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Chattopadhyay S, Goswami S, Sengupta N, Baidya A. Can the 128-Hz tuning fork be an alternative to the biothesiometer for diabetic peripheral neuropathy screening? A cross-sectional study in a tertiary hospital in East India. BMJ Open 2024; 14:e082193. [PMID: 38862223 PMCID: PMC11168183 DOI: 10.1136/bmjopen-2023-082193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 05/29/2024] [Indexed: 06/13/2024] Open
Abstract
INTRODUCTION Diabetic neuropathy is frequently underdiagnosed and undertreated. Logistic problems accompany the routine use of the biothesiometer. Hence, we attempted to find a more easily available alternative. RESEARCH DESIGN AND METHODS 149 patients with diabetes visiting the outpatient endocrinology clinic were assessed for vibration sense using a 128-Hz tuning fork (absolute timing method) and a biothesiometer. A reading of >25 V on the biothesiometer (known as vibration perception threshold or VPT) was taken as the diagnostic criterion for severe neuropathy while >15 V was used as an indicator of the mild form. The sensitivity and specificity were calculated by constructing the receiver operating characteristic curve (ROC). A p value of <0.05 was considered as statistically significant. RESULTS The timed tuning fork (TTF) test showed a statistically significant correlation with the VPT measurements (r=-0.5, p=0.000). Using the VPT findings as a reference, a timed tuning fork cut-off of 4.8 s was 76% sensitive and 77% specific in diagnosing mild neuropathy while absent tuning fork sensation demonstrated 70% sensitivity and 90% specificity in detecting severe neuropathy. CONCLUSIONS The tuning fork test demonstrated significant sensitivity and specificity in diagnosing diabetic peripheral neuropathy when compared against the biothesiometer. A cut-off of 4.8 s can be a useful indicator of the early stages of onset of the condition.
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Affiliation(s)
| | - Soumik Goswami
- Department of Endocrinology, Nilratan Sircar Medical College, Kolkata, West Bengal, India
| | - Nilanjan Sengupta
- Department of Endocrinology, Nilratan Sircar Medical College, Kolkata, West Bengal, India
| | - Arjun Baidya
- Department of Endocrinology, Nilratan Sircar Medical College, Kolkata, West Bengal, India
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Cardoso J, Rogean de Jesus Alves de Baptista C, Parra Buzzetti B, Dallemole Sartor C, Marques Júnior W, de Camargo Neves Sacco I, Mattiello-Sverzut AC. Vibration perception among children and adolescents with Charcot-Marie-tooth disease and implications for foot posture. Clin Biomech (Bristol, Avon) 2023; 110:106114. [PMID: 37804594 DOI: 10.1016/j.clinbiomech.2023.106114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 09/08/2023] [Accepted: 09/26/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Alterations in vibration perception among children and adolescents with Charcot-Marie-Tooth disease might explain observed changes in foot posture. Therefore, this cross-sectional study compared the vibration perception of the lower limbs in youths with and without Charcot-Marie-Tooth disease and verified the cut-off value of the distal vibration perception for the Charcot-Marie-Tooth group. In addition, associations between dynamic plantar pressure, vibration perception and isometric muscle strength were investigated. METHODS Participants aged 9-18 (Charcot-Marie-Tooth group n = 32; Typical group n = 32) had vibration perception measured by a 128-Hz graduated tuning fork. The static and dynamic foot posture were evaluated by the Foot Posture Index and pressure distribution measuring system, respectively. For the Charcot-Marie-Tooth group, a hand-held dynamometer evaluated the isometric muscle strength of the lower limbs. FINDINGS Children with Charcot-Marie-Tooth disease presented impaired vibration perception at the distal phalanx of the hallux and head of the first metatarsal compared to their typically developing peers, while adolescents with Charcot-Marie-Tooth disease showed impairment in all the tested regions compared to their typically developing peers. The cut-off value for vibration perception for participants with Charcot-Marie-Tooth disease was 5.7, considering the original grade of the tuning-fork 128 Hz. Among the associations established for the Charcot-Marie-Tooth group, a greater vibration perception at the distal phalanx of the hallux was associated with a longer rearfoot contact time (β = 31.02, p = 0.04). INTERPRETATION These new findings may guide the clinical evaluation and rehabilitation treatment for children and adolescents with Charcot-Marie-Tooth disease.
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Affiliation(s)
- Juliana Cardoso
- Health Science Department, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Beatriz Parra Buzzetti
- Health Science Department, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Cristina Dallemole Sartor
- Physical Therapy, Speech, and Occupational Therapy Department, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Wilson Marques Júnior
- Neuroscience and Behavioral Sciences Department, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Isabel de Camargo Neves Sacco
- Physical Therapy, Speech, and Occupational Therapy Department, School of Medicine, University of São Paulo, São Paulo, Brazil
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Wolf K, Beume LA, Hohenhaus M, Harloff A. The Rydel Seiffer tuning fork – Age and gender matter. Clin Neurol Neurosurg 2022; 221:107385. [DOI: 10.1016/j.clineuro.2022.107385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 11/26/2022]
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McIllhatton A, Lanting S, Lambkin D, Leigh L, Casey S, Chuter V. Reliability of recommended non-invasive chairside screening tests for diabetes-related peripheral neuropathy: a systematic review with meta-analyses. BMJ Open Diabetes Res Care 2021; 9:e002528. [PMID: 34952841 PMCID: PMC8710873 DOI: 10.1136/bmjdrc-2021-002528] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/14/2021] [Indexed: 01/08/2023] Open
Abstract
The objective is to determine, by systematic review, the reliability of testing methods for diagnosis of diabetes-related peripheral neuropathy (DPN) as recommended by the most recent guidelines from the International Diabetes Foundation, International Working Group on the Diabetic Foot and American Diabetes Association. Electronic searches of Cochrane Library, EBSCO Megafile Ultimate and EMBASE were performed to May 2021. Articles were included if they reported on the reliability of recommended chairside tests in diabetes cohorts. Quality appraisal was performed using a Quality Appraisal of Reliability Studies checklist and where possible, meta-analyses, with reliability reported as estimated Cohen's kappa (95% CI). Seventeen studies were eligible for inclusion. Pooled analysis found acceptable inter-rater reliability of vibration perception threshold (VPT) (κ=0.61 (0.50 to 0.73)) and ankle reflex testing (κ=0.60 (0.55 to 0.64)), but weak inter-rater reliability for pinprick (κ=0.45 (0.22 to 0.69)) and 128 Hz tuning fork (κ=0.42 (0.15 to 0.70)), though intra-rater reliability of the 128 Hz tuning fork was moderate (κ=0.54 (0.37 to 0.73)). Inter-rater reliability of the four-site monofilament was acceptable (κ=0.61 (0.45 to 0.77)). These results support the clinical use of VPT, ankle reflexes and four-site monofilament for screening and ongoing monitoring of DPN as recommended by the latest guidelines. The reliability of temperature perception, pinprick, proprioception, three-site monofilament and Ipswich touch test when performed in people with diabetes remains unclear.
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Affiliation(s)
- Ally McIllhatton
- Discipline of Podiatry, The University of Newcastle Faculty of Health and Medicine, Ourimbah, New South Wales, Australia
| | - Sean Lanting
- Discipline of Podiatry, The University of Newcastle Faculty of Health and Medicine, Ourimbah, New South Wales, Australia
| | - David Lambkin
- Hunter Medical Research Institute, The University of Newcastle, New Lambton, New South Wales, Australia
| | - Lucy Leigh
- Hunter Medical Research Institute, The University of Newcastle, New Lambton, New South Wales, Australia
| | - Sarah Casey
- Discipline of Podiatry, The University of Newcastle Faculty of Health and Medicine, Ourimbah, New South Wales, Australia
| | - Vivienne Chuter
- Discipline of Podiatry, The University of Newcastle Faculty of Health and Medicine, Ourimbah, New South Wales, Australia
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Wittenberg B, Svendsen TK, Gaist LM, Itani M, Gylfadottir SS, Jensen TS, Gaist D, Sindrup SH, Krøigård T. Test-retest and time dependent variation and diagnostic values of vibratory sensation determined by biothesiometer and the Rydel-Seiffer tuning fork. Brain Behav 2021; 11:e2230. [PMID: 34087955 PMCID: PMC8413738 DOI: 10.1002/brb3.2230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/21/2021] [Accepted: 05/19/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND AIMS Polyneuropathy is a common neurological disorder with many potential causes. An essential part in screening, diagnosis, and follow-up evaluation of polyneuropathy is testing of the sensory function including vibratory sensation. The graduated Rydel-Seiffer tuning fork and the biothesiometer have been developed to quantify vibratory sensation through detection thresholds. The aim of this study is to compare the vibration detection thresholds determined by the two instruments regarding intraindividual temporal changes, interindividual variation in healthy subjects and comparison of the diagnostic value in patients with a clinical suspicion of polyneuropathy. METHODS Ninety-four healthy subjects, 98 patients with and 97 patients without a diagnosis of polyneuropathy were included. Quantitative sensory testing including biothesiometry, structured clinical examination, and nerve conduction studies were performed three times during 52 weeks in healthy subjects and once in patients. RESULTS There were no significant changes over time for neither the Rydel-Seiffer tuning fork nor the biothesiometer, and both had larger between-subject variation than within-subject variation. Relative intertrial variability was largest for the biothesiometer. Diagnostic value (sensitivity, specificity, positive predictive value, and negative predictive value) was moderate for both methods (Rydel-Seiffer tuning fork: 58%, 74%, 70%, 64%; biothesiometer: 47%, 77%, 68%, 59%). INTERPRETATION The Rydel-Seiffer tuning fork and the biothesiometer have a low test-retest and time dependent variation. They perform almost equally as diagnostic tools in patients with suspected polyneuropathy with a tendency toward better performance of the tuning fork.
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Affiliation(s)
- Bolette Wittenberg
- Research Unit for Neurology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Toke K Svendsen
- Research Unit for Neurology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Laura M Gaist
- Research Unit for Neurology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Mustapha Itani
- Research Unit for Neurology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Sandra S Gylfadottir
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Troels S Jensen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - David Gaist
- Research Unit for Neurology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Søren H Sindrup
- Research Unit for Neurology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Thomas Krøigård
- Research Unit for Neurology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
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Akinci G, Savelieff MG, Gallagher G, Callaghan BC, Feldman EL. Diabetic neuropathy in children and youth: New and emerging risk factors. Pediatr Diabetes 2021; 22:132-147. [PMID: 33205601 PMCID: PMC11533219 DOI: 10.1111/pedi.13153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/02/2020] [Accepted: 11/12/2020] [Indexed: 12/23/2022] Open
Abstract
Pediatric neuropathy attributed to metabolic dysfunction is a well-known complication in children and youth with type 1 diabetes. Moreover, the rise of obesity and in particular of type 2 diabetes may cause an uptick in pediatric neuropathy incidence. However, despite the anticipated increase in neuropathy incidence, pathogenic insights and strategies to prevent or manage neuropathy in the setting of diabetes and obesity in children and youth remain unknown. Data from adult studies and available youth cohort studies are providing an initial understanding of potential diagnostic, management, and preventative measures in early life. This review discusses the current state of knowledge emanating from these efforts, with particular emphasis on the prevalence, clinical presentation, diagnostic approaches and considerations, and risk factors of neuropathy in type 1 and type 2 diabetes in children and youth. Also highlighted are current management strategies and recommendations for neuropathy in children and youth with diabetes. This knowledge, along with continued and sustained emphasis on identifying and eliminating modifiable risk factors, completing randomized controlled trials to assess effectiveness of strategies like weight loss and exercise, and enhancing awareness to support early detection and prevention, are pertinent to addressing the rising incidence of neuropathy associated with diabetes and obesity in children and youth.
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Affiliation(s)
- Gulcin Akinci
- Department of Neurology, University of Michigan Medicine, Ann Arbor, MI
| | | | - Gary Gallagher
- Department of Neurology, University of Michigan Medicine, Ann Arbor, MI
| | | | - Eva L. Feldman
- Department of Neurology, University of Michigan Medicine, Ann Arbor, MI
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Xirou S, Kokotis P, Zambelis T, Anagnostou E. Vibratory testing with the 64 Hz
Rydel‐Seiffer
tuning fork and its relation to the sural nerve action potential. J Peripher Nerv Syst 2020; 25:395-400. [DOI: 10.1111/jns.12418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/16/2020] [Accepted: 10/20/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Sophia Xirou
- Department of Neurology University of Athens Eginition Hospital, Athens Greece
| | - Panagiotis Kokotis
- Department of Neurology University of Athens Eginition Hospital, Athens Greece
| | - Thomas Zambelis
- Department of Neurology University of Athens Eginition Hospital, Athens Greece
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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: 2.4] [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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9
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Exercise improves functional capacity and lean body mass in patients with gastrointestinal cancer during chemotherapy: a single-blind RCT. Support Care Cancer 2018; 27:2159-2169. [DOI: 10.1007/s00520-018-4478-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 09/18/2018] [Indexed: 02/02/2023]
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Bozkurt A, Claeys KG, Schrading S, Rödler JV, Altinova H, Schulz JB, Weis J, Pallua N, van Neerven SGA. Clinical and biometrical 12-month follow-up in patients after reconstruction of the sural nerve biopsy defect by the collagen-based nerve guide Neuromaix. Eur J Med Res 2017; 22:34. [PMID: 28938917 PMCID: PMC5610476 DOI: 10.1186/s40001-017-0279-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 09/19/2017] [Indexed: 12/01/2022] Open
Abstract
Many new strategies for the reconstruction of peripheral nerve injuries have been explored for their effectiveness in supporting nerve regeneration. However only a few of these materials were actually clinically evaluated and approved for human use. This open, mono-center, non-randomized clinical study summarizes the 12-month follow-up of patients receiving reconstruction of the sural nerve biopsy defect by the collagen-based nerve guide Neuromaix. Neuromaix was implanted as a micro-structured, two-component scaffold bridging 20–40 mm nerve defects after sural nerve biopsy in twenty patients (eighteen evaluated, two lost in follow-up). Safety of the material was evaluated by clinical examination of wound healing. Performance was assessed by sensory testing of modalities, pain assessment, and palpation for the Hoffmann–Tinel’s sign as well as demarcating the asensitive area at each follow-up visit. Every patient demonstrated uneventful wound healing during the complete 12-month time course of the study. Two patients reported complete return of sensation, whereas eleven out of eighteen patients reported a positive Hoffmann–Tinel’s sign at the lower leg with simultaneous reduction of the asensitive area by 12 months. Our data show that Neuromaix can be implanted safely in humans to bridge sural nerve gaps. No procedure-related, adverse events, or severe adverse events were reported. These first clinical data on Neuromaix provide promising perspectives for the bridging of larger nerve gaps in combined nerves, which should be investigated more through extensive, multi-center clinical trials in the near future.
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Affiliation(s)
- Ahmet Bozkurt
- Department of Plastic Surgery, Reconstructive and Hand Surgery, Burn Center, RWTH Aachen University Hospital, Aachen, Germany.,Department of Plastic & Aesthetic, Reconstructive & Hand Surgery, Center for Reconstructive Microsurgery and Peripheral Nerve Surgery (ZEMPEN), Agaplesion Markus Hospital, Johann Wolfgang von Goethe University, Frankfurt, Germany
| | - Kristl G Claeys
- Department of Neurology, RWTH Aachen University Hospital, Aachen, Germany.,Institute of Neuropathology, RWTH Aachen University Hospital, Aachen, Germany.,Department of Neurology, University Hospitals Leuven and University of Leuven (KU Leuven), Louvain, Belgium
| | - Simone Schrading
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Jana V Rödler
- Department of Plastic Surgery, Reconstructive and Hand Surgery, Burn Center, RWTH Aachen University Hospital, Aachen, Germany
| | - Haktan Altinova
- Institute of Neuropathology, RWTH Aachen University Hospital, Aachen, Germany.,Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Jörg B Schulz
- Department of Neurology, RWTH Aachen University Hospital, Aachen, Germany.,Jülich-Aachen Research Alliance (JARA)-Translational Brain Medicine, Forschungszentrum Jülich GmbH and RWTH Aachen University, Aachen, Germany.,Jülich-Aachen Research Alliance (JARA)-Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Aachen, Germany
| | - Joachim Weis
- Institute of Neuropathology, RWTH Aachen University Hospital, Aachen, Germany.,Jülich-Aachen Research Alliance (JARA)-Translational Brain Medicine, Forschungszentrum Jülich GmbH and RWTH Aachen University, Aachen, Germany
| | - Norbert Pallua
- Department of Plastic Surgery, Reconstructive and Hand Surgery, Burn Center, RWTH Aachen University Hospital, Aachen, Germany
| | - Sabien G A van Neerven
- Department of Plastic Surgery, Reconstructive and Hand Surgery, Burn Center, RWTH Aachen University Hospital, Aachen, Germany. .,Institute of Neuropathology, RWTH Aachen University Hospital, Aachen, Germany. .,Institute of Neuroscience, Université Catholique de Louvain, Avenue Mounier 53, 1200, Brussels, Belgium.
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Alanazy MH, Alfurayh NA, Almweisheer SN, Aljafen BN, Muayqil T. The conventional tuning fork as a quantitative tool for vibration threshold. Muscle Nerve 2017; 57:49-53. [PMID: 28466970 DOI: 10.1002/mus.25680] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 04/06/2017] [Accepted: 04/25/2017] [Indexed: 11/11/2022]
Abstract
INTRODUCTION This study was undertaken to describe a method for quantifying vibration when using a conventional tuning fork (CTF) in comparison to a Rydel-Seiffer tuning fork (RSTF) and to provide reference values. METHODS Vibration thresholds at index finger and big toe were obtained in 281 participants. Spearman's correlations were performed. Age, weight, and height were analyzed for their covariate effects on vibration threshold. Reference values at the fifth percentile were obtained by quantile regression. RESULTS The correlation coefficients between CTF and RSTF values at finger/toe were 0.59/0.64 (P = 0.001 for both). Among covariates, only age had a significant effect on vibration threshold. Reference values for CTF at finger/toe for the age groups 20-39 and 40-60 years were 7.4/4.9 and 5.8/4.6 s, respectively. Reference values for RSTF at finger/toe for the age groups 20-39 and 40-60 years were 6.9/5.5 and 6.2/4.7, respectively. DISCUSSION CTF provides quantitative values that are as good as those provided by RSTF. Age-stratified reference data are provided. Muscle Nerve 57: 49-53, 2018.
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Affiliation(s)
- Mohammed H Alanazy
- Department of Internal Medicine, Division of Neurology, King Saud University Medical City and College of Medicine, King Saud University, PO Box 7805, Riyadh, 11472, Saudi Arabia
| | - Nuha A Alfurayh
- Department of Internal Medicine, Division of Neurology, King Saud University Medical City and College of Medicine, King Saud University, PO Box 7805, Riyadh, 11472, Saudi Arabia
| | - Shaza N Almweisheer
- Department of Internal Medicine, Division of Neurology, King Saud University Medical City and College of Medicine, King Saud University, PO Box 7805, Riyadh, 11472, Saudi Arabia
| | - Bandar N Aljafen
- Department of Internal Medicine, Division of Neurology, King Saud University Medical City and College of Medicine, King Saud University, PO Box 7805, Riyadh, 11472, Saudi Arabia
| | - Taim Muayqil
- Department of Internal Medicine, Division of Neurology, King Saud University Medical City and College of Medicine, King Saud University, PO Box 7805, Riyadh, 11472, Saudi Arabia
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Amin N, Doupis J. Diabetic foot disease: From the evaluation of the “foot at risk” to the novel diabetic ulcer treatment modalities. World J Diabetes 2016; 7:153-164. [PMID: 27076876 PMCID: PMC4824686 DOI: 10.4239/wjd.v7.i7.153] [Citation(s) in RCA: 168] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 11/02/2015] [Accepted: 02/16/2016] [Indexed: 02/05/2023] Open
Abstract
The burden of diabetic foot disease (DFD) is expected to increase in the future. The incidence of DFD is still rising due to the high prevalence of DFD predisposing factors. DFD is multifactorial in nature; however most of the diabetic foot amputations are preceded by foot ulceration. Diabetic peripheral neuropathy (DPN) is a major risk factor for foot ulceration. DPN leads to loss of protective sensation resulting in continuous unconscious traumas. Patient education and detection of high risk foot are essential for the prevention of foot ulceration and amputation. Proper assessment of the diabetic foot ulceration and appropriate management ensure better prognosis. Management is based on revascularization procedures, wound debridement, treatment of infection and ulcer offloading. Management and type of dressing applied are tailored according to the type of wound and the foot condition. The scope of this review paper is to describe the diabetic foot syndrome starting from the evaluation of the foot at risk for ulceration, up to the new treatment modalities.
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Fernando ME, Crowther RG, Cunningham M, Lazzarini PA, Sangla KS, Golledge J. Lower limb biomechanical characteristics of patients with neuropathic diabetic foot ulcers: the diabetes foot ulcer study protocol. BMC Endocr Disord 2015; 15:59. [PMID: 26499881 PMCID: PMC4619003 DOI: 10.1186/s12902-015-0057-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 10/15/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Foot ulceration is the main precursor to lower limb amputation in patients with type 2 diabetes worldwide. Biomechanical factors have been implicated in the development of foot ulceration; however the association of these factors to ulcer healing remains less clear. It may be hypothesised that abnormalities in temporal spatial parameters (stride to stride measurements), kinematics (joint movements), kinetics (forces on the lower limb) and plantar pressures (pressure placed on the foot during walking) contribute to foot ulcer healing. The primary aim of this study is to establish the biomechanical characteristics (temporal spatial parameters, kinematics, kinetics and plantar pressures) of patients with plantar neuropathic foot ulcers compared to controls without a history of foot ulcers. The secondary aim is to assess the same biomechanical characteristics in patients with foot ulcers and controls over-time to assess whether these characteristics remain the same or change throughout ulcer healing. METHODS/DESIGN The design is a case-control study nested in a six-month longitudinal study. Cases will be participants with active plantar neuropathic foot ulcers (DFU group). Controls will consist of patients with type 2 diabetes (DMC group) and healthy participants (HC group) with no history of foot ulceration. Standardised gait and plantar pressure protocols will be used to collect biomechanical data at baseline, three and six months. Descriptive variables and primary and secondary outcome variables will be compared between the three groups at baseline and follow-up. DISCUSSION It is anticipated that the findings from this longitudinal study will provide important information regarding the biomechanical characteristic of type 2 diabetes patients with neuropathic foot ulcers. We hypothesise that people with foot ulcers will demonstrate a significantly compromised gait pattern (reduced temporal spatial parameters, kinematics and kinetics) at base line and then throughout the follow-up period compared to controls. The study may provide evidence for the design of gait-retraining, neuro-muscular conditioning and other approaches to off-load the limbs of those with foot ulcers in order to reduce the mechanical loading on the foot during gait and promote ulcer healing.
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Affiliation(s)
- Malindu Eranga Fernando
- Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia.
- Movement analysis Laboratory, Discipline of Sports and Exercise Science, James Cook University, Townsville, Australia.
- Podiatry Service, Kirwan Community Health Campus, Townsville, QLD, Australia.
| | - Robert George Crowther
- Movement analysis Laboratory, Discipline of Sports and Exercise Science, James Cook University, Townsville, Australia.
- Sport and Exercise, School of Health and Wellbeing, University of Southern Queensland, Brisbane, Australia.
| | - Margaret Cunningham
- Department of Health Sciences, University of Stirling, Stirling, Scotland, UK.
| | - Peter Anthony Lazzarini
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Queensland Health, Brisbane, Australia.
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia.
| | | | - Jonathan Golledge
- Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia.
- Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Australia.
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Immediate Influence of Carbon Composite Ankle-Foot Orthoses on Balance and Gait in Individuals with Peripheral Neuropathy. ACTA ACUST UNITED AC 2014. [DOI: 10.1097/jpo.0000000000000040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Yang Z, Zhang Y, Chen R, Huang Y, Ji L, Sun F, Hong T, Zhan S. Simple tests to screen for diabetic peripheral neuropathy. Cochrane Database Syst Rev 2014. [DOI: 10.1002/14651858.cd010975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Zhirong Yang
- School of Public Health, Peking University; Centre for Evidence Based Medicine and Clinical Research, Department of Epidemiology and Biostatistics; 38 Xueyuan Road, Haidian District Beijing China 100191
- Shantou University Medical College; Shantou-Oxford Clinical Research Unit; Shantou, Guangdong China 515041
| | - Yuan Zhang
- McMaster University; Department of Clinical Epidemiology and Biostatistics; 1280 Main Street West Hamilton Ontario Canada L8S4K1
| | - Ru Chen
- School of Public Health, Peking University; Centre for Evidence Based Medicine and Clinical Research, Department of Epidemiology and Biostatistics; 38 Xueyuan Road, Haidian District Beijing China 100191
| | - Yuansheng Huang
- School of Public Health, Peking University; Centre for Evidence Based Medicine and Clinical Research, Department of Epidemiology and Biostatistics; 38 Xueyuan Road, Haidian District Beijing China 100191
| | - Linong Ji
- Peking University People's Hospital; Department of Endocrinology; 11 Xizhimen South Street Xicheng District Beijing China 100044
| | - Feng Sun
- School of Public Health, Peking University; Centre for Evidence Based Medicine and Clinical Research, Department of Epidemiology and Biostatistics; 38 Xueyuan Road, Haidian District Beijing China 100191
| | - Tianpei Hong
- Peking University Third Hospital; Department of Endocrinology; 49 North Huayuan Road Haidian District Beijing China 100191
| | - Siyan Zhan
- School of Public Health, Peking University; Centre for Evidence Based Medicine and Clinical Research, Department of Epidemiology and Biostatistics; 38 Xueyuan Road, Haidian District Beijing China 100191
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Whitton TL, Johnson RW, Lovell AT. Use of the Rydel-Seiffer graduated tuning fork in the assessment of vibration threshold in postherpetic neuralgia patients and healthy controls. Eur J Pain 2012; 9:167-71. [PMID: 15737809 DOI: 10.1016/j.ejpain.2004.05.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2004] [Accepted: 05/06/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS Afferent large fibre impairment has been reported as a useful predictor of postherpetic neuralgia (PHN) in patients with acute herpes zoster infection, using an electromechanical device to provide quantitative vibrametry. We aimed to demonstrate a clinically significant increase in vibration threshold in individuals with PHN compared to age-matched controls, using the portable and affordable Rydel-Seiffer graduated tuning fork. METHODS We studied 45 PHN subjects aged over 55 years, and 45 age-matched controls with no history of herpes zoster infection. We excluded subjects with a history of disorders associated with neuropathy or immunocompromise. Measurements were performed at the ulnar styloid process and the head of the first metatarsal on the right side, in a warm room with the subject seated. Readings were taken in triplicate and the data analysed by a repeated measures design. RESULTS We observed a significant difference in vibration threshold at both wrist and toe between the PHN and control groups (p < 0.001). Age-stratification of subjects produced an increased and clinically useful difference between the two groups at both sites in subjects between 55 and 70 years (p < 0.0001). CONCLUSIONS We have shown a statistically significant decrease in vibration sensitivity in individuals with PHN aged 55-70 years compared to age-matched healthy controls, using the Rydel-Seiffer graduated tuning fork. A prospective study of patients with acute zoster infection is needed to determine the sensitivity and specificity of the graduated tuning fork in predicting PHN in patients with acute zoster infection.
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Cettomai D, Kwasa J, Kendi C, Birbeck GL, Price RW, Bukusi EA, Cohen CR, Meyer AC. Utility of quantitative sensory testing and screening tools in identifying HIV-associated peripheral neuropathy in Western Kenya: pilot testing. PLoS One 2010; 5:e14256. [PMID: 21170387 PMCID: PMC2999535 DOI: 10.1371/journal.pone.0014256] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 11/09/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND/AIM Neuropathy is the most common neurologic complication of HIV but is widely under-diagnosed in resource-constrained settings. We aimed to identify tools that accurately distinguish individuals with moderate/severe peripheral neuropathy and can be administered by non-physician healthcare workers (HCW) in resource-constrained settings. METHODS We enrolled a convenience sample of 30 HIV-infected outpatients from a Kenyan HIV-care clinic. A HCW administered the Neuropathy Severity Score (NSS), Single Question Neuropathy Screen (Single-QNS), Subjective Peripheral Neuropathy Screen (Subjective-PNS), and Brief Peripheral Neuropathy Screen (Brief-PNS). Monofilament, graduated tuning fork, and two-point discrimination examinations were performed. Tools were validated against a neurologist's clinical assessment of moderate/severe neuropathy. RESULTS The sample was 57% male, mean age 38.6 years, and mean CD4 count 324 cells/µL. Neurologist's assessment identified 20% (6/30) with moderate/severe neuropathy. Diagnostic utilities for moderate/severe neuropathy were: Single-QNS--83% sensitivity, 71% specificity; Subjective-PNS-total--83% sensitivity, 83% specificity; Subjective-PNS-max and NSS--67% sensitivity, 92% specificity; Brief-PNS--0% sensitivity, 92% specificity; monofilament--100% sensitivity, 88% specificity; graduated tuning fork--83% sensitivity, 88% specificity; two-point discrimination--75% sensitivity, 58% specificity. CONCLUSIONS Pilot testing suggests Single-QNS, Subjective-PNS, and monofilament examination accurately identify HIV-infected patients with moderate/severe neuropathy and may be useful diagnostic tools in resource-constrained settings.
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Affiliation(s)
- Deanna Cettomai
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
| | - Judith Kwasa
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Caroline Kendi
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Gretchen L. Birbeck
- International Neurologic and Psychiatric Epidemiology Program, Michigan State University, East Lansing, Michigan, United States of America
| | - Richard W. Price
- Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
| | - Elizabeth A. Bukusi
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Craig R. Cohen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Ana-Claire Meyer
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
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[Health status of type 2 diabetics in Austria - perspective of a quality improvement initiative]. Wien Med Wochenschr 2009; 159:126-33. [PMID: 19343289 DOI: 10.1007/s10354-009-0659-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Accepted: 01/20/2009] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine the prevalence of late complications in a large clinical sample of type 2 diabetic patients in Austria. METHODS Data of all patients with type 2 diabetes entered into the database of the Forum for Quality Systems in Diabetes Care Austria (FQSD-A) between 1 January 1997 and 1 September 2007 were used for the analyses. RESULTS Data from 23,641 persons with Type 2 Diabetes Mellitus were collected. Patients were 66.3 +/- 11.5 years old, with an average diabetes duration of 8.0 +/- 8.5 years. Prevalence of blindness, amputation, myocardial infarction or bypass, stroke and end stage renal failure was 0.9%, 2.3%, 12.2%, 8.7% and 0.8%, respectively. CONCLUSIONS Prevalence of late diabetic complications in Austria is high compared with other European countries. The management of persons with Type 2 Diabetes should be further optimized to reduce the incidence of late complications of diabetes.
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Abstract
BACKGROUND AND OBJECTIVES Foot ulcers are one of the main complications in diabetes mellitus, with a 15% lifetime risk in all diabetic patients. The rate of lower extremity amputation among diabetic patients is 17-40 times higher than in non-diabetics. A critical triad of neuropathy, minor foot trauma and foot deformity was found in > 63% of diabetic foot ulcers (DFU). Peripheral vascular disease (PVD) has been identified in 30% of foot ulcers. We present a comprehensive assessment and the treatment of DFUs. We also want to notify physicians not to ignore foot assessment and examinations in patients with diabetes. METHODS We conducted this study on DFU on the basis of: pathogenesis and risk factors, assessment and physical examination, paraclinic assessment, treatment, cost and mortality and prevention. RESULTS AND FINDINGS Approximately 20% of hospital admissions among diabetic patients are the result of foot problems. Diabetic foot assessment should include dermatological, vascular, neurological and musculoskeletal systems. There are three basic treatments for management of DFU: (i) debridement; (ii) antibiotics and (iii) revascularization. The cost to treat one simple ulcer is $5000 to $8000. CONCLUSION Awareness of physicians about foot problems in diabetic patients, clinical examination and paraclinical assessment, regular foot examination, patient education, simple hygienic practices and provision of appropriate footwear combined with prompt treatment of minor injuries can decrease ulcer occurrence by 50%.
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Affiliation(s)
- A Shojaie Fard
- Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Juma A, Mandal A. Vibration sensitivity testing with tuning fork—256 Hz or 512 Hz? EUROPEAN JOURNAL OF PLASTIC SURGERY 2007. [DOI: 10.1007/s00238-007-0125-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Garrow AP, Boulton AJM. Vibration perception threshold--a valuable assessment of neural dysfunction in people with diabetes. Diabetes Metab Res Rev 2006; 22:411-9. [PMID: 16741996 DOI: 10.1002/dmrr.657] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Diabetic peripheral neuropathy (DPN) has been identified as a key element in the causal pathway to foot ulceration and other lower-extremity complications, impaired quality of life and increased mortality. Early detection is essential to optimise effective risk management, including adequate foot care, patient education, and future pharmacological therapy. However, data suggest that screening has been mostly sub-optimal, and many physicians remain unfamiliar with non-invasive screening tests. There is evidence in the literature to suggest that vibration perception threshold (VPT) measures can be used to easily and accurately identify at-risk diabetic patients, including those with early neuropathic deficits. These measures have been used in population-based studies and are associated with an increased risk of severe and expensive outcomes, such as ulcers and amputations. Incorporating VPT testing into clinical practice has the potential to significantly improve the outcomes in patients with DPN, thereby substantially reducing the socio-economic burden of this common and challenging disease.
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Affiliation(s)
- Adam P Garrow
- Diabetes Foot Clinic, Disablement Services Centre, Withington Hospital, Manchester, UK.
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O'Neill J, McCann SM, Lagan KM. Tuning fork (128 Hz) versus neurothesiometer: a comparison of methods of assessing vibration sensation in patients with diabetes mellitus. Int J Clin Pract 2006; 60:174-8. [PMID: 16451290 DOI: 10.1111/j.1742-1241.2005.00650.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The current study compared the effectiveness of the graduated tuning fork (128 Hz) and the neurothesiometer in assessing vibration sensation perception in patients presenting with type II diabetes mellitus. A quota sample of patients (n = 21; age range 43-73 years) were assessed using the neurothesiometer and tuning fork by two investigators at five sites on both feet. There was a positive correlation between the results for the two methods of assessment for both investigators, and also between the results for both tools at three individual sites. Overall, there was 66.2% agreement between the results obtained from the two investigators using the tuning fork at each site; however, Kappa values only reached statistical significance at one site, indicating variability between the results from the two tools. This study suggests that assessment of vibration sensation with the tuning fork may be unreliable. These preliminary findings are based on a small sample size; thus further research is warranted.
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Affiliation(s)
- J O'Neill
- School of Health Sciences, Podiatry Department,School of Psychology, University of Ulster, N Ireland
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Kästenbauer T, Sauseng S, Brath H, Abrahamian H, Irsigler K. The value of the Rydel-Seiffer tuning fork as a predictor of diabetic polyneuropathy compared with a neurothesiometer. Diabet Med 2004; 21:563-7. [PMID: 15154940 DOI: 10.1111/j.1464-5491.2004.01205.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
AIMS The aim of the study was to investigate the predictive value of the Rydel-Seiffer tuning fork for detecting diabetic neuropathy and to compare it with an electronic neurothesiometer. METHODS In 2022 consecutive diabetic subjects, peripheral polyneuropathy was diagnosed by vibration perception threshold (VPT) at the tip of both great toes using a 128-Hz tuning fork and a neurothesiometer, by simple bedside tests and by the presence of neuropathic symptoms. These evaluations were further combined to diagnose peripheral nerve dysfunction (abnormal bedside tests) and symptomatic neuropathy. VPT was also measured in 175 non-diabetic control subjects to define normal values. RESULTS VPT was normal in 1917 subjects and abnormal in 105 (5.2%) patients when measured by the tuning fork. Patients with an abnormal vibration test were significantly (P < 0.0001) older than subjects with a normal vibration sense, while diabetes duration and HbA(1c) of the former were also significantly elevated. The same was true for the percentages of an abnormal 10-g monofilament test (66.7% vs. 7.2%, P < 0.0001) and a missing Achilles' tendon reflex (68.6% vs. 24.8%, P < 0.0001). Finally, the VPT measured by the neurothesiometer was 2.5 times higher in patients with an abnormal tuning fork test (32.0 +/- 9.8 vs. 12.5 +/- 6.4 V, P < 0.0001). The plot of the difference of both methods against their mean yielded a good agreement of the two VPT measurements, and the tuning fork had a high sensitivity and positive predictive value for the diagnosis of abnormal bedside tests and for symptomatic neuropathy. CONCLUSION The tuning fork reliably detected peripheral neuropathy in comparison with the neurothesiometer. A tuning fork is a useful screening test for diabetic neuropathy.
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Affiliation(s)
- T Kästenbauer
- L. Boltzmann Institute of Metabolic Diseases and Nutrition, Hospital Lainz, Vienna, Austria.
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Plank J, Haas W, Rakovac I, Görzer E, Sommer R, Siebenhofer A, Pieber TR. Evaluation of the impact of chiropodist care in the secondary prevention of foot ulcerations in diabetic subjects. Diabetes Care 2003; 26:1691-5. [PMID: 12766095 DOI: 10.2337/diacare.26.6.1691] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the influence of regular chiropodist care on the recurrence rate of diabetic foot ulcers within 1 year. RESEARCH DESIGN AND METHODS Ninety-one diabetic outpatients with healed foot ulcers (age 65 +/- 11 years, 40 women and 51 men, diabetes type 1 (n = 6) or 2 (n = 85), BMI 28.5 +/- 4.4, diabetes duration 16 +/- 11 years, HbA(1c) 8.4 +/- 1.6%) were randomized to a group that received monthly remunerated routine chiropodist care (n = 47) or a control group (n = 44). RESULTS Within a median follow-up of 386 days, ulceration recurred in 18 patients in the chiropodist group and 25 patients in the control group (hazard ratio [HR] 0.60; 95% CI, 0.32, 1.08; P = 0.09). Analysis of ulceration per foot demonstrated a significant reduction (20 vs. 32 ulcerations; Cox relative risk [Cox RR] 0.52; 95% CI, 0.30, 0.93; P = 0.03) in favor of chiropodist care. Per protocol, analysis of patients who actually underwent chiropodist foot care on a regular basis also indicates the beneficial influence of chiropodist care with ulceration in 13 vs. 30 patients (HR, 0.53; 95% CI, 0.30-1.01; P = 0.05) and in 15 vs. 37 feet (Cox RR, 0.46; 95% CI, 0.24-0.90; P = 0.02) for the intervention and control groups, respectively. Minor amputation was required in two patients in the intervention group and one patient in the control group. Four patients in the control group and two patients in the intervention group died during the trial. CONCLUSIONS These data suggest that secondary preventive measures by a chiropodist may reduce recurrence of foot ulcers in diabetic patients.
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Affiliation(s)
- Johannes Plank
- Division of Diabetes und Metabolism, Department of Internal Medicine, Karl-Franzens University Hospital, Graz, Austria.
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Abstract
PURPOSE To provide physicians and nurses with an overview of diabetic foot assessment. TARGET AUDIENCE This continuing-education activity is intended for physicians and nurses with an interest in learning about proper diabetic foot assessment. OBJECTIVES After reading the article and taking the test, the participant will be able to: 1. Review the epidemiology of diabetes, diabetic foot ulcers, and lower-extremity amputation related to diabetes. 2. Identify risk factors for foot ulceration in patients with diabetes. 3. Identify normal and abnormal findings in the dermatologic, vascular, neurologic, and musculoskeletal assessment of the foot in patients with diabetes.
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Affiliation(s)
- Steven R Kravitz
- Wound Healing Center, Temple University School of Podiatric Medicine, Philadelphia, PA, USA
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Ziegler D, Luft D. Clinical trials for drugs against diabetic neuropathy: can we combine scientific needs with clinical practicalities? INTERNATIONAL REVIEW OF NEUROBIOLOGY 2003; 50:431-63. [PMID: 12198820 DOI: 10.1016/s0074-7742(02)50085-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Diabetic neuropathy is a chronic progressive disease accounting for considerable morbidity and reduced quality of life among patients with diabetes. Accumulating evidence suggests that the clinical and neurophysiological markers used to assess neuropathy not only predict the development of neuropathic foot ulceration, one of the most common causes for hospital admission and lower limb amputations, but are also predictors of increased mortality in diabetic patients. In addition to metabolic control, drug treatment of both incipient and clinically manifest diabetic neuropathy will be necessary for the years to come. Because 1-2% of the whole population in western societies may be affected, the search for effective drug treatment is not only a very important goal for the patient suffering from diabetic neuropathy and for the practicing physician, but also an economic task for both the health care systems and pharmaceutical companies. The validity of inferences about the clinical consequences of the use of any given agent to induce a specific pharmacologic effect will depend not only on the extent to which it affects the targeted biological phenomenon, but also on the extent to which all of the actions of the agent have been defined and the extent to which all affect the entire organism, alone and in concert. The ultimate test of the usefulness of a drug or device depends on the determination of outcomes, ideally in randomized clinical trials (RCTs) of sufficient scope and duration. The efficacy and safety of a variety of drugs based on the different pathogenetic hypotheses proposed have been evaluated in RCTs since the 1970s. However, the quality of RCTs published between 1981 and 1992 that evaluated the effects of medical treatment in diabetic polneuropathy was poor. Adequate designs for RCTs in diabetic neuropathy must consider the following criteria: type and stage of neuropathy, homogeneity of the study population, outcome measures (neurophysiological markers, intermediate clinical end points, ultimate clinical outcomes, quality of life), natural history, sample size, study duration, reproducibility of neurophysiological and intermediate end points, nonspecific effects of treatment, measures of treatment effect, the extent to which the overall trail result applies to individual patients (external validity), and the reporting of the RCTs. Trials focusing preferentially on patients with mild or moderate early stages of neuropathy over long periods of 3-5 years aimed at slowing or prevention, rather than reversal, using end point measures that have clinical and prognostic significance are most likely to produce meaningful results.
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Affiliation(s)
- Dan Ziegler
- German Diabetes Research Institute at the Heinrich Heine University, German Diabetes Clinic, 40225 Düsseldorf, Germany
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Abstract
When 'at risk' patients say that their feet are killing them, they may be right. Diabetes mellitus accounts for 50 to 70% of all nontraumatic amputations with a three year survival rate of those who undergo a lower limb amputation of 50%. Furthermore, when compared to the 'normal' foot, the 'at risk' foot is more likely to develop complications, thus it is vital to identify such 'at risk' individuals in an attempt to prevent the risk of deformity, ulceration, infection and/or necrosis/gangrene. The assessment involves history taking, the examination and further investigations, providing the necessary information to make a clinical diagnosis and identify 'at risk' groups. During the examination the foot-wear should be checked, nails and skin condition should be closely inspected and tests should be carried out for signs of peripheral neuropathy, ischaemia and venous/lymphatic deficiency. Other complications like deformity and increases in foot pressure may cause ulceration. Where ulcers are present, an in-depth systematic inspection is necessary. A thorough lower limb examination of high risk patients provides the necessary information to make a clinical diagnosis and plan preventative measures to avoid future complications.
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Affiliation(s)
- D Santos
- Department of Podiatry & Radiography, Queen Margaret University College, Leith Campus, Duke Street, Edinburgh EH6 8HF
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Mason J, O'Keeffe C, McIntosh A, Hutchinson A, Booth A, Young RJ. A systematic review of foot ulcer in patients with Type 2 diabetes mellitus. I: prevention. Diabet Med 1999; 16:801-12. [PMID: 10547206 DOI: 10.1046/j.1464-5491.1999.00133.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM To evaluate the role of preventative strategies in reducing foot ulcers in patients with Type 2 diabetes mellitus, both in the general population and those identified to be at a raised risk. METHOD A systematic review of interventions to prevent diabetic foot ulcers. RESULTS Available studies are generally unsatisfactory in their ability to answer the important questions relating to prevention. However, where people with diabetes receive well-organized and regular care with rapid referral to appropriate specialist multidisciplinary teams when problems (or their precursors) occur, ulcer morbidity can be substantially reduced. CONCLUSION Foot ulcers are common in people with diabetes and are costly in terms of both patient morbidity and the use of healthcare resources. Although it is nearly a decade since the St Vincent Declaration called for a marked reduction in morbidity to be achieved through better patient management, available evidence suggests that the process of care in Britain is still very variable in quality. Foot care for people with diabetes must be organized to provide monitoring, education and referral in a manner acceptable to patients and realistic for local healthcare providers.
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Affiliation(s)
- J Mason
- Medicines Evaluation Group, Centre for Health Economics, University of York, UK.
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Martina IS, van Koningsveld R, Schmitz PI, van der Meché FG, van Doorn PA. Measuring vibration threshold with a graduated tuning fork in normal aging and in patients with polyneuropathy. European Inflammatory Neuropathy Cause and Treatment (INCAT) group. J Neurol Neurosurg Psychiatry 1998; 65:743-7. [PMID: 9810949 PMCID: PMC2170371 DOI: 10.1136/jnnp.65.5.743] [Citation(s) in RCA: 176] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To provide clinically useful vibration threshold normal values. METHODS The graduated Rydel-Seiffer tuning fork was evaluated in 198 healthy controls and 59 patients with a polyneuropathy. The measures were done in triplicate at four locations: the distal interphalangeal joint of the index finger, ulnar styloid process, interphalangeal joint of the hallux, and internal malleolus. The values obtained with this tuning fork in healthy controls and patients with polyneuropathy were compared with the values of an electronic device, the Vibrameter. RESULTS Vibration sense was better perceived in the arms compared with the legs. There was a significant age related decline of vibration sense at all locations. The values from the Rydel-Seiffer tuning fork and the Vibrameter were significantly correlated in both groups. The sensitivity of these two instruments for the four sites examined in the polyneuropathy group ranged from 29-76% and 31-73%, respectively and was the highest at the hallux for both instruments. CONCLUSION This study provides clinical useful normal values of vibration threshold for the Rydel-Seiffer tuning fork. This is a simple and easily applicable instrument that assesses vibration sense semiquantitatively and should therefore have a place in routine neurological examination.
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Affiliation(s)
- I S Martina
- Department of Neurology, University Hospital Rotterdam, The Netherlands
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Verrotti A, Chiarelli F, Amerio P, Morgese G. Necrobiosis lipoidica diabeticorum in children and adolescents: a clue for underlying renal and retinal disease. Pediatr Dermatol 1995; 12:220-3. [PMID: 7501550 DOI: 10.1111/j.1525-1470.1995.tb00162.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The prevalence of persistent microalbuminuria, retinopathy, and peripheral and autonomic neuropathy was assessed in 18 children and adolescents with type 1 (insulin-dependent) diabetes mellitus (IDDM) who suffered from necrobiosis lipoidica diabeticorum (NLD) and in 40 diabetics without NLD, matched for sex, age, duration of disease, and metabolic control. The mean +/- SD age of the patients was 15.1 +/- 8.6 years (range 7.9-23.9 yrs) and their duration of IDDM was 10.9 +/- 8.1 years (range 7.1-21.0 yrs). Their mean glycosylated hemoglobin level was 9.9 +/- 5.0% (7.3-16.6%) and their fructosamine level was 274 +/- 180 mumol/L (199-466 mumol/L). Patients with NLD had a higher frequency of persistent microalbuminuria (p < 0.001) and retinopathy (p < 0.001) than those without NLD. Our study suggests that children as well as adult diabetics with NLD can be at high risk for nephropathy and retinopathy; NLD can be a clue for diabetic nephropathy and retinopathy.
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Affiliation(s)
- A Verrotti
- Department of Pediatrics, University of Chieti, Italy
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