Journal of Endocrinology and Metabolism, ISSN 1923-2861 print, 1923-287X online, Open Access |
Article copyright, the authors; Journal compilation copyright, J Endocrinol Metab and Elmer Press Inc |
Journal website http://www.jofem.org |
Original Article
Volume 1, Number 1, April 2011, pages 21-26
The Diagnostic Sensitivity, Specificity and Reproducibility of the Clinical Physical Examination Signs in Patients of Diabetes Mellitus for Making Diagnosis of Peripheral Neuropathy
Tables
Modality tested | Test procedure | Interpretation of abnormal test |
---|---|---|
Cutaneous sensations | Equipment: 10 g Semmes Weinstein monofilament Procedure: Cutaneous touch sensation tested on ten sites of spirit alcohol wiped foot. These sites were i) dorsal surface of the foot between the base of the first and second toes, ii) first toe, iii) third toe, iv) fifth toe, v) the first metatarsal head, vi) third metatarsal head, vii) fifth metatarsal head, viii) medial midfoot, ix) lateral midfoot and x) heel. The monofilament was pressed perpendicular to the test site with enough pressure to bend the monofilament for 1 sec. Patients was asked to answer “Yes” or “No”, when felt or did not feel the press of the monofilament, respectively. | If a patient did not perceive the filament at more than 4 out of 10 sites, then the test was considered abnormal. |
Vibration test | Equipment: 128 hertz vibration fork Procedure: The stimulus was applied over the distal phalanx of the large toe. The patient reported whether they felt vibration sense and then reported when it stoped in order to assess the minimal threshold to perceive the stimulus. | If the patient did not perceive the vibration it would be labeled as absent vibration sensation or impaired vibration. |
Ankle reflex | Equipment: Standard percussion hammer Procedure: The ankle reflex was elicited by holding the relaxed foot with one hand and striking the Achilles tendon with the hammer with other hand, and noting plantar flexion. | A positive result would be the jerking of the foot towards its plantar surface (plantar flexion) and the contraction of calf muscles and its absence was labeled as absent ankle reflex. |
Observer 1 (Medical student) vs. Observer 2 (Physician) | Impaired vibration | Impaired sensation | Absent ankle reflex |
---|---|---|---|
Percent agreement | 83 | 82 | 77 |
Kappa | 0.35 | 0.53 | 0.45 |
95% CI | 0.11 - 0.60 | 0.35 - 0.72 | 0.27 - 0.64 |
Variable | Sensitivity | Specificity | LR+ | LR- | PPV | NPV |
---|---|---|---|---|---|---|
Sensory | ||||||
Parasthesia | 50 (36.84 - 63.16) | 41.3 (27.82 - 55.86) | 0.85 | 1.21 | 50 (37.1 - 62.8) | 41.3 (28.88 - 55.66) |
Dysthesia | 50 (30.59 - 69.41) | 42.11 (31.40 - 43.40) | 0.86 | 1.18 | 21.4 (12.7 - 33.81) | 72.72 (58.15 - 83.65) |
Impaired vibration | 25.93 (15.58 - 38.79) | 80.43 (67.12 - 90.01) | 1.33 | 0.92 | 19.57 (9.99 - 32.880 | 74.07 (61.21 - 81.42) |
Impaired sensations | 27.78 (17.09 - 40.79) | 71.74 (57.53 - 83.29) | 0.98 | 1.01 | 53.57 (37.81 - 70.460 | 45.83 (34.82 - 57.26) |
Absent ankle reflex | 72.22 (59.21 - 82.91) | 45.65 (31.74 - 60.09) | 1.33 | 0.16 | 54.35 (39.91 - 68.26) | 27.78 (17.09 - 40.79) |
Motor | ||||||
Motor weakness symptom | 63.16 (47.11 - 77.22) | 40.32 (28.69 - 52.84) | 1.06 | 0.91 | 59.68 (47.16 - 71.31) | 36.84 (22.73 - 52.89) |
Absent ankle reflex | 78.95 (63.91 - 89.71) | 46.77 (34.64 - 59.20) | 1.48 | 0.45 | 52.23 (40.80 - 65.36) | 21.05 (10.29 - 36.09) |
Mixed | ||||||
Parasthesia | 50 (30.59 - 69.41) | 42.11 (31.40 - 43.40) | 0.86 | 1.18 | 21.42 (12.70 - 33.81) | 72.72 (58.15 - 83.65) |
Dysthesia | 66.67 (46.36 - 83.16) | 34.21 (24.22 - 45.39) | 1.01 | 0.97 | 65.79 (54.6 - 75.7) | 33.33 (16.84 - 53.64) |
Motor weakness symptom | 45.83 (26.96 - 65.66) | 32.89 (23.05 - 44.02) | 0.68 | 1.64 | 17.74 (10.2 - 29.0) | 65.48 (49.89 - 78.78) |
Impaired vibration | 25 (10.81 - 44.92) | 85.53 (76.24 - 92.15) | 1.73 | 0.88 | 14.47 (7.85 - 23.76) | 75 (55.08 - 89.18) |
Impaired sensations | 33.33 (16.84 - 53.64) | 72.37 (61.53 - 81.53) | 1.21 | 0.92 | 27.63 (18.47 - 38.47) | 66.67 (46.36 - 83.16) |
Absent ankle reflex | 75 (55.08 - 89.19) | 43.42 (32.63 - 54.71) | 1.33 | 0.58 | 56.58 (45.29 - 67.37) | 25 (10.81 - 44.92) |