Agreement between clinical screening procedures for neuropathy in the feet

Introduction: The correlation between monofila- ment testing, symptom surveys, and electrodiagnostic studies for the diagnosis of axonal polyneuropathy has not been well stud- ied. This investigation was done to assess the agreement between these procedures in a non-random sample of volun- teers. Methods: The procedures evaluated included electrodiag- nostic tests of the sural nerve, monofilament testing of the great toe, a symptom survey, and a body diagram. Kappa coefficients and sensitivity and specificity, using nerve conduction as a ' standard,' were used to determine the agreement between vari- ous combinations of procedures. Results: Poor agreement (kappa values � 0.12-0.44) and sensitivity (sensitivity <30%) were found for all combinations of symptoms and monofilament results in comparison with sural peak latency and amplitude. Conclusions: Overall, the results demonstrated a low discrimina- tory power for the screening procedures for identifying persons with impaired sural nerve function. The results highlight the need for further development and evaluation of screening methods for distal neuropathy in population-based studies. Muscle Nerve 45: 653-658, 2012 Peripheral neuropathy in the lower extremity is clinically important in the general population. Polyneuropathy can have a variety of causes, including exposure to toxins, metabolic disorders, or infection. The detection of mild peripheral neu- ropathy may require careful clinical examination and/or the use of electrodiagnostic testing. The American Academy of Neurology and others have offered consensus definitions of polyneuropathy. 1 Quick and accurate screening and clinical diagno- ses rely on high sensitivity and specificity for the methods employed. The sensitivity and specificity of the techniques employed significantly affect the outcomes of clinical screening and are also impor- tant for epidemiological research of peripheral neuropathy in the lower extremity. Several tools and procedures, such as electro- diagnostic testing, quantitative sensory tests, physi- cal examination procedures, body diagrams, and symptom questionnaires, have been employed for screening and epidemiological research of periph- eral neuropathy. Each of these tools and proce- dures has strengths and weaknesses. Both electro- diagnostic testing and quantitative sensory tests are highly reproducible and complementary to each other. 2-4 However, the role of quantitative sensory tests in the diagnosis of distal neuropathy requires further study. 1 The advantage of electrodiagnostic testing is that it provides an objective measure of peripheral nerve function, which clinical psycho- physical examinations do not offer. Therefore, to detect peripheral neuropathy in the lower extrem- ities, sural nerve conduction testing is considered to be an appropriate tool. 5 However, electrodiag- nostic testing requires specific equipment and training for examiners. The objective of this study was to assess the agreement between electrodiagnostic testing, monofilament testing, a lower extremity symptom survey, and a body diagram in the identification of possible peripheral neuropathy in the feet. The analysis for the assessment was carried out in a population of dental professionals.