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. 2012 Mar;69(3):339-45.
doi: 10.1001/archneurol.2011.1735. Epub 2011 Nov 14.

The evaluation of distal symmetric polyneuropathy: a physician survey of clinical practice

Brian C Callaghan  1 , Kevin Kerber, Andrea L Smith, A Mark Fendrick, Eva L Feldman
Affiliations

The evaluation of distal symmetric polyneuropathy: a physician survey of clinical practice

Brian C Callaghan et al. Arch Neurol. 2012 Mar.

Abstract

Objective: To define current clinical practice for evaluating distal symmetric polyneuropathy.

Design: Using a modified Dillman method, we sent surveys to 600 internists, 600 neurologists, and 45 neuromuscular specialists selected from the American Medical Association Physician Masterfile. Survey questions pertained to which tests providers would order in the following 3 scenarios: (1) the initial evaluation of distal symmetric polyneuropathy, (2) the use of additional tests if the initial evaluation was unrevealing, and (3) patients with diabetes. The t test was used to compare the number of tests ordered by physician type, and the χ(2) test was used to compare proportions of tests ordered.

Setting: National survey of physicians.

Participants: Internists, neurologists, and neuromuscular specialists.

Results: The response rate was 35%. Overall, many tests were ordered for the full evaluation of distal symmetric polyneuropathy (mean [SD], 16.5 [7.2] tests), and there was substantial variation within and between provider types. Internists ordered fewer tests (mean [SD], 14.5 [6.1] tests) than did neurologists (mean [SD], 17.5 [7.9] tests) (P < .001). Regarding the glucose tolerance test, substantial differences were found between physician types, with neurologists and neuromuscular specialists ordering this test more frequently (28.6% and 72.3%, respectively) and internists ordering it less frequently (4.1%). A brain and/or spine magnetic resonance imaging scan was ordered by 19.8% of internists and 12.9% of neurologists.

Conclusions: From the supporting evidence, current practice intent on evaluating distal symmetric polyneuropathy is highly variable and differs widely. For this disorder of the peripheral nerves, a high-yield test such as the glucose tolerance test is rarely used, whereas magnetic resonance imaging is likely overused. Research that defines the optimal evaluation of distal symmetric polyneuropathy has the potential to result in more efficient care.

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Conflict of interest statement

Author Disclosures:

Dr. Callaghan reports no disclosures.

Dr. Kerber received speaker honoraria from the American Academy of Neurology 2010 and 2011 annual meeting, and performed consulting work for the American Academy of Neurology. He is supported by NIH/NCRR #K23 RR024009 and AHRQ #R18 HS017690.

Ms. Smith reports no disclosures.

Dr. Fendrick serves as a consultant to the following: Abbott, ActiveHealth Management/Aetna, AstraZeneca, Avalere Health, BlueCross BlueShield Association, Blue Shield of California, Center for Medicare and Medicaid Services [CMS], GlaxoSmithKline, Health Alliance Plan, Hewitt Associates, Highmark BlueCross BlueShield, Integrated Benefits Institute, MedImpact HealthCare Systems Inc., Merck, and Co., National Business Coalition on Health, National Pharmaceutical Council, Perrigo, Pfizer Inc., Regence BlueCross BlueShield of Oregon, sanofi-aventis Pharmaceuticals, State of Indiana, Thomson Reuters, TriZetto, UCB, WebMD, zanzors. He is also on the Speaker’s Bureau for Merck and Co. He also is involved with research with the following: Abbott, AstraZeneca, Eli Lilly, Genentech, GlaxoSmithKline, Merck and Co., Novartis, Pfizer Inc., sanofi-aventis Pharmaceuticals.

Dr. Feldman reports no disclosures.

Figures

Figure 1
Figure 1
The percentage of tests indicated by provider type: A) in the initial evaluation of DSP (scenario 1); B) in the full evaluation of DSP (Scenario 1 plus 2)
Figure 2
Figure 2
The percentage of AAN recommended tests (fasting glucose, SPEP, B12, GTT) indicated by provider type in the full evaluation of DSP
See this image and copyright information in PMC

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