal nerve, namely the supraorbital, supratrochlear, zygomaticofacial, and zygomaticotemporal nerves, especially if a fronto-orbital advancement is performed. Despite numerous studies demonstrating successful esthetic outcome after FOA, there are no long-term studies assessing facial sensation after possible damage to these nerves as the result of surgery. Methods: A cross-sectional case-control research design was used to evaluate facial sensory threshold in the trigeminal branches after cranial vault reconstruction in children with isolated, nonsyndromic metopic, and unicoronal craniosynostosis, compared with those with sagittal craniosynostosis and age-matched nonaffected controls. Study participants were recruited from the Hospital for Sick Children between the ages of 6 and 18 years. Sensory outcome was determined using the Weinstein Enhanced Sensory Test, the Ten Test, and self-reported facial sensibility function questionnaire. Results: The sensory outcomes of 28 patients and 16 controls were examined at an average age of 9.6 years and 10.3 years, respectively. No subjective or objective sensory deficit was noted in supraorbital, supratrochlear, zygomaticofacial, or zygomaticotemporal nerve distributions between groups. Qualitative reports of facial sensibility function indicated no difference in subjective sensation, protective sensation, or motor behavior between groups. Conclusions: These results suggest that while sensory nerve injury during routine FOA may occur, it does not result in a quantifiable nor clinically significant long-term sensory deficit threshold. Patients do not develop long-term neuropathic pain following surgical intervention.
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Chikai M, Ino S. Buckling Force Variability of Semmes⁻Weinstein Monofilaments in Successive Use Determined by Manual and Automated Operation. SENSORS 2019; 19:s19040803. [PMID: 30781464 PMCID: PMC6412527 DOI: 10.3390/s19040803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 02/10/2019] [Accepted: 02/13/2019] [Indexed: 11/16/2022]
Abstract
(1) Objective: This study was conducted with the objective of characterizing the variability of a force on a simulated skin surface using the Semmes⁻Weinstein monofilament test (SWMT). (2) Research Design and Methods: Two distinct experiments were performed to determine the effects of human hand motion variability on the monofilament buckling force, and to determine the monofilament's mechanical properties using a positioning stage. (3) Results: In manual operation (by human hand motion), the buckling force over the ten compressions decreased by over 10%, and the human hand motion variations during the SWMT may have impacted the buckling force. When the SWMT was performed under manual control, the buckling force was closely correlated with the number of compressions. In automated operation (by positioning stage), the buckling force was affected not only by the number of compressions but also by both the velocity and the contact angle between the monofilament and the skin surface. (4) Conclusions: The buckling force decreased in ten successive compressions, independent of the hand motion. Hence, medical staff need to consider not only the operator's hand motion but also the effect of repeated trials.
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Affiliation(s)
- Manabu Chikai
- Human Informatics Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba 305-8566, Japan.
| | - Shuichi Ino
- Human Informatics Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba 305-8566, Japan.
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Molassiotis A, Cheng HL, Lopez V, Au JSK, Chan A, Bandla A, Leung KT, Li YC, Wong KH, Suen LKP, Chan CW, Yorke J, Farrell C, Sundar R. Are we mis-estimating chemotherapy-induced peripheral neuropathy? Analysis of assessment methodologies from a prospective, multinational, longitudinal cohort study of patients receiving neurotoxic chemotherapy. BMC Cancer 2019; 19:132. [PMID: 30736741 PMCID: PMC6368751 DOI: 10.1186/s12885-019-5302-4] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 01/14/2019] [Indexed: 12/19/2022] Open
Abstract
Background There are inconsistencies in the literature regarding the prevalence and assessment of chemotherapy-induced peripheral neuropathy (CIPN). This study explored CIPN natural history and its characteristics in patients receiving taxane- and platinum-based chemotherapy. Patients and methods Multi-country multisite prospective longitudinal observational study. Patients were assessed before commencing and three weekly during chemotherapy for up to six cycles, and at 6,9, and 12 months using clinician-based scales (NCI-CTCAE; WHO-CIPN criterion), objective assessments (cotton wool test;10 g monofilament); patient-reported outcome measures (FACT/GOG-Ntx; EORTC-CIPN20), and Nerve Conduction Studies. Results In total, 343 patients were recruited in the cohort, providing 2399 observations. There was wide variation in CIPN prevalence rates using different assessments (14.2–53.4%). Prevalence of sensory neuropathy (and associated symptom profile) was also different in each type of chemotherapy, with paclitaxel (up to 63%) and oxaliplatin (up to 71.4%) showing the highest CIPN rates in most assessments and a more complex symptom profile. Peak prevalence was around the 6-month assessment (up to 71.4%). Motor neurotoxicity was common, particularly in the docetaxel subgroup (up to 22.1%; detected by NCI-CTCAE). There were relatively moderately-to-low correlations between scales (rs = 0.15,p < 0.05-rs = 0.48 p < 0.001), suggesting that they measure different neurotoxicity aspects from each other. Cumulative chemotherapy dose was not associated with onset and course of CIPN. Conclusion The historical variation reported in CIPN incidence and prevalence is possibly confounded by disagreement between assessment modalities. Clinical practice should consider assessment of motor neuropathy for neurotoxic chemotherapy. Current scales may not be all appropriate to measure CIPN in a valid way, and a combination of scales are needed.
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Affiliation(s)
- Alex Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong, Special Administrative Region of China.
| | - Hui Lin Cheng
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong, Special Administrative Region of China
| | - Violeta Lopez
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | - Joseph S K Au
- The Hong Kong Adventist Hospital, Hong Kong, Hong Kong, Special Administrative Region of China
| | - Alexandre Chan
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Aishwarya Bandla
- Singapore Institute for Neurotechnology (SINAPSE), National University of Singapore, Singapore, Singapore
| | - K T Leung
- Department of Clinical Oncology, Queen Elisabeth Hospital, Hong Kong, Hong Kong, Special Administrative Region of China
| | - Y C Li
- Department of Clinical Oncology, Queen Elisabeth Hospital, Hong Kong, Hong Kong, Special Administrative Region of China
| | - K H Wong
- Department of Clinical Oncology, Queen Elisabeth Hospital, Hong Kong, Hong Kong, Special Administrative Region of China
| | - Lorna K P Suen
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong, Special Administrative Region of China
| | - Choi Wan Chan
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong, Special Administrative Region of China
| | - Janelle Yorke
- Division of Nursing, Midwifery & Social Work, University of Manchester, UK and Christie NHS Foundation Trust, Manchester, UK
| | - Carole Farrell
- Division of Nursing, Midwifery & Social Work, University of Manchester, UK and Christie NHS Foundation Trust, Manchester, UK
| | - Raghav Sundar
- Department of Haematology-Oncology, National University Health System, Singapore, Singapore.
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Campagna D, Alamo A, Di Pino A, Russo C, Calogero AE, Purrello F, Polosa R. Smoking and diabetes: dangerous liaisons and confusing relationships. Diabetol Metab Syndr 2019; 11:85. [PMID: 31666811 PMCID: PMC6813988 DOI: 10.1186/s13098-019-0482-2] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 10/11/2019] [Indexed: 02/07/2023] Open
Abstract
The combined harmful effects of cigarette smoking and hyperglycemia can accelerate vascular damage in patients with diabetes who smoke, as is well known. Can smoking cause diabetes? What are the effects of smoking on macro and microvascular complications? Now growing evidence indicates that regular smokers are at risk of developing incident diabetes. Since the prevalence rates of smoking in patients with diabetes are relatively similar to those of the general population, it is essential to address the main modifiable risk factor of smoking to prevent the onset of diabetes and delay the development of its complications. Quitting smoking shows clear benefits in terms of reducing or slowing the risk of cardiovascular morbidity and mortality in people with diabetes. Does quitting smoking decrease the incidence of diabetes and its progression? What are the effects of quitting smoking on complications? The current evidence does not seem to unequivocally suggest a positive role for quitting in patients with diabetes. Quitting smoking has also been shown to have a negative impact on body weight, glycemic control and subsequent increased risk of new-onset diabetes. Moreover, its role on microvascular complications of the disease is unclear. What are the current smoking cessation treatments, and which ones are better for patients with diabetes? Stopping smoking may be of value for diabetes prevention and management of the disease and its macrovascular and microvascular complications. Unfortunately, achieving long-lasting abstinence is not easy and novel approaches for managing these patients are needed. This narrative review examines the evidence on the impact of smoking and smoking cessation in patients with diabetes and particularly in type 2 diabetes mellitus and its complications. In addition, management options and potential future directions will be discussed.
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Affiliation(s)
- D. Campagna
- Centro per la Prevenzione e Cura del Tabagismo (CPCT), University Teaching Hospital “Policlinico-Vittorio Emanuele”, University of Catania, Catania, Italy
- U.O.C. MCAU, University Teaching Hospital “Policlinico-Vittorio Emanuele”, University of Catania, Catania, Italy
| | - A. Alamo
- Centro per la Prevenzione e Cura del Tabagismo (CPCT), University Teaching Hospital “Policlinico-Vittorio Emanuele”, University of Catania, Catania, Italy
- Division of Andrology and Endocrinology, University Teaching Hospital “Policlinico-Vittorio Emanuele”, University of Catania, Catania, Italy
- Department of Clinical and Experimental Medicine, (MEDCLIN), University of Catania, Catania, Italy
| | - A. Di Pino
- Department of Clinical and Experimental Medicine, (MEDCLIN), University of Catania, Catania, Italy
- Center of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of Catania, Catania, Italy
| | - C. Russo
- Centro per la Prevenzione e Cura del Tabagismo (CPCT), University Teaching Hospital “Policlinico-Vittorio Emanuele”, University of Catania, Catania, Italy
| | - A. E. Calogero
- Division of Andrology and Endocrinology, University Teaching Hospital “Policlinico-Vittorio Emanuele”, University of Catania, Catania, Italy
- Department of Clinical and Experimental Medicine, (MEDCLIN), University of Catania, Catania, Italy
- Center of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of Catania, Catania, Italy
| | - F. Purrello
- Department of Clinical and Experimental Medicine, (MEDCLIN), University of Catania, Catania, Italy
- Center of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of Catania, Catania, Italy
| | - R. Polosa
- Centro per la Prevenzione e Cura del Tabagismo (CPCT), University Teaching Hospital “Policlinico-Vittorio Emanuele”, University of Catania, Catania, Italy
- Department of Clinical and Experimental Medicine, (MEDCLIN), University of Catania, Catania, Italy
- Center of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of Catania, Catania, Italy
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Henderson AD, Johnson AW, Ridge ST, Egbert JS, Curtis KP, Berry LJ, Bruening DA. Diabetic Gait Is Not Just Slow Gait: Gait Compensations in Diabetic Neuropathy. J Diabetes Res 2019; 2019:4512501. [PMID: 31815148 PMCID: PMC6878800 DOI: 10.1155/2019/4512501] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/05/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Neuropathic complications from diabetes mellitus affect multiple nerve types and may manifest in gait. However, gait compensations are still poorly understood, as narrow analyses and lack of speed controls have contributed to conflicting or equivocal results. PURPOSE To evaluate gait mechanics and energetics in diabetic peripheral polyneuropathy. METHODS Instrumented gait analysis was performed on 14 participants with diabetic peripheral polyneuropathy and 14 matched controls, walking at 1.0 m/s. A full-body model with a multisegment foot was used to calculate inverse dynamics and analyze sagittal plane metrics and time series waveforms across stance phase. RESULTS Alterations included increased hip and knee flexion in early stance followed by a prolonged hip extension moment in midstance. Late stance ankle dorsiflexion and power absorption were increased, and final push-off was delayed and truncated. CONCLUSION A neuropathic diabetic gait shares important similarities to a mild crouch gait with weakness/dysfunction in the foot and ankle. This study highlights two main compensation mechanisms that have been overlooked in previous literature. First, increased triceps surae stretch in terminal stance may be used to increase proprioception and/or energy storage, while a prolonged hip extension moment in midstance compensates for a limited push-off. These result in an overall workload shift from distal to proximal joints. Clinical assessment, monitoring, and treatment of neuropathy may benefit by focusing on these specific functional alterations.
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Affiliation(s)
| | - A. Wayne Johnson
- Exercise Sciences Department, Brigham Young University, Provo, UT, USA
| | - Sarah T. Ridge
- Exercise Sciences Department, Brigham Young University, Provo, UT, USA
| | | | - Kevin P. Curtis
- Exercise Sciences Department, Brigham Young University, Provo, UT, USA
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Sanz-Corbalán I, Lázaro-Martínez JL, García-Morales E, Molines-Barroso R, Álvaro-Afonso F, García-Álvarez Y. Advantages of early diagnosis of diabetic neuropathy in the prevention of diabetic foot ulcers. Diabetes Res Clin Pract 2018; 146:148-154. [PMID: 29287839 DOI: 10.1016/j.diabres.2017.12.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/13/2017] [Accepted: 12/21/2017] [Indexed: 12/18/2022]
Abstract
AIMS To evaluate the utility of the sudomotor function test (SFT) as a clinical tool in the Risk Stratification System of diabetic patients and to demonstrate the earlier detection of the risk of developing diabetic foot ulcers (DFU) compared to the standard clinical tests. METHODS Prospective follow-up study on 263 patients enrolled consecutively over 3.5 years. Diabetic patients without active DFU were classified according to the International Working Group Risk Stratification System (RSS) and categorized according to the results of the Semmes-Wenstein Monofilament (SWM) and biothesiometer measurements or the SFT. The main outcome evaluated was the development of DFU. RESULTS Median follow-up was 42 [38-44] months. Sixty patients (22.8%) developed DFU after a median of 6.2 [3-17] months. Ten patients that were included in the no-risk group (group 0) based on the SWM and biothesiometer results developed DFU. Thus the sensitivity of this approach was 83.33% and the specificity was 50.47%. Based on the SFT results, all patients that developed DFU were included in the correct risk group. This approach had 100% sensitivity and 31.53% specificity. Regarding the diagnostic accuracy of the two Methods, the respective AUC values were 0.776 (95% CI 0.702-0.849) and 0.816 (95% CI 0.757-0.874). CONCLUSIONS SFT improved RSS in diabetic patients in a specialized diabetic foot unit. SFT categorized patients correctly according to the risk of developing DFU.
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Lipsitz LA, Manor B, Habtemariam D, Iloputaife I, Zhou J, Travison TG. The pace and prognosis of peripheral sensory loss in advanced age: association with gait speed and falls. BMC Geriatr 2018; 18:274. [PMID: 30419857 PMCID: PMC6233369 DOI: 10.1186/s12877-018-0970-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 11/01/2018] [Indexed: 02/08/2023] Open
Abstract
Background Peripheral sensory loss is considered one of many risk factors for gait impairments and falls in older adults, yet no prospective studies have examined changes in touch sensation in the foot over time and their relationship to mobility and falls. Therefore, we aimed to determine the prevalence and progression of peripheral sensory deficits in the feet of older adults, and whether sensory changes are associated with the slowing of gait and development of falls over 5 years. Methods Using baseline, and 18 and 60 month followup data from the Maintenance Of Balance, Independent Living, Intellect, and Zest in the Elderly (MOBILIZE) Study in Boston, MA, we determined changes in the ability to detect stimulation of the great toe with Semmes Weinstein monofilaments in 351 older adults. We used covariate-adjusted repeated measures analysis of variance to determine relationships between sensory changes and gait speed or fall rates. Results Subjects whose sensory function was consistently impaired over 5 years had a significantly steeper decline in gait speed (− 0.23 m/s; 95% CI: -0.28 to − 0.18) compared to those with consistently intact sensory function (− 0.12 m/s; 95% CI: -0.15 to − 0.08) and those progressing from intact to impaired sensory function (− 0.13 m/s; − 0.16 to − 0.10). Compared to subjects with consistently intact sensation, those whose sensory function progressed to impairment during followup had the greatest risk of falls (adjusted risk ratio = 1.57 (95% confidence interval = 1.12 to 2.22). Conclusions Our longitudinal results indicate that a progressive decline in peripheral touch sensation is a risk factor for mobility impairment and falls in older adults.
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Affiliation(s)
- Lewis A Lipsitz
- Hebrew SeniorLife Institute for Aging Research, 1200 Centre Street, Boston Roslindale, MA, 02131, USA. .,Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| | - Brad Manor
- Hebrew SeniorLife Institute for Aging Research, 1200 Centre Street, Boston Roslindale, MA, 02131, USA.,Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Daniel Habtemariam
- Hebrew SeniorLife Institute for Aging Research, 1200 Centre Street, Boston Roslindale, MA, 02131, USA
| | - Ikechukwu Iloputaife
- Hebrew SeniorLife Institute for Aging Research, 1200 Centre Street, Boston Roslindale, MA, 02131, USA
| | - Junhong Zhou
- Hebrew SeniorLife Institute for Aging Research, 1200 Centre Street, Boston Roslindale, MA, 02131, USA.,Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Thomas G Travison
- Hebrew SeniorLife Institute for Aging Research, 1200 Centre Street, Boston Roslindale, MA, 02131, USA.,Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Hafström A. Low efficacy using the 256-Hz tuning fork when evaluating the influence of somatosensation in balance control for relatively healthy elderly. Acta Otolaryngol 2018; 138:937-944. [PMID: 30113876 DOI: 10.1080/00016489.2018.1488084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Diminished foot somatosensation contributes to balance deficits and increased fall risk. However, it remains unclear if the 256-Hz tuning fork is adequate to measure, in the outpatient clinical setting, somatosensation in relatively healthy elderly. AIMS/OBJECTIVES To evaluate the performance of the 256-Hz tuning fork compared to other measures of somatosensation and balance. MATERIAL AND METHODS Thirty-six subjects (mean 69.4 ± 5.3 years) were allocated into four 256-Hz tuning fork sensation groups (TFSG) based on their ability to detect vibration at the first metatarsal, malleolus, tibia or no sites. A biothesiometer measured vibration perception thresholds (VPTs) and 20 monofilaments tactile pressure sensation thresholds (TPSTs). Balance was evaluated with posturography, functional balance tests and questionnaires. RESULTS There were no significant differences in age, VPTs or TPSTs between the four TFSGs, nor in outcome of functional balance tests, posturography and questionnaires. Very few significant associations were found between TFSGs and VPTs, TPSTs, functional balance tests, posturography and questionnaires. CONCLUSIONS AND SIGNIFICANCE Somatosensation measured with a 256-Hz tuning fork seems to be a minor determinant for balance and thus superfluous when evaluating the importance of vibration perception for balance control in relatively healthy elderly.
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Affiliation(s)
- Anna Hafström
- Department of Otorhinolaryngology, Head and Neck Surgery, Skåne University Hospital, Lund, Sweden
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Jie F, Zafar M, Xu L, Shafqat R, Gao F. SENSITIVITY OF FOUR SIMPLE METHODS TO SCREEN CHINESE PATIENTS FOR DIABETIC PERIPHERAL NEUROPATHY. ACTA ENDOCRINOLOGICA (BUCHAREST, ROMANIA : 2005) 2018; 14:410-415. [PMID: 31149292 PMCID: PMC6525770 DOI: 10.4183/aeb.2018.410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
CONTEXT Diabetic peripheral neuropathy (DPN) is a common complication associated with long-term type 2 diabetes mellitus, although early diagnosis can improve prognosis. OBJECTIVE Our objective was to develop a simple protocol for early diagnosis of DPN in Chinese type 2 diabetic patients. SUBJECTS AND METHODS A total of 209 type 2 diabetic patients were included; these patients were categorized as symptomatic and asymptomatic group based on their symptoms. Clinical data of these patients were recorded and they were screened for DPN by vibration perception threshold test (VPT), 10-G nylon monofilament test, temperature identification, and the tendon reflex test. RESULTS The total combined rate of patients who were tested positive for DPN with all four screening methods was 68.7%. Patients tested positive for DPN were significantly older and had a longer disease duration than those who were tested negative (p<0.01); however, glycated hemoglobin levels, presence of hypertension, and gender did not differ significantly between them (p>0.05). Among screening methods, the highest positive rate observed among patients screened with the VPT test was 63.64% as compared to other tests. The total positive rate for temperature discrimination, 10-G monofilament and tendon reflex test were 26.79%, 11.96 % and 17.22 % respectively. In asymptomatic group VPT showed the highest positive rate for DPN (48.41%). CONCLUSIONS The combination of four simple methods can improve the detection rate of DPN and identify subclinical cases. Abnormal vibration perception was the most common feature of DPN and it was associated with both disease duration and the age of the patient.
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Affiliation(s)
- F.Y. Jie
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
- Department of Intensive Care Unit, Wuhan Third Hospital, Wuhan, China
| | - M.I. Zafar
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - L. Xu
- Department of Intensive Care Unit, Wuhan Third Hospital, Wuhan, China
| | - R.A. Shafqat
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - F. Gao
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
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Hafström A. Perceived and Functional Balance Control Is Negatively Affected by Diminished Touch and Vibration Sensitivity in Relatively Healthy Older Adults and Elderly. Gerontol Geriatr Med 2018; 4:2333721418775551. [PMID: 29900186 PMCID: PMC5990875 DOI: 10.1177/2333721418775551] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 03/07/2018] [Accepted: 03/19/2018] [Indexed: 11/17/2022] Open
Abstract
Background: Severe diminished foot somatosensation, for example, caused by neuropathies and advanced aging, contributes to balance deficits and increased fall risk. However, little is known about somatosensory impairment and functional and subjective balance problems in relatively healthy elderly. Method: Vibration perception thresholds (VPTs) were assessed with a biothesiometer and tactile pressure sensation thresholds (TPSTs) with 20 monofilaments in 34 relatively healthy community-dwelling older adults (M = 69.4 years). Balance was evaluated with functional balance tests and questionnaires. A stepwise regression analysis was performed to determine the extent to which VPTs, TPSTs, and age could explain balance impairments. Results: High VPTs had negative effects on Berg Balance Scale and Dizziness Handicap Inventory scores (p ≤ .011), as did high TPSTs on walking speed and Figure-8 test (p ≤ .001). With visual information available, one-leg standing time (OLST) was significantly affected by ipsilateral VPTs on solid and TPSTs on compliant surface (p ≤ .002). Without visual information, age was the only factor with a main effect on OLST (p < .001). Age had no significant correlations with TPSTs or VPTs. Discussion: Somatosensation appears to be very important for perceived as well as functional balance control in older adults. Our findings have important clinical implications when assessing balance impairment and impending fall risk.
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