Optimizing reliability and sensitivity of Semmes-Weinstein monofilaments

NewsBot · May 25, 2012

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Optimizing reliability and sensitivity of Semmes-Weinstein monofilaments for establishing point tactile thresholds.
Tracey EH, Greene AJ, Doty RL.
Physiol Behav. 2012 Feb 28;105(4):982-6.

Semmes-Weinstein monofilaments (SWM) are widely used to assess tactile point pressure sensitivity. However, the reliability of SWMs has been questioned, standardization of stimulus presentation procedures is lacking, and the sensitivity measure is commonly confounded by the response criterion. This study sought to assess the reliability of two versions of a forced-choice single staircase SWM test with the goal of optimizing test reliability with a minimum number of test trials. Test-retest and intra-test reliability coefficients for SWM threshold values from the plantar halluces of 24 normal subjects were obtained using two versions of a forced-choice single-staircase procedure. One version followed a two-down one-up rule (2D) and the other a three-down one-up rule (3D). The 3D procedure was significantly more reliable than the 2D procedure for all sequential combinations of reversal pairs. A total of four 3D reversal pairs (i.e., eight reversals) were sufficient to achieve test-retest and intra-test reliability coefficients>0.90. High reliability with the minimum number of trials was obtained by calculating the threshold as the mean of eight reversals (test-retest r=0.93, p<0.001; Sessions 1 and 2 intra-test rs=0.87 and 0.92; ps<0.001). Identical median detection thresholds were noted for the two repeated test sessions (5.1g/mm(2)). The threshold values correlated with subject age despite the small range of ages tested, suggesting high sensitivity (Sessions 1 and 2 rs=0.61 and 0.63, ps<0.001). This study demonstrates that SWMs provide highly reliable and sensitive point pressure thresholds with very few trials when an appropriate psychophysical paradigm is employed. The brief forced-choice procedure described herein could serve as a basis for standardizing SWM stimulus presentation methods.
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Admin2 · May 26, 2012

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NewsBot · Oct 17, 2015

Interrater and Intrarater Reliability of the Semmes-Weinstein Monofilament 4-2-1 Stepping Algorithm.
Snyder BA et al
Muscle Nerve. 2015 Oct 16

INTRODUCTION:
Semmes-Weinstein monofilaments (SWM) are used to examine light touch sensation of the skin. Reliability of the 4-2-1 stepping algorithm approach for determining light touch detection thresholds has not been examined. The purpose of this study was to determine the interrater and intrarater reliability of the SWM 4-2-1 stepping algorithm on the plantar surface of the foot.
METHODS:
Four raters with varying levels of SWM assessment experience tested light touch sensation over the plantar aspect of the first metatarsal head in 14 healthy adults. During the initial session, all raters performed the 4-2-1 stepping algorithm technique on each subject to determine interrater reliability. One week later, subjects were reassessed by 2 raters to determine intrarater reliability.
RESULTS:
Interrater reliability ranged from moderate-to-good (ICC2,1 =0.62-0.92). Intrarater reliability also ranged from moderate-to-good (ICC2,1 =0.61-0.85).
DISCUSSION:
The 4-2-1 stepping algorithm demonstrated acceptable interrater and intrarater reliability when measured in healthy adults
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NewsBot · Jan 20, 2020

Non-invasive assessment of vibration perception and protective sensation in people with diabetes mellitus: inter- and intra-rater reliability
Sean Michael Lanting, Martin Jeremy Spink, Peta Ellen Tehan, Stephanie Vickers, Sarah Louise Casey & Vivienne Helaine Chuter
Journal of Foot and Ankle Research volume 13, Article number: 3 (2020)

Background
Testing of protective sensation and vibration perception are two of the most commonly used non-invasive methods of screening for diabetes-related peripheral neuropathy (DPN). However, there is limited research investigating the reliability of these tests in people with diabetes. The aim of this study was to determine the inter- and intra-rater reliability of methods used to test vibration perception and protective sensation in a community-based population of adults with type 2 diabetes.

Methods
Three podiatrists with varying clinical experience tested four- and 10-site, 10 g monofilament and vibration perception threshold (VPT). In a separate cohort, the reliability of a graduated tuning fork as well as two methods of conventional tuning fork (on/off method and dampening method) was undertaken by a new graduate podiatrist and podiatrist with one-year’s clinical experience. The intra- (Cohen’s К) and inter-rater (Cohen’s or Fleiss’ К) reliability of each test was determined.

Results
Fifty participants (66% male, 100% type 2, 32% with DPN) underwent monofilament and neurothesiometer testing with 44 returning for the retest. Twenty-four participants (63% male, 100% type 2, 4% with DPN) underwent tuning fork testing and returned for retest. All tests demonstrated acceptable inter-rater reliability ranging from moderate (10-site monofilament, К: 0.54, CI: 0.38–0.70, p = 0.02) to substantial (graduated tuning fork, К: 0.68, CI: 0.41–0.95, p < 0.01). The 10-site monofilament (К: 0.44–0.77) outperformed the 4-site test (К: 0.34–0.67) and the dampened tuning fork method (К: 0.41–0.49) showed lower intra-rater reliability compared to both conventional (К: 0.52–0.57) and graduated methods (К: 0.50–0.57).

Conclusion
We support the current recommendations of using more than one test to screen and monitor progression of DPN. Four- and 10-site 10 g monofilament testing have similarly acceptable levels of reliability and the neurothesiometer is the most reliable method of assessing vibration perception function. Use of a graduated tuning fork was slightly more reliable than other methods of tuning fork application however all had substantial reliability. Years of clinical experience only marginally affected test reliability overall and due to subjective nature of the tests we suggest that testing should be performed regularly and repetitively.
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