The study was approved by the Medical Ethics Committee of the University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. Participants’ demographic data were recorded at the first session. Normal reflex item is scored 0, reduced reflex item is scored 1 and the lack of reflex item is scored 2. Symptom and sensation items answered as yes or no are given scores 0 and 1, respectively. TCNS consists of 13 items 6 items focusing on symptoms, two items testing reflexes and 5 items assessing sensation. Neuropathy severity was assessed by the Toronto Clinical Neuropathy Score (TCNS) to maintain the patient’s condition during the two test sessions.
#Tuning fork test foot skin
Participants with skin ulcer or scar in the testing site, vascular diseases (absence of at least one foot pulse) and other causes of neuropathy such as alcoholism, thyroid disease, lumbar or cervical radiculopathy, inflammatory and infection diseases were excluded. Thirty-four patients with type 2 diabetes, aged 40-60 years were recruited from Taban diabetic center, Tehran City, Iran. The present study aimed to determine the within- and between-subject intra- and inter-rater reliability of pressure and vibration senses measurements with SWM presented with a 6-piece foot kit and 128 and 256 Hz tuning fork in diabetic patients. Reliability of SWM and tuning fork on/off tests are important in the evaluation of periodic clinical sensation. Previous studies demonstrated that SWM and tuning fork are appropriate tools to clinically evaluate pressure and vibration senses, respectively. Limited studies evaluated the reliability of graduated tuning fork for the detection of fracture- and immune-mediated polyneuropathies however, the tuning fork on/off test reliability was overlooked. Tuning fork test determines the ability of subjects to discriminate vibration sensation. The graduated tuning fork and tuning fork on/off tests are available in every dialectology clinic. Reliability of SWM in healthy and elderly people was evaluated by the previous studies.
Monofilaments are used to detect the pressure sensation in neuropathic patients. The higher the value of the monofilament, the stiffer and more difficult it is to bend. Monofilaments, often called SWM, are calibrated, single fiber nylon threads, identified by values ranging from 1.65 to 6.65 that generate reproducible buckling stress. Monofilaments and tuning fork are non-invasive, available and easy to use instruments. Previous studies demonstrated that Semmes-Weinstein Monofilament (SWM) and tuning fork are appropriate tools for the clinical evaluation of pressure and vibration sense, respectively. Several instruments are frequently used to screen peripheral neuropathies such as monofilaments, tuning fork, and biothesiometry. The ideal instrument for neuropathy examination should be easily accessible, simple to use, and reliable with high sensitivity and specificity. This test is a complex, costly, and time consuming method and not suitable for clinical evaluations. Nerve conduction velocity is a gold standard test to detect neuropathy. According to the Polish Diabetes Society, diabetic patient’s feet should be examined at every medical visit. Periodical sensory examinations are appropriate to detect neuropathy and decrease the risk of diabetic foot ulcer. Early diagnosis of PSN is important in diabetic patients to prevent diabetic foot problems. Approximately 50% of diabetic patients experience peripheral neuropathy and more than 50% of them experience symptomatic neuropathy. Previous research recognized sensory neuropathy as the major cause of ulceration in diabetic patients. Peripheral neuropathy involves sensory, motor and autonomous systems and causes decreased pressure sensation, increased vibration perception threshold, foot deformities, and dry skin. Peripheral Sensory Neuropathy (PSN) is the main risk factor for foot ulceration and lower extremity amputations in diabetic patients.
0 kommentar(er)
