Clinical examination for the detection of protective sensation in the feet of diabetic patients. International Cooperative Group for Clinical Examination Research

Details

Serval ID
serval:BIB_869171001D14
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Clinical examination for the detection of protective sensation in the feet of diabetic patients. International Cooperative Group for Clinical Examination Research
Journal
Journal of General Internal Medicine
Author(s)
Smieja  M., Hunt  D. L., Edelman  D., Etchells  E., Cornuz  J., Simel  D. L.
ISSN
0884-8734 (Print)
Publication state
Published
Issued date
07/1999
Volume
14
Number
7
Pages
418-24
Notes
Comparative Study
Journal Article
Multicenter Study
Research Support, U.S. Gov't, Non-P.H.S. --- Old month value: Jul
Abstract
OBJECTIVE: We compared the reproducibility and accuracy of conventional clinical examination of the diabetic foot to monofilament examination. We also sought to simplify the monofilament examination by reducing it to fewer touch points. METHODS: In a cross-sectional study at 10 centers in the United States, Canada, and Switzerland, general internists and residents performed a structured history and physical examination for neuropathy on the feet of diabetic patients. Independent examination by two observers included monofilament sensation, pinprick, vibration, position sense, and ankle reflexes. MAIN RESULTS: A total of 304 patients were examined by at least one practitioner, and 200 received duplicate examinations. Monofilament examination and ankle reflexes had the best reproducibility, with moderate agreement (kappa = 0.59); pinprick, position, and vibration sense had fair agreement (kappa = 0.28-0.36). No component of the history or physical examination, singly or in aggregate, was both sensitive and specific for identifying a patient with an abnormal monofilament examination. A simplified monofilament examination using only 4 sites per foot (total 8 sites) detected 90% of patients with an abnormal 16-site monofilament evaluation. CONCLUSIONS: Conventional clinical examination had low reproducibility and correlated poorly with monofilament examination for the identification of the at-risk patient. The Semmes-Weinstein monofilament examination, a reproducible, valid, and generalizable test of foot sensation, is recommended as the screening procedure of choice for examining diabetic feet.
Keywords
Adult Aged Aged, 80 and over Cross-Sectional Studies Diabetic Foot/diagnosis/*physiopathology Female Humans Logistic Models Male Middle Aged Physical Examination/*methods Predictive Value of Tests Reproducibility of Results Sensation Sensitivity and Specificity
Pubmed
Web of science
Create date
25/01/2008 13:41
Last modification date
20/08/2019 14:45
Usage data