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Clinical Trial
. 2014 May;49(5):645-53.
doi: 10.1002/mus.23982. Epub 2014 Jan 28.

Multicenter trial of the proficiency of smart quantitative sensation tests

Peter J Dyck  1 , Barbara Argyros, James W Russell, Linde E Gahnstrom, Susan Nalepa, James W Albers, Karen A Lodermeier, Andrew J Zafft, P James B Dyck, Christopher J Klein, William J Litchy, Jenny L Davies, Rickey E Carter, L Joseph Melton 3rd; members of the Cl versus NPhys Trials
Collaborators, Affiliations
Clinical Trial

Multicenter trial of the proficiency of smart quantitative sensation tests

Peter J Dyck et al. Muscle Nerve. 2014 May.

Abstract

Introduction: We assessed proficiency (accuracy and intra- and intertest reproducibility) of smart quantitative sensation tests (smart QSTs) in subjects without and with diabetic sensorimotor polyneuropathy (DSPN).

Methods: Technologists from 3 medical centers using different but identical QSTs independently assessed 6 modalities of sensation of the foot (or leg) twice in patients without (n = 6) and with (n = 6) DSPN using smart computer assisted QSTs.

Results: Low rates of test abnormalities were observed in health and high rates in DSPN. Very high intraclass correlations were obtained between continuous measures of QSTs and neuropathy signs, symptoms, or nerve conductions (NCs). No significant intra- or intertest differences were observed.

Conclusions: These results provide proof of concept that smart QSTs provide accurate assessment of sensation loss without intra- or intertest differences useful for multicenter trials. Smart technology makes possible efficient testing of body surface area sensation loss in symmetric length-dependent sensorimotor polyneuropathies.

Keywords: accuracy and reliability of nerve tests; diabetic sensorimotor polyneuropathy; intra- and intertest reproducibility; neurophysiology tests; smart quantitative sensation tests.

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Figures

Figure 1
Figure 1
Features of Smart QSTing. In A and B monofilament testing is illustrated. C) Illustrated is testing with Dyck thermal disks. D) In vibratory sensation testing with CASE IVc, vibratory stimuli are superimposed on a static load to allow eloquent and quantitative control of stimuli and null stimuli. E) The standard thermode in place on the foot to test cooling and heat-as-pain thresholds. Standard thermal pulses are superimposed on a small offset from skin temperature to assess modalities of thermal sensation. The restraining strap must be tightened just to the point at which the thermode makes full contact with the skin.
Figure 2
Figure 2
An illustration of smart QSTing of body surface areas to assess distributed sensation loss of touch pressure and heat as pain 5 (of 1–10) in a patient with transthyretin amyloid polyneuropathy.
See this image and copyright information in PMC

References

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