Diabetic Neuropathy: Likelihood Ratios

Introduction: None written.

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Prevalence

Population / Calculator	Prevalence	Comments / Study / Link
Diabetics 60-74 years old	40%	(32-50%) Arch Phys Med Rehabil. 2002 Nov;83(11):1553-8. PMID: 12422324
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The likelihood ratios of findings for Diabetic Neuropathy are listed below. See the left navigation bar to change the display.

Good Positive and Negative Likelihood Ratios

Finding	+LR	-LR	Comments, Study
Michigan Diabetes Neuropathy Score	4.3	0.1	The MDNS is a point scale ranging from 0 to 46 (higher score reflecting more severe peripheral neuropathy), and it correlates well with more extensive neuropathy staging scales. The MDNS includes muscle stretch reflexes at the biceps, triceps, patella, and Achilles, pinprick sensation at the great toe, ability to perceive the touch of a 10-g monofilament and a 128Hz tuning fork at the great toe, strength of hand dorsal interossei, great toe extension, and ankle dorsiflexion. (Normal < 10 points) Study: Arch Phys Med Rehabil. 2002 Nov;83(11):1553-8. PMID: 12422324
Vibration sensation Duplicate	40	0.2	timed Vibration testing by the timed method was conducted using a 128-Hz tuning fork applied to the same bony prominences bilaterally situated at the dorsum of the first toe. The patient was asked to report the time at which vibration diminished beyond perception. The tuning fork was then applied to the dorsal aspect of the distal phalanx of the examiner's thumb. The time (in seconds) at which vibration sensation diminished beyond the examiner's perception was then recorded on a standardized form. Study: Diabetes Care. 2001 Feb;24(2):250-6. PMID: 11213874
Monofilament	19.3	0.2	aka Semmes-Weinstein monofilament Study: Diabetes Care. 2001 Feb;24(2):250-6. PMID: 11213874
Proprioception Duplicate	2.8	0.2	at great toe Study: Arch Phys Med Rehabil. 2002 Nov;83(11):1553-8. PMID: 12422324
Achilles Reflex	8	0.3	Study: Arch Phys Med Rehabil. 2002 Nov;83(11):1553-8. PMID: 12422324
Vibration sensation Duplicate	4.7	0.3	at ankle. Note that this study also looked at the great toe and obtained values of 96% sensitivity with 75% specificity. Study: Arch Phys Med Rehabil. 2002 Nov;83(11):1553-8. PMID: 12422324
Superficial Pain	19.7	0.4	Superficial pain sensation was conducted using a sterile Neurotip (Owen Mumford, Oxford, U.K.) applied four times in an arrhythmic manner to the two sites described for the SWME. The superficial pain threshold was defined as the total number of times the application of the pain sensation was not perceived, with scores varying from 0 to 8. Study: Diabetes Care. 2001 Feb;24(2):250-6. PMID: 11213874
Vibration sensation Duplicate	53	0.5	on-off Vibration testing by the on-off method was conducted using a 128-Hz tuning fork applied to the bony prominence bilaterally situated at the dorsum of the first toe just proximal to the nail bed. The patient was asked to report the perception of both the start of the vibration sensation and the cessation of vibration on dampening. The testing was conducted twice on each toe, and correct responses were circled on a standardized sheet. The vibration testing threshold was defined as the total number of times the application of the vibrating tuning fork and the dampening of vibration was not felt, with scores varying between 0 and 8. Study: Diabetes Care. 2001 Feb;24(2):250-6. PMID: 11213874

Good Negative Likelihood Ratio

Unipedal Stance Testing

1.8

0.3

For UPS, subjects stood with their weight evenly distributed on both feet, which were shoulder-width apart, and arms held comfortably at the side. Subjects were then asked to balance on the foot of their choice for as long as possible to a maximum of 30 seconds. Failure occurred when the stance foot

shifted in any way or the nonstance foot touched the ground. This procedure was repeated 3 times, and the number of seconds the subject was able to balance on 1 foot was recorded for each trial. (Normal >= 10s)

Study: Arch Phys Med Rehabil. 2002 Nov;83(11):1553-8. PMID: 12422324

Good Positive Likelihood Ratio

Finding	+LR	-LR	Comments, Study
Proprioception Duplicate	inf	0.8	at ankle Study: Arch Phys Med Rehabil. 2002 Nov;83(11):1553-8. PMID: 12422324
Romberg Test	inf	0.8	Romberg testing was performed by having the subject stand with the feet close together but not touching. Initially, the subjects stood with eyes open for about 10 seconds; subjects then closed their eyes. The ability to stand without opening the eyes or taking a step for 30 seconds was considered a negative or normal test. Study: Arch Phys Med Rehabil. 2002 Nov;83(11):1553-8. PMID: 12422324
Patellar Reflex	inf	0.9	Study: Arch Phys Med Rehabil. 2002 Nov;83(11):1553-8. PMID: 12422324