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Reliability of the 10 g monofilament

Discussion in 'Diabetic Foot & Wound Management' started by ajs604, Oct 23, 2007.

  1. ajs604

    ajs604 Active Member


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    Hiya, I was wondering if anyone could help me. I am doing a quantative project proposal on the reliability of the monofilament. I have done lots of research but am having difficulties finding sources. I am trying to compare operator intra-reliability ect in proving how successful the monofilament is in determing neuropathy in diabetic patients. The reasons for my research are because when i have been on placement as a student, i have seen lots of different techniques for assessing diabetics feet for neuropathy. Within accordance with my university training i have been taught to assess 10 areas of the feet including both the dorsum and plantar sufaces.

    Also sometimes when assessing patients feet I have noticed that patients sometimes say they can feel senation even though I am not touching their feet. I need to find some resources up back up my research, so would appreciate any advice. I must stress that I do not dispute the reliability of the monofilament, but the way it is used by different people.

    Look forward to any suggestions
     
  2. Admin2

    Admin2 Administrator Staff Member

  3. Tuckersm

    Tuckersm Well-Known Member

    A medline search should be able to answer most of your questions. Below is part of a students Lit Review, conducted for us when we reviewed our diabetic foot assessment form in 2005

     
  4. Just a thought. Be very aware of your language. Are you talking about intra - reliability or repeatability.

    Two different things

    Regards
    Robert
     
  5. In terms of reliability i would argue that it is not. I think its a pointless test because a positive (ie could feel the 10g) response does not mean neuropathy is NOT present!

    Podiatry Now carried a rather interesting case study.

    The development of extensive painless heel
    ulceration with preserved monofilament sensation
    in a newly -diagnosed diabetic
    B y D O McConville ,Podiatrist ,Belfast City Hospital

    In which a diabetic patient has a rather large and nasty (30mm by 16mm) painless heel ulcer tracking an inch or so proximally but preserved 10g monofilament sensation.

    As the author observes.

    If you pm me your e mail addressi'll send you the PDF. It has some nice pictures.

    Regards
    Robert
     
  6. johnmccall

    johnmccall Active Member

    Hi All,

    The 10g monofilament test is recommended as a screening tool. It is not claimed to be 100% perfect but it is as good as anything else currently as a screening tool for risk of neuropathic ulceration.
    I'd suggest that if a patient hws a foot ulcer that is not painful then you don't need a monofilament to help you decide the risk of ulceration or to assess for loss of protective sensation.
    Mousley has written a nice article in the Diabetic Foot Journal (Summer edition?) 2007. about the difference between screening and assessment. It's on the DFJ website at www.diabeticfootjournal.co.uk
    The 10g Monofilament test is used for screening - not assessment.
    It would be nice if we could find a neuropathy disability score or a screening tool that is 100% reliable.
    It's easy to criticise the existing methods (and we should!) but is there something better to put in their place?
     
  7. ajs604

    ajs604 Active Member

    Thank you for all your advice it has been fully appreciated. For my research proposal I am working on a methodology that will test the reliability on the monofilament. When it is complete I will post it on the forum for others to observe.
     
  8. G Hicks

    G Hicks Member

    Hi ,

    Intra observer reliability should not be an issue if you use a calibrated monofilament. Some monofilaments on the market are cheap ( and inaccurate) devices.
    I do declare my interest here as I work for Bailey Instruments ( we manufacture one of the monos recommended by Booth& Young -Diabetes Care 2000. Owen Mumford's neuropen was the other device which was found to be accurate.
    In both these cases , the filament is mathematically tailored to bend at 10 gram , not at 9 or 11, but at 10. Its to do with the modulus of elasticity , and Euler's rule of collapsing columns. The limiting factor with these filaments is number of uses. Monofilaments ought to be changed regularly.
     
  9. markjohconley

    markjohconley Well-Known Member

    Robert, interesting post; question, monofilaments test pressure/touch?, how is this related to pain perception?, cheers, mark c
     
  10. markjohconley

    markjohconley Well-Known Member

    OK, too difficult, too obvious or irrelevant? Any takers?
     
  11. Very relevant. Which begs the question as to why we bother!
     
  12. G Hicks

    G Hicks Member

    Hi ,
    I have been away from the (beloved) computer so my apologies for the delay in my reply. Monofilaments don't test for pain . I understood they tested pressure sensation. The idea is to subject the foot to 10 grams of pressure. I don't want to get involved with the "how many and which sites " questions going on at present, but pressure sensation is the idea.
     
  13. robby

    robby Active Member

    75 gramme monofilament fires off pain receptors. You can use it to test for pain.
     
  14. Tuckersm

    Tuckersm Well-Known Member

    and
    Monofilaments do not measure pressure sensation, and have not been validated to test for pain (in a neuropathic foot a 75g filament may not elicit a pain response.

    They measure cutaneous perception threshold, which is a mixture of light touch, pressure, and pain
     
  15. We did these kind of studies with under-grads every year when I was an academic. Note how this undergrad needs to submit a proposal- rather than actually carrying out the research? I know my old school no longer has the students carrying out the research for their final dissertation. And this is progress??????????:bang:

    Rant aside, as I recall from some of the numerous undergrad studies, factors like ambient room temperature can influence the tests outcomes. Seem to recall a published study by Mooney & ? on reliability?

    Sorry, my mistake I was thinking of this: A model to assess age-related changes in two-point discrimination of plantar skin Lynch and Mooney J Am Podiatr Med Assoc.1999; 89: 383-391
     
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