Monofilamenten onderzoek niet zinvol
Het blijkt uit onderzoek dat het onderzoek met de zogenaamde monofilamenten van neuropathische klachten weinig zinnig is. Dat is het resultaat van een systematisch onderzoek.
In de press release werd gesteld:
“Several tests are used to detect peripheral neuropathy, including vibration perception, application of warmth and cold, and nerve conduction studies, which are assumed to be the reference standard,” write Jacquelien Dros, MD, from the University of Amsterdam in Amsterdam, the Netherlands, and colleagues.
“Electrodiagnostic tests can be complex, expensive, and time consuming, which hampers their widespread use. Especially in primary care, where for most patients peripheral neuropathy is diagnosed and treated. Monofilament testing is an inexpensive, easy-to-use, and portable test for assessing the loss of protective sensation. And it is recommended by several practice guidelines to detect peripheral neuropathy in otherwise normal feet.”
Vervolgens de kwalitatieve meta-analyse:
Of 173 titles and abstracts of articles reviewed, 54 potentially eligible studies were identified, and 3 of these were ultimately selected for data synthesis. These studies included only patients with diabetes mellitus and had limitations, based on the QUADAS tool. Sensitivity of the 5.07/10-g monofilament to detect peripheral neuropathy ranged from 41% to 93%, and specificity ranged from 68% to 100%. Meta-analysis could not be performed because of heterogeneity in the included studies.
“Despite the frequent use of monofilament testing, little can be said about the test accuracy for detecting neuropathy in feet without visible ulcers,” the study authors write. “Optimal test application and defining a threshold should have priority in evaluating monofilament testing, as this test is advocated in many clinical guidelines. Accordingly, we do not recommend the sole use of monofilament testing to diagnose peripheral neuropathy.”
Limitations of this study include those in the included studies, as well as heterogeneity in these studies, precluding meta-analysis.
“The diagnosis of peripheral neuropathy can be made only after a careful clinical examination with more than 1 test, as recommended by the American Diabetes Association,” the study authors conclude. “Tests for this clinical examination are vibration perception (using a 128-Hz tuning fork), pressure sensation (using a 10-g monofilament at least at the distal halluces), ankle reflexes, and pinprick. When in doubt, a nerve conduction test might be necessary to establish a firm diagnosis.”
Dros J, Wewerinke A, Bindels PJ, van Weert HC. Accuracy of mono-filament testing to diagnose peripheral neuropathy: a systematic review. Ann Fam Med. 2009;7(6):555–559.[Abstract/Free Full Text]